We all know about bacteria and its role in bad breath, periodontal disease, and wound healing. But do you know about the hidden enemy? The enemy which bacteria releases to help itself be more successful in the disease process? Bacteria, like all other living organisms, must eat to survive. Once they eat, they have to go to the bathroom. What they release through the process of metabolization are volatile sulfur compounds (VSCs), which often reside in the mouth uncontrolled. VSCs stink, which is why they are associated with bad breath, but they also are toxic to your tissue, facilitate bacterial assaults, and impede wound healing. Because of this, they are a major contributor to periodontal disease, infections, and hamper gingival healing.
When referring to VSCs, most often we think of bad breath. Bad breath is a top complaint from patients, and as dental professionals, we are expected to have a solution. Bad breath affects patients’ daily lives; people spend over one billion dollars a year on halitosis products. Some often feel embarrassed and frustrated, as they have tried everything over-the-counter without results. This is because most of these products either only address killing bacteria (not VSCs they produce) or try to mask the smell. To fight bad breath, you must eliminate bacteria and VSCs.
Toxic to the Tissue
Studies show VSCs are toxic to periodontal tissue, even at low concentration levels. We’ve all had that patient, when as soon as they enter the operatory, you can tell, by smell, they have active periodontal disease. In dentistry, we sometimes have this backward; it’s not the periodontal disease causing the smell, it’s the VSCs attributing to periodontal disease.
Bacteria excretions and death cause VSCs. VSCs weaken periodontal cell membrane’s which allow an easier bacterial assault on the already compromised tissues. The presence of VSCs expedites the progression of the initial infection of gingivitis to full-blown periodontitis, as both hard and soft tissues are affected. The longer VSCs go uncontrolled, the more damage they are capable of. To sum it up, VSCs have a multiplier effect which can worsen periodontal disease.
Impede Wound Healing
There are many theories about how VSCs impede wound healing. Some suggest the presence of VSCs prevents oxygen from reaching the wound; others say it causes collagen degradation. What we do know, is there is a direct correlation between VSCs and poor healing. Many studies note, if you decrease VSCs, you can increase healing time. For us in dentistry, we are able to experience the unique challenge of treatment which promotes wounds to heal, but in an environment not really conducive to healing. The mouth is the perfect environment for microbial growth and VSC proliferation.
Obviously, to fight bad breath, periodontal disease, and infections, while increasing gingival healing, we must address VSCs. Therefore, controlling bacteria and VSCs is the best way to help with bad breath, provide effective tissue management, and decrease healing time. The challenging part of removing VSCs is their location. They are normally located in areas which are often neglected by patients and missed in a normal brushing and interdental cleaning routine. The interproximal areas, back of the tongue, and periodontal pockets are the spots with the highest concentration of bacteria, and subsequently, high concentrations of VSCs. Because brushing and interdental cleaning only mechanically remove debris, we can’t effectively remove VSCs without introducing something that is therapeutic.
Activated chlorine dioxide has been proven to be one of the best known VSC eliminators. This is because it is a gas which reacts directly with gaseous VSCs in the mouth. Also, this chlorine dioxide gas can reach those frequently missed and hard to reach areas. In order to create this gas, you must activate it with each use, so it needs to come from a two bottle system. Single bottle systems that claim to be chlorine dioxide are actually just sodium chlorite which does not eliminate VSCs at the rate of true, activated chlorine dioxide. Keep this in mind when choosing a product to battle volatile sulfur compounds.
In conclusion, we all know the mouth is a breeding ground for microbes. It is imperative we choose products that eliminate both bacteria and the hidden enemy, VSCs.
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