Critical Role of Saliva Testing in Your Practice
Below is a transcript from Dr. Thomas Nabors AAOSH webinar on Saliva testing. Watch a short clip from the video. Register for AAOSH Membership to gain access to all Core Curriculum E-Learning and resources.
Another example of why testing is really important is to look at before and after as you've seen earlier in these presentations. In cases we want to see a dramatic shift from the microflora before treatment and in the microflora at the end of treatment.
Here we have a type 2 diabetic male patient with very high-risk pathogens present and here this same patient is post-treatment. You can clearly see and I don't know what treatment was done for this patient but we do know that the treatment was not successful based on our pathogen burden here.
What I would really like to say here is we have we need to reconsider the types of treatment that we have available to us just as we would in general medicine. There are different medications for different illnesses and also different medications for the same illness.
This is a perfect case to have a collaborative appointment with your fellow physician and your fellow nurse practitioner so you can work out the problems related to this [patient].
Maybe it's a blood sugar issue maybe it's another issue rated related to the health of the patient but for some reason, this patient is not getting well. This is the perfect case to have a collaborative conversation with.
There's another example. This is a patient that I was sent to ask the question
"When is it okay to place additional implants?"
Based on the photos I was sent I suggested to this provider:
- Do not do anything to this patient until this patient has a collaborative appointment with the medical provider.
- This patient has infections around the existing implants and a pathogen burden. As you look to the left is very very high.
- Based on this patient's history he's already has a history of an acute heart attack
- Increased risk for stroke by 2.8 times and also increased risk for having a fatal coronary artery
This is the type of patient we want to collaborate with very very quickly to make sure that this patient doesn't have a heart attack or have an ischemic stroke. We can deal with these oral health issues as a collaborative effort in making sure that we stabilize this patient before we do any aggressive treatment.
We have cases that are documented like or similar to this where patients have had acute events. In some cases we've identified the specific pathogen in the mouth, as in case of ischemic strokes that occurred during periodontal therapy.
So where are we today, relative to understanding the role of microorganisms:
In this particular illustration [view video below]
This is nature's review immunology one of the most respected peer reviews journals in the world; published in July of this particular year. What this particular illustration is designed to do is give us three types of information
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We are looking at Alzheimer's disease aspiration pneumonia cardiovascular disease. Non-alcoholic fatty liver disease, diabetes, colorectal cancer, inflammatory bowel disease, and adverse pregnancy outcomes as well as rheumatoid arthritis arthritis today also
When Dr Bale and Dr. Doneen and i attended the first AAOSH meeting in 2010, what we were dealing with in the in the realm of periodontal pathogens was level a evidence that periodontal disease is associated with cardiovascular disease. Well, we had level a evidence that was showing that is very high.
There are relationships today, however, we're talking about mechanisms of causation and as we read the papers, particularly from Dr. Bale and Dr. Doneen we see there is a cause of causative mechanism involved we'll touch on that a little bit later in our presentation. So how does this happen? As we look at the post-responses linking to periodontal disease what we see and we've known about endothelial dysfunction for at least a decade we've known about low-grade inflammation, we've known about acute phase response from the liver, especially hs-CRP, we've known about metabolic alterations.
Now we're learning about the types of cells. Immune cells are being produced in the long bones. We are learning about the priming of osteoclast precursors as a result of periodontal pathogens getting into the bloodstream and traveling throughout the body so the red component of this represents the modes of periodontal bacteria dissemination. Let's highlight those.
How do these bacteria get to these distant sites? The first mode that we've really recognized is through bacteremias. Other modes are oral pharyngeal aspiration. We've already known, for at least a decade, that certain individuals have a difficult time - maybe choking on their own saliva, they aspirate infected saliva from these pathogens and end up, in some cases, very deadly lung infections. Another is the oral digestive translocation that is still very new to us as i look in other words oral bacteria that we swallow they get to the stomach my initial impression from years ago is that the digestive juices of the stomach would surely kill the bacteria that we swallow and end up in the stomach that's not true though what we find today is these high-risk bacteria can actually pass through the stomach into the small intestine and large intestine and can invade the cells of the intestinal regions.
Here's a paper called oral administration of porphyromonas gingivalis alters the gut microbiome and serum metabolism so a metal beyond so the point that we make here is that poor pheromonous gingivalis and these other high risk pathogens have other routes other than just um bacteremia and the other route that we want to really make a reference to is the blood the brain the blood brain barrier here so with those four areas where bacteria can get to distant areas there's actual inflammation that all of us should be aware of and what is that and that is that we have the ability to totally stop bacteremias we have the ability to totally stop or pharyngeal aspiration and oral digestive translocation and we have the ability to totally stop the blood-brain barrier from being penetrated by these pathogens but we have to know which microorganisms are present and the only way that we can know that are these infections that we call periodontal disease that are infected by these high risk pathogens in our day and age today there is no reason why should this be occurring if these patients are going through what we would call an oral systemic practice today both on the medical side and on the oral medical side as well so in 2021 we recognize the power of testing because it affects all of these entities that we've referenced here so as we are looking through our presentation this evening we're really going to focus on high-risk pathogens and there's a reason for that so let's rethink micro-organisms.