Letter
to the
Editors:
The question of what constitutes periodontal health after an individual has experienced destructive periodon tal disease raised by your editorial in the March, 1975, Journal is one that has too long lain dormant. It deserves serious thinking and open discussion by both clinicians and researchers even in the absence of involvement of third party payment groups in the practice of periodon tics. Basically, clinicians are morphologists and seek perio dontal health through a change in the diseased patient's anatomic structure. This is the basis of periodontal therapy from oral hygiene instruction to disrupt the morphology of bacterial plaques on the hard structures in the oral cavity to the more obvious elimination of pockets, occlusal adjustment of the teeth, and the reconstruction or rebuilding of alveolar bone support for the teeth. Thus the clinician seeks to make tissues less susceptible to the biologic mechanisms of the disease through these changes rather than dealing directly with the destructive processes. On the other hand the re searcher seeks the knowledge of the processes in expecta tion that the disease can be controlled or halted with an alteration of these processes. T o date these two groups have not had a meeting of their approaches, although the field of oral immunology seems promising to develop knowledge of an important mechanism of periodontal diseases that the clinician will be able to manipulate. The clinician's ability to manipulate the host immune proc esses so that the tissues and secretions of the oral cavity
might manage the etiologic factors of periodontal dis eases without destruction or disruption could be such a clinical implementation. In the meantime, the question of what is an acceptable level of periodontal health in a patient will have to be answered anatomically. M y visceral reaction after a dozen years of practice is that there is a level of periodontal disease that a patient's tissues may tolerate. N o clinician can deny the return of anatomic deformities in patients after full periodontal surgical therapy. That has been documented by the ongoing studies of Dr. Ramfjord's group at the Univer sity of Michigan. With periodic periodontal maintenance and with varying levels of plaque control by the patient, these teeth are comfortable to the patient and functioning in an acceptable manner. Although the goals of our therapies remain as normal depth gingival crevices, ideal anatomic forms of gingiva and bone, lack of mobility to grossly applied forces to the crowns of teeth, and an intact procession of teeth around the dental arches, many teeth are retainable without the absolute attainment of these goals. Underlying any definition of periodontal health in the patient already afflicted with periodontal disease must be the comfortable retention of teeth capable of masticating the diet of our civilization. In absence of a working knowledge of the mechanisms of periodontal diseases, other anatomic measures seem too variable to be considered standards. Sheldon Holen, D . D . S . Washington, D . C .
dental control's disclosing solution solidifies! TABLETS AS WELL AS "NO-MESS" SOLUTION
Finally, there is a tablet that can match the professional detail of D E N T A L C O N T R O L D I S C L O S I N G S O L U T I O N . Dental Control's unique red e r y t h r o s i n e f o r m u l a is now in tablet f o r m developed by dentists to be t h e most rapidly dissolving and best-tasting tablet available. Dental Control once again offers you the best professional quality and the lowest cost. T r y it a n d compare! For those w h o prefer a disclosing s o l u t i o n , Control offers " n o rinse, no m e s s " disclosing in a 2 - o u n c e office size and 3 / 4 ounce, and single-use patient sizes.
I am enclosing $
to cover my order of:
Bottle(s) Disclosing Solution
Box(es) Disclosing Tablets
(2 oz. Office Size)
(Cello-Wrapped), Box of 1000, $8.00
Set(s) SAMPLER i oz. Really Fresh spray, 40 yds. Really Fresh Flavored Floss, and an assortment of single use units of disclosing liquid and tablets, and waxed and unwaxed flosses, $1.00
Box(es) Disclosing Solution (Single-Use Unettes) Box of 700, $34.00 Bottle(s) Disclosing Solution (\oz.
Patient Dispensing Size),
12 bottles, $10.00
144 bottles. $93.00
To order, please complete and return this coupon to: Dental Control Products, 590 Valley Road, Upper Montclair, N.J. 07043.
