In This Section: Polishing by Trisha O'Hehir, RDH, MS Hygienetown Editorial Director


Polishing

by Trisha O'Hehir, RDH, MS
Hygienetown Editorial Director


The subgingival root surfaces feel smooth to the explorer and the patient appears to be doing well with oral hygiene, yet there is bleeding upon probing. Why? There's buzz about the immune response explaining this bleeding. The immune response explains the second stage of this disease. The first is infection triggered by toxic waste products from subgingival bacterial biofilm. Endotoxins and antigens pass through an altered junctional epithelium, triggering the body's immune system. It is this bacterial infection that triggers the second step - the immune response. For the immune system, the first line of defense is white blood cells. The body sends polymorphonuclear neutrophils (PMNs) to the area to phagocytize the intruding bacteria. Mast cells around the blood vessels in the connective tissue release histamines causing vasodilation and slowing of the blood flow so that PMNs can exit the blood vessels by squeezing between the endothelial cells. The PMNs are on a mission to attack the bacteria in the sulcus and to reach the sulcus they must travel through healthy connective tissue and epithelium. The PMNs release cytokines that act as chemical machetes to chop through and destroy healthy cells. At last the PMNs reach the sulcus, which takes them outside the body where they no longer function. Their traverse and destruction of healthy tissue didn't eliminate bacteria in the sulcus. With a constant influx of endotoxins and antigens, the body's immune system continues sending PMNs to the area causing significant connective tissue, bone and epithelial damage.

The key is removal of subgingival bacterial biofilm. Hand instruments, power scaler and rubber cup polishing are used but these approaches need to touch each area of bacterial biofilm to remove it. Glycine, a new air polishing powder that is safe for subgingival use just might turn dental hygiene treatment upside down, resulting in faster and better removal of subgingival bacterial biofilm."

Inside This Section
90    Perio Reports
94    Profile in Oral Health: How Subgingival Air Polishing will Turn Dental Hygiene Upside Down
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