Periodontal Maintenance With Natural Alternatives

One of my patients who I see four times a year for scaling and root planing is opposed to using anything that’s not natural post-therapy. Can you suggest any natural alternatives that offer antimicrobial benefits?

Acute inflammation is extremely important to protect the host from injury or infection, but it should cease once the stimulus is removed. Inflammation can be terminated by elimination of the antigen or the injury-causing factor, and therefore, the goals of the etiotrophic phase of therapy are to remove the factors that cause this inflammation,¹ while the goals of the maintenance phase are to maintain the biofilm in its pre-ordered state. If the etiotrophic phase is not able to reverse the inflammation, other therapeutic interventions are needed. Most of the time, surgical interventions are necessary to remove chronically inflamed tissue and stubbornly adherent biofilms in hard-to-access areas, in addition to restoring physiological morphology compatible with health. It might be wise to revisit the scenario with this patient to determine if he or she will benefit from surgical approaches.

Bacteria colonize the tooth surface and subgingival environment almost from the moment of tooth eruption and continue to exist in a state of equilibrium with the immune system.² Each individual hosts a specific group of bacteria, which is determined very early in life. These species play important roles in maintaining oral health through signaling and by secreting specific enzymes and proteins. The levels of each of these species and the genes they express are tightly regulated by the host and the entire microbial community itself. When this regulation goes awry, it results in a chronic, nonresolving inflammation that manifests as clinical disease.³ Therefore, at no time should the goal of therapy or therapeutic adjuncts be to eliminate bacteria completely or indiscriminately, because this causes a reset of the original host-bacterial dynamics. 

Natural alternatives to maintaining the results of professionally administered therapy may include products that change the environment by increasing oxygen tension, lower free-oxygen radicals and other pro-oxidant molecules; decrease inflammation by recruiting molecules, including the essential fatty acid-derived lipoxins, resolvins, protectins, and maresins;⁴ and restore the microbial species that originally colonized the individual in states of health. Evidence suggests that polyphenolic compounds, such as those found in blue/purple/red fruits and vegetables (eg, strawberry, raspberry, grapes, purple yam, and potatos), are powerful antioxidant agents when used over time.⁵ Emerging literature also supports the role of curcumin, green tea, triphala, and piperine as antioxidants to reduce periodontal inflammation.⁶  

References

1. Azouni KG, Tarakji B. The trimeric model: a new model of periodontal treatment planning. J Clin Diagn Res. 2014;8:ZE17–20
2. Mason MR, Chambers S, Dabdoub SM, Thikkurissy S, Kumar PS. Characterizing oral microbial communities across dentition states and colonization niches. Microbiome. 2018;6:67.
3. Kumar P.S. Microbial dysbiosis: the root cause of periodontal disease. J Periodontol. 2021;92:1079–1087.
4. Sommer C, Birklein F. Resolvins and inflammatory pain. F1000 Med Rep. 2011;3:19.
5. Palaska I, Papathanasiou E, Theoharides TC. Use of polyphenols in periodontal inflammation. Eur J Pharmacol. 2013;720:77–83.
6. Ramesh A, Varghese SS, Doraiswamy JN, Malaiappan S. Herbs as an antioxidant arsenal for periodontal diseases. J Intercult Ethnopharmacol. 2016;5:92–96.

From Dimensions of Dental Hygiene. June 2022; 20(6)46.