TREATMENT OF GRANULOMA

This subject is divided into two parts as follows:

1. Etiology of dental pathology
2. Granuloma


Examine carefully the dental terms on the figure below for a better understanding of the text in the subject.
TREATMENT OF GRANULOMA
Fig.1. Tooth structure and paradental area

1. Etiology of dental pathology

The etiology of dental pathology or put simply the causes of diseases of the teeth and oral cavity are bacteria. They can act directly or may produce the following pathogenic (disease-causing) processes in the oral area:

They have direct toxic effect on tissues by secretion of toxins. Bacteria secrete into us enzymes produced by themselves that degrade hyaluronic acid contained into surrounding tissues - the main constructive substance of connective tissue and other building substances like chondroitin and collagen and also act hemolytically decomposing our blood elements and those of the immune system - erythrocytes, leukocytes, platelets, lymphocytes, etc. These enzymes are released both by pathogenic microorganisms ("foreign bacteria") and the normal microflora ("our own bacteria") and have a destructive effect on cells, tissues and organs in the oral cavity. Once this destruction becomes a fact follows the entry of bacteria in the teeth (in the pulp, periodontal pockets, apical foramen), mucous membranes, bones, nerves, lymph and blood vessels in the mouth where they settle and begin to breed or move to other parts of the body.

Bacteria affect our health by the toxic products released in the course of their metabolism as a result of the enzymatic degradation exerted on the organic compounds that make up the tissues and organs in our oral cavity and on food residues present therein. In other words these are the decay processes caused by them and therefore our teeth begin to deteriorate and our mouth starts to smells bad. Particular importance have metabolic products such as lactic acid, hydrogen sulphide, indole, skatole, ammonia, toxic amines which decalcify enamel and increase gingival pockets (onset of periodontitis - inflammation of the periodontal tissues). Many of these metabolic products are gases, which for example in case of granuloma (local, focal infection), which usually is limited in a closed area in the alveolar bone in the apical openings cause inflammation followed by edema (swelling of the surrounding tissue) due to the increasing volume of gas produced by bacteria thus pressuring the surrounding tissue and the nerves and blood vessels passing through. When nerves are being pressed we feel