12 bottles, $18.00
570
NAME ADDRESS. CITY STATE
.ZIP
to the
Editors:
The question of what constitutes periodontal health after an individual has experienced destructive periodon tal disease raised by your editorial in the March, 1975, Journal is one that has too long lain dormant. It deserves serious thinking and open discussion by both clinicians and researchers even in the absence of involvement of third party payment groups in the practice of periodon tics. Basically, clinicians are morphologists and seek perio dontal health through a change in the diseased patient's anatomic structure. This is the basis of periodontal therapy from oral hygiene instruction to disrupt the morphology of bacterial plaques on the hard structures in the oral cavity to the more obvious elimination of pockets, occlusal adjustment of the teeth, and the reconstruction or rebuilding of alveolar bone support for the teeth. Thus the clinician seeks to make tissues less susceptible to the biologic mechanisms of the disease through these changes rather than dealing directly with the destructive processes. On the other hand the re searcher seeks the knowledge of the processes in expecta tion that the disease can be controlled or halted with an alteration of these processes. T o date these two groups have not had a meeting of their approaches, although the field of oral immunology seems promising to develop knowledge of an important mechanism of periodontal diseases that the clinician will be able to manipulate. The clinician's ability to manipulate the host immune proc esses so that the tissues and secretions of the oral cavity
might manage the etiologic factors of periodontal dis eases without destruction or disruption could be such a clinical implementation. In the meantime, the question of what is an acceptable level of periodontal health in a patient will have to be answered anatomically. M y visceral reaction after a dozen years of practice is that there is a level of periodontal disease that a patient's tissues may tolerate. N o clinician can deny the return of anatomic deformities in patients after full periodontal surgical therapy. That has been documented by the ongoing studies of Dr. Ramfjord's group at the Univer sity of Michigan. With periodic periodontal maintenance and with varying levels of plaque control by the patient, these teeth are comfortable to the patient and functioning in an acceptable manner. Although the goals of our therapies remain as normal depth gingival crevices, ideal anatomic forms of gingiva and bone, lack of mobility to grossly applied forces to the crowns of teeth, and an intact procession of teeth around the dental arches, many teeth are retainable without the absolute attainment of these goals. Underlying any definition of periodontal health in the patient already afflicted with periodontal disease must be the comfortable retention of teeth capable of masticating the diet of our civilization. In absence of a working knowledge of the mechanisms of periodontal diseases, other anatomic measures seem too variable to be considered standards. Sheldon Holen, D . D . S . Washington, D . C .
dental control's disclosing solution solidifies! TABLETS AS WELL AS "NO-MESS" SOLUTION
Finally, there is a tablet that can match the professional detail of D E N T A L C O N T R O L D I S C L O S I N G S O L U T I O N . Dental Control's unique red e r y t h r o s i n e f o r m u l a is now in tablet f o r m developed by dentists to be t h e most rapidly dissolving and best-tasting tablet available. Dental Control once again offers you the best professional quality and the lowest cost. T r y it a n d compare! For those w h o prefer a disclosing s o l u t i o n , Control offers " n o rinse, no m e s s " disclosing in a 2 - o u n c e office size and 3 / 4 ounce, and single-use patient sizes.
I am enclosing $
to cover my order of:
Bottle(s) Disclosing Solution
Box(es) Disclosing Tablets
(2 oz. Office Size)
(Cello-Wrapped), Box of 1000, $8.00
Set(s) SAMPLER i oz. Really Fresh spray, 40 yds. Really Fresh Flavored Floss, and an assortment of single use units of disclosing liquid and tablets, and waxed and unwaxed flosses, $1.00
Box(es) Disclosing Solution (Single-Use Unettes) Box of 700, $34.00 Bottle(s) Disclosing Solution (\oz.
Patient Dispensing Size),
12 bottles, $10.00
144 bottles. $93.00
To order, please complete and return this coupon to: Dental Control Products, 590 Valley Road, Upper Montclair, N.J. 07043.
12 bottles, $18.00
570
NAME ADDRESS. CITY STATE
.ZIP
