Successful treatment of generalized refractory chronic periodontitis through discontinuation of waxed or coated dental floss use
Drs. Anastasia Kelekis-Cholakis and John B. Perry from the University of Manitoba spoke with Dr. John O’Keefe about a recent article they published in the Journal of the American Dental Association: Successful treatment of generalized refractory chronic periodontitis through discontinuation of waxed or coated dental floss use: A report of 4 cases.
Dr. Anastasia Kelekis-Cholakis is associate professor, the division head, and the postgraduate program director of periodontics, Department of Dental Diagnostic and Surgical Sciences, College of Dentistry, University of Manitoba. (Bio at the end of this post)
Dr. John B. Perry is an associate professor and the division head of oral pathology, Department of Dental Diagnostic and Surgical Sciences, College of Dentistry, University of Manitoba, Winnipeg, Manitoba, and private practitioner, Southwest Specialty Group, Winnipeg, Manitoba. (Bio at the end of this post)
Generalized refractory chronic periodontitis is a periodontal condition that is resistant to conventional therapy. Management of this condition often is frustrating to both the patient and the clinician.
The authors present 4 cases of generalized refractory chronic periodontitis characterized by an inflammatory gingival response and progressive bone loss that did not respond to extensive periodontal treatments and regular periodontal care. Histologic examination of affected gingival tissue revealed an abundance of plasma cells, a feature seen in certain oral contact hypersensitivity reactions. The authors suspected that waxed or coated dental floss was the offending contactant, and its removal from the patients’ oral hygiene regimens resulted in a dramatic improvement of the periodontal characteristics.
Conclusions and Practical Implications
In cases of periodontal disease as described in this report, dental practitioners should consider the possibility of a contact hypersensitivity reaction to waxed or coated dental floss, whereby the floss exacerbates the condition instead of assisting in its resolution.
Dr. John Perry earned his D.M.D. degree from the University of Manitoba in 1976. After four years in private dental practice, Dr. Perry undertook graduate studies in oral pathology at Emory University in Atlanta, Georgia. In 1982 he joined the dental faculty of the University of Manitoba in a part-time capacity while completing a MSc. in the Department of Immunology in the University’s Faculty of Medicine. Since 1985, as an Associate Professor in the Department of Dental Diagnostic and Surgical Sciences at the Faculty of Dentistry, University of Manitoba, Dr. Perry has instructed in the undergraduate and graduate dental and undergraduate dental hygiene programs in the disciplines of oral pathology and oral radiology. He conducts a part-time oral pathology specialty practice dealing mainly with soft tissue lesions. Dr. Perry is a Fellow of the American Academy of Oral and Maxillofacial Pathology and a Fellow of the Royal College of Dentists of Canada.
Dr. Anastasia Kelekis-Cholakis obtained her BA in 1988 and her DMD and Diploma in Periodontics from the University of Manitoba in 1992 and 1998. Dr. Kelekis-Cholakis is a fellow of the Royal College of Dentists of Canada and a member of the Canadian and American Academy of Periodontology, Canadian Dental Association and Winnipeg Chapter of the Seattle Study Club. Dr. Kelekis- Cholakis is the Director of the Graduate Periodontal Program at the University of Manitoba, College of Dentistry. She lectures nationally and internationally and has published articles in peer-reviewed journals and an electronic book chapter. Her current areas of interest are: periodontal soft tissue microsurgery, peri-implant maintenance and biological implant complications. She maintains a private practice with the Southwest Specialty Group in Winnipeg.