By Lynne H. Slim, RDH, BSDH, MSDH
It’s late at night and I’m watching a French film called “Paris, Je T’aime” (which means “Paris, I love you” in English). It’s one of those foreign films with captions that sometimes bother me, but the movie contains short stories about couples falling in love in the most romantic city in the world and I’m lapping it up. Parisians are bold in expressing themselves, and that includes messages of love. In one particular scene, a group of young boys are flirting with a beautiful young girl and one of the daring ones shouts at her when she walks by and says, “Show me your thong – I need to floss my teeth.” I laughed out loud and my mind started wandering. I’ve decided that I’m sick to the teeth of this boring, outdated message: the one about flossing one’s teeth.
Emeril Lagasse, the famous N.Y. chef, always talks about “kicking it up a notch” or “spicing it up,” and the same thing goes for our “flossing” message, especially when we are talking about prevention of gingival and periodontal diseases. We need to change it up, tweak it a bit, or get rid of the “flossing lecture” altogether. Patients are tired of hearing the same old message from registered dental hygienists, so I’m going to write to you about how
Here’s a completely new theory/topic that’s worth exploring, and I already know you’ve never heard anything about it before!
Back in November 2007, I reported on my attendance at a course given by Dr. Jorgen Slots, a distinguished periodontal researcher and professor at the University of Southern California, School of Dentistry. Although the focus of the course was on the use of antiseptics like povidone iodine and bleach in periodontal therapy, Dr. Slots talked about the presence of viruses found in individuals with untreated periodontitis. According to Dr. Slots, viruses often reside in an inflamed periodontium and their presence can lower host resistance, making infected individuals more suspectible to periodontal pathogens and subsequent destruction of the periodontium. So, where do these viruses live? Apparently they hang out in macrophages, B cells, and T cells in the gingiva and are activated during periods of impaired host response like smoking, stress, cancer treatment, and old age. In particular, two members of the herpesvirus family – human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) – can be detected in periodontal pockets, saliva, acute necrotizing ulcerative gingivitis, and periodontal abscesses.1 The good news is that periodontal therapy can result in a marked decrease in subgingival herpesvirus counts, often to undetectable levels.1
According to Dr. Slots, there are now more than 40 research studies that have confirmed the presence of herpesviruses in periodontal lesions. Once the HCMV and EBV herpesviruses enter the saliva from periodontal habitats, they can be transmitted through salivary contact among close family members and acquaintances.
In reviewing the seriousness of HCMV and EBV infections in humans, both herpesviruses can cause disease and/or disability. According to the Centers for Disease Control and Prevention (CDC), EBV infection in adolescents and young adults can cause infectious mononucleosis 35 to 50 percent of the time. CMV is the most common virus transmitted to a woman’s unborn child. Read these statistics below to familiarize yourself with the seriousness of this particular herpesvirus:
- About 1 in 500 children in the United States is born with or develops permanent disabilities caused by CMV.
- Approximately 8,000 children in the United States each year suffer permanent disabilities caused by CMV.
- CMV is the most common cause of virus-induced mental retardation in the Western World.
In other high-risk groups, immunocompromised individuals such as organ and bone marrow transplant recipients and persons infected with HIV, CMV infection can be problematic. HCMV is the most frequent infectious reason for rejection of solid organ transplants and bone marrow and stem cell grafts and causes life-threatening infection in HIV-infected patients. In immunocompromised individuals, severe pneumonia, hepatitis, and CMV retinitis can occur.
Epstein-Barr virus (EBV) may also be implicated in oncogenesis.2 Researchers have begun to associate this particular herpesvirus with the development of both lymphoid and epithelial tumors and is frequently detected in certain tumors like Burkitt’s lymphoma, Hodgkin’s disease, and nasopharyngeal carcinoma.
The gingival tissue-salivary herpesvirus linkage is a new one, and it is not being talked about in dental hygiene circles until now. Saliva is one of several vehicles for transmitting the herpesvirus from person to person, so it makes sense to educate patients about suppressing these viruses through periodontal therapy and good home-care habits.
OK, let’s get practical now. How can you apply what you’ve just learned about herpesviruses to patient education and periodontal therapy?
- We’ve always preached to pregnant women about the importance of good oral hygiene during pregnancy. We can now expand our message by talking about the danger of HCMV in pregnant women and inform them that HCMV can set up residence in their gums! Reduction of gingival/periodontal inflammation during pregnancy is essential since periodontitis lesions are a source of salivary cytomegalovirus. Antimicrobial periodontal therapy (cleaning and disinfecting pockets) should be a priority for pregnant women with gingivitis and periodontitis. As a general public health message about HCMV prevention, we can remind pregnant women not to kiss young children on the mouth or cheek and not to share food, drinks, or utensils with young children. We can also remind them about good handwashing practices and keep in mind that pregnant women can contract HCMV in day care settings, particularly when in contact with children 1 to 2 ½ years of age.
- The potential of periodontal therapy to decrease herpesvirus salivary counts may also be important when treating immunocompromised patients, and they should also be informed that herpesviruses can reside in their gums too. It’s possible that antimicrobial periodontal therapy may decrease the rate of herpesvirus transmission among close family members and acquaintances.1
- Both pregnant and immunocompromised patients might want reassurance that individuals in close personal/intimate contact have a reduced viral load in saliva. Periodontal exams and antimicrobial periodontal therapy for intimate partners should be explored further as a recommendation, even if we don’t yet have strong evidence of a positive correlation between decreased salivary herpesvirus load and the rate of herpes transmission.
- As a general public health recommendation, antimicrobial periodontal therapy to decrease herpesvirus salivary counts may help to decrease herpesvirus transmission from person to person and, most important, herpesvirus-related diseases may be reduced in exposed individuals.
About the Author
Lynne H. Slim, RDH, BSDH, MSDH, is an award-winning dental author who has published extensively in dental/dental hygiene journals. She is the CEO of Perio C Dent, a dental practice management company that specializes in the incorporation of conservative periodontal therapy into the hygiene department of the general dental practice. Lynne coaches dental hygienists and dentists in ultrasonic instrumentation and other advanced hygiene initiatives. Lynne is also the owner and moderator of the periotherapist yahoo group:www.yahoogroups.com/group/periotherapist. In addition, she is the editor of Sunstar America’s e-newsletter “The GUMline.” Lynne welcomes speaking engagements on the topic of conservative periodontal therapy and other dental hygiene-related topics. Lynne can be reached at: [email protected] or www.periocdent.com.
- Saygun I, Kubar A, Ozdemir A, Slots J. Periodontitis lesions are a source of cytomegalovirus and Epstein-Barr virus. J Periodont Res 2005; 40:187-191.
- Young LS, Murray PG. Epstein-Barr virus and oncogenesis: from latent genes to tumors. Oncogene Aug 11, 2003; 22(33):5108-21.
- Slots J. Herpesviruses in periodontal diseases. Periodontology 2000 2005; 38:33-62.