Type to search

Periodontics Supporting Your Practice

A Paradigm Shift in Periodontal Disease

Drs. Ian Needleman and Adam Roberts spoke with Dr. Suham Alexander about a new paradigm shift in periodontal disease. 


Periodontal disease is a progressive condition associated with bacteria. There has been little in terms of innovation with respect to periodontal disease. Traditional approaches have focused on eliminating bacteria; however, there may be alternative or adjunct treatments which can influence the ecology of the oral cavity.

It is impossible to “sterilize” the oral cavity. This has led to new thinking about the use of probiotics as an adjunct to periodontal disease treatment. Various diseases are linked to dysbiosis in the gut and it has been postulated that the oral microbiome can also be affected by the alteration of gut microflora.

While diet does play a role in periodontal disease, it is one of many factors related to periodontal disease. Nutrition, alone, may or may not have a role in disease progression or development. There is evidence that nutrition can influence inflammatory markers and other biomarkers. The intake of refined sugars and carbohydrate continues to directly impact the microbiota to produce lactic acid, lower the pH and demineralizes enamel surfaces which can lead to caries and the onset of periodontal disease. There is data showing that communities with higher refined sugar diets suffer from various oral diseases. Oral healthcare professionals should discuss nutritional habits and get involved in discussion about weight and obesity with patients or refer patients to the appropriate professionals to help lessen the risk of developing periodontal disease.




  1. Vasant Ramlaggan November 8, 2016

    Thanks for the great interview!

    The concept being presented seems to be that alteration of oral microbiology will hopefully affect balance and hopefully improve the oral condition. I think it’s a great idea to consider probiotics for the mouth and hope that this would be maintained if there is a connection to overall health, stress, etc. as mentioned.

    We are currently using oral microbiology assessment in conjunction with treatments which include Oravital treatment (which was developed here in Canada, to alter the balance of bacteria in the mouth), Soft Tissue Management (the actual program) and nutritional counselling (along with other tools such as lasers) with our patients. We have seen increased success in management of periodontal issues including bleeding, biofilm deposits and with deeper pockets by ensuring we have a potential multi-armed protocol to address each patient’s situation.

    Again, I’m happy to see the increased discussion on oral microbiological balance!

    I’m always encouraged to see dentists who bring their team (especially hygienists) out to CE because I feel that it takes a team approach to help our patients. I’m happy to see a discussion of the possible multiple aetiologies for periodontal issues too.

    Thanks again for giving us access to the interview!

    1. JCDA Oasis November 9, 2016

      You are most welcome Vasant 🙂
      CDA Oasis

Leave a Comment Vasant Ramlaggan Cancel Comment

Your email address will not be published. Required fields are marked *