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From Trisha's Desk Trisha E. O’Hehir, RDH, BS Hygienetown Editorial Director

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Open Wounds

Trisha E. O’Hehir, RDH, BS
Editorial Director,
Hygienetown Magazine




Every day in dental practices around the world, dentists and hygienists work together to diagnose and plan effective treatment for their patients. To bolster this natural collaboration, feature stories, content from the message boards of Hygienetown.com and Perio Reports research summaries are presented in every issue of Dentaltown Magazine. The goal of this section is to present topics that will create discussions between dentists and hygienists to ultimately improve dental hygiene outcomes.		 Periodontal disease is an open wound, much like open wounds on the feet of those with diabetes, or bedsores on those confined to a bed or wheelchair. Biofilm infections in open wounds can be deadly – in fact these infections kill hundreds of thousands of people each year. Actor Christopher Reeves is one of those fatalities. He died due to severe systemic effects of a biofilm infection in open pressure wounds.

Chronic open wounds on the skin are multipathogen infections, similar to periodontal disease. These biofilms target blood vessels, as a nutrient source and the body’s immune response to the toxic proteins of the biofilm actually feeds the bacteria. These biofilms live on the surface and in underlying tissues, resulting in destruction of connective tissue and bone. The sloughing tissues also contain biofilm. After debridement of an open wound, the biofilm begins reforming in 20 minutes, and within eight hours, the biofilm has reorganized and continues destroying the surrounding tissue. Systemic antibiotics are not effective in most chronic open wounds, so many other organic approaches are being tested, including xylitol, herbs, viruses and probiotics.

The open wounds of periodontal disease are not seen directly, because the ulcerated tissues face the root surfaces of the teeth. It seems that this infection is inside the body and not on the surface because we can’t see it directly. However, technically, the teeth are outside the body so the ulcerated pocket wall is actually an open wound on the outside surface of the body. Endoscopic images of the pocket wall reveal open, ulcerated wounds. The underlying epithelial attachment, connective tissue and bone are inside the body. Bacterial toxins from the biofilm are released into the tissue of the open wound, propagating chronic periodontal disease.

It’s difficult to calculate the size of the periodontal open wound, since we can only see it one pocket at a time with an endoscope. Calculating the size of the subgingval area involved in a full-mouth case of moderate periodontal disease with 5 to 7mm pockets throughout the mouth would be 762mm by 5mm or 30 inches by 0.2 inches. Just imagine a 30-inch length of ¼-inch ribbon. Shaping the ribbon into a flat shape, it measures 3,810-square-mm or six square inches. Now it looks like an open wound of the type seen on the feet of those with diabetes.

Chronic periodontal disease can go untreated in some people for years. If you could see this open wound on the foot, you’d see similar destruction of epithelium, connective tissue and bone. If the periodontal wound didn’t respond to treatment, and if biofilm was allowed to accumulate, the disease would progress and extractions might be suggested. On the foot, amputation is the traditional treatment of choice when the infection cannot be stopped. In both cases, treatment removes the biofilm infection in one area, but the loss of teeth or feet leaves the patient worse than before the infection. The highest risk factor for future periodontal disease is past disease. The same is true of open wounds on the feet. Amputation of one foot significantly increases the risk of amputation for the other foot and significantly shortens the life expectancy.

Periodontal disease is indeed an open wound, even if we can’t see it directly with our eyes. Letting patients know the seriousness of an open wound will help them better understand periodontal disease and lead to greater treatment acceptance and compliance with oral hygiene. Comparing the open wound of periodontitis to the open wounds on the feet of those with diabetes visually demonstrates the seriousness of both gingivitis and periodontitis.

Inside This Section
70 Perio Reports
74 Profile in Oral Health: Color Me Calm
77 Message Board: Am I Too Gentle?
79 Poll: Xylitol
Dentaltown Magazine
September 2025
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