Which word should you use?

July 1, 2003
I met two cover girls, and I got their autographs! I recently had the privilege of meeting Rhodana Janssens and her sister, Marlene Hoard. They were the cover models for the August 2001 issue of RDH

By Trisha E. O'Hehir

I met two cover girls, and I got their autographs! I recently had the privilege of meeting Rhodana Janssens and her sister, Marlene Hoard. They were the cover models for the August 2001 issue of RDH, and I met them at the annual meeting for the Lane Society of Periodontal Study, located in Eugene, Ore. The sisters are the founding members of the society.

I was the group's featured speaker this year, and I addressed about 100 dedicated hygienists.

Since I live in hot, dry Tucson, I was thrilled to have cloudy, rainy weather in Eugene. The weather also ensured good attendance at the course. The day flew by with lots of laughter and lively discussions.

One participant brought up an interesting question. Which is the most accurate term to use with patients —inflammation or infection?

What do you use with your patients and why?

Technically, inflammation describes the disease process more accurately. The terms gingivitis and periodontitis include the "itis" ending, indicating an inflammatory process, and suggesting it might be the more accurate term. Destruction is definitely the result of a complex inflammatory process.

Inflammation is defined as "a fundamental pathologic process consisting of a dynamic complex of etiologic and histologic reactions that occur in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by physical, chemical or biologic agents."

This certainly describes the pathogenesis of periodontal disease. In last month's column, we took a cell level look at what happens during the inflammatory process in periodontal tissues. This is a complex cascade of reactions, leading to destruction of connective tissue and bone. Our immune systems actually cause the destruction of periodontal support.

Where does the term infection fit into this picture? The definition of infection is "the invasion of the body by living pathogenic microorganisms which reproduce and multiply, causing disease by local cellular injury, secretion of a toxin, or antigen-antibody reaction in the host."

This is where bacterial plaque biofilm comes into the equation. This is the bacterial infection aspect of periodontal disease. But here's an interesting concept: There can be inflammation without infection, but there can't be infection without inflammation.

Before an infection can occur, there must be a breakdown in the body's defenses. This happens when the junctional epithelium is altered by volatile sulfur compounds and becomes more permeable, triggering the complex series of events in the inflammatory process, which is the body's way of preparing for repair and healing.

It is also defensive in nature, as it walls the infection and keeps it from spreading throughout the body. If more toxins enter the area, more destruction than healing will occur.

Both infection and inflammation take place during periodontal pathogenesis. Subgingival bacterial biofilm accumulate and mature in the sulcus, release toxins that penetrate the juctional epithelium, and pass into the underlying connective tissue. This infection triggers the immune response and begins the complex inflammatory process.

I conclude that both terms are correct because we deal with both infection and inflammation. What term you use with your patients is up to you. Technically, the destruction is caused by inflammation, which is triggered by infection.

I prefer to use the term infection because people often associate inflammation with something they can't control, like arthritis or a bruise. People perceive infection much more seriously. With this in mind, are we scaring patients unnecessarily by using the term infection rather than inflammation?

I don't see it as a scare tactic because infection better communicates our message to patients. It ties in the importance of the bacterial component, which is something each person can control in their mouth.

When I tell patients they have a bacterial infection, I get better results than when I tell them they have inflammation. My goal is to get each person to take ownership of the disease and take responsibility for controlling and preventing it.

Linking infection to each bleeding point puts it into perspective. Instead of telling them about a few four millimeter pockets and some bleeding and inflammation, I tell them they have infection at each bleeding point. It sounds much more impressive to have 23 infections instead of 23 bleeding points.

You pick the words that get your message across clearly and quickly. For me, that word is infection.

Trisha E. O'Hehir, RDH, BS, is a senior consulting editor of RDH. She is also an international speaker, author, instrument designer, inventor, and oral health detective. Her Web sites are www.perioreports.com and www.toothpastesecret.com. She can be reached at (800) 374-4290 or at [email protected].