CDA Essentials 2017 • Volume 4 • Issue 2

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Issues and People
Dental decay will be viewed as a medical, rather than a surgical, problem.
In the past, dental decay was a surgical problem; we found it, drilled it out, put in a filling.
Today, dental decay is managed as a microbial problem, as some kind of infection in the oral
cavity. We still need to drill and fill and we’ve made some advances in eliminating the specific
organisms that cause the disease, but in reality we haven’t effectively eliminated the disease.
We sometimes blame the patient for not following our directions properly but maybe one
of the reasons they’re having such a hard time getting rid of the disease is that the tools we
currently have available are not directed at the underlying cause of the disease. Why are
those specific organisms there? It probably has to do with the acid/base balance, the foods
they’re eating, the components in their saliva. We need to step back and look at all of those
factors beyond the specific organisms.
There will be a new paradigm of periodontal disease.
I think we’re making advances in understanding that we’re not focusing on the right problem
in periodontal disease. We’ve all seen patients with all kinds of plaque and calculus, yet
their bone is as solid as stone and holding those teeth in place. Other people do a great
job of brushing and flossing, and rinsing with the rinses we have for them, and they’re still
losing bone. We call it all one thing: periodontal disease. But I suspect there are multiple
periodontal diseases. What we’re not capturing in our understanding of periodontal disease
is the host inflammation response; the inflammatory mediators destroy bone, not the
organism. Advances in understanding the human inflammatory response will lead to an
understanding of periodontal disease that goes way beyond brushing and flossing.
There will be a growth in host inflammatory mediator medications.
Because we’re still doing basic science in trying to understand host mediators in periodontal
disease, we’re pretty far away from developing drugs that are going to make a difference.
But we already have one host inflammatory mediator medication for treating periodontal
disease: doxycylcine. You might think it’s just an antibiotic but doxycycline used in
periodontal disease is not prescribed at a dosage that affects organisms. The dosage that’s
commonly used affects collagenase, the host enzymes that break down collagen. This
category of medication will only grow as we better understand periodontal disease. a
To hear the full interview
with Dr. Jacobsen, see:
This interviewhasbeencondensedandedited.
Theviewsexpressedarethoseoftheauthoranddo
notnecessarilyreflecttheopinionsorofficialpolicies
oftheCanadianDentalAssociation.