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| Frequently asked questions Question: How do I know that I have a gum problem? Answer: You may not be aware until damage has already occurred, and this is why regular visits to your dentist or dental hygienist are important. If your gums bleed after brushing or eating this can be a sign. Regularly trapping food between teeth can indicate damage to the tooth or support of the tooth is taking place and should be investigated. Others may notice your bad breath. Movement of teeth on finger pressure as you feel each one can be an indication. Question: What's the procedure to receive this type of treatment, and what are the costs? Answer:
Question: Does the treatment always work? Answer: It's not possible to say that it will work for everyone. Sometimes it will work very well, and for other people not so well. No independent clinical trials have been carried out, but from the results achieved so far with over 55 people (April 2008) in every case it has reduced swelling and bleeding for everyone. Many have teeth which have tightened, but some were so damaged that it was too late to save them. The sooner treatment is started the more certain we can be of a good result. The results of treatment appear to be far better than achieved by other non-surgical approaches. Similar results have been achieved by using surgery, which is much more time-consuming, costly, and uncomfortable. Surgical approaches are generally carried out by specialist periodontologists, whilst this new approach is straightforward enough to be carried out by general dentists and dental hygienists. Question: How often do I need this kind of treatment? Answer: We can't be sure at this stage, but it appears likely that a single successful treatment should give long-term benefits. It does depend on you brushing properly afterwards to prevent new bacteria taking hold. We do know that people who have never had advanced gum problems can prevent disease by brushing and flossing. Question: Are there any side effects? Answer: For those who have no allergies to tetracycline or to any edible plants there should be no problem. The plant extract is from a plant eaten by many millions around the world every day. Of course it isn't in the same concentration as placed around the gums. Studies in Denmark show it causes no harm at the concentrations used around gums, when injected into mice at similar and even higher concentrations. Before trying it on any patients, Ray Steggles tested some on his gums, without any ill-effects. No one who has had the treatment has had side-effects. All successful gum treatment reduces the swelling of gums and the teeth may appear longer and spaces between the roots of teeth greater. This is not the effect of the treatment, instead it is because of the amount of pre-existing damage caused by the disease. After treatment you may have some sensitivity of roots, and if your diet is poor you may be more likely to get root decay. Again this is not a specific side effect of this treatment, but care is needed to prevent them occurring. Question: Why isn't it available from my dentist? Answer: We hope it will be within a few years. Before a medicine can be supplied to other dentists it has to be approved, and this requires a number of trials being carried out. We are trying to get these underway, but the funding to do so runs into several hundreds of thousands of pounds. Where a person attends for treatment here, if in the opinion of the dentist the disease is severe, and there is no already licensed product able to treat the problem effectively, the dentist may, with the patient's informed consent, mix and use a specially prepared alternative. Because we know what is in it, have carried out a risk assessment, and know how it is intended to work, we can in those special circumstances use it. Should you have a gum problem, which your dentist can't get under control, you may ask your dentist to refer to us specifically to be considered for this type of treatment. Question: Is it available on the NHS? Answer: It cannot be used on the NHS until it has received medicines approval, requiring clinical trials as mentioned in the previous answer. Question: How does it work and why aren't other treatments effective? Answer: This is complex and this response is to give a general understanding. Gum disease is caused by bacteria growing into masses called dental plaque. As the plaque grows, because brushing hasn't been effective, our cells detect the bacteria and their products. Some people are very sensitive and their cells fight the bacteria vigorously and the outcome is a lot of tissue damage with swelling and bleeding. Other people's cells are less sensitive and less damage is caused, and they take longer to develop the disease. Some types of bacteria cause greater response by our cells, and these tend to grow in deeper pockets and take longer to develop. If we had a way of completely removing the bacteria there would be no gum disease. If we manage to remove most of them gum disease is slight, and develops very slowly, perhaps never reaching the stage of causing problems during our lifetimes. This is why careful, regular, brushing and flossing can be effective. Unfortunately, most people don't carry these out well enough and the bacteria slowly take over. Once the bacteria have the upper hand it becomes increasingly difficult to control them. The accepted method of treating advanced gum disease is for the dentist or hygienist to mechanically scrape them away. This is very time consuming, and recent trials have shown that even after five or six hours there are still markers in the blood showing bacteria are still present. To lower the blood markers it took six to eight hours of scraping and the use of antibiotic pastes. How many would tolerate this, and afford it? Only after the mass of bacteria was reduced to a very small amount was the antibiotic effective. With this new approach, the response appears very much better than others. Less scraping time is required to get a good result, with the treatment of a whole mouth taking about 80 minutes, and we have evidence of bleeding stopping, gums shrinking to normal, teeth tightening, and bone healing. We won't know about the level of markers in the blood until full trials are completed. We know that bacteria growing in a mass are less affected by antibiotics than those floating freely. This is because they act in different ways, because they are aware they are part of a group. It appears the plant extract contains one or more substances which makes them act as if they were floating freely, becoming sensitive to the antibiotic, which kills them. It is believed many more bacteria are killed by this new method, allowing the body to heal.
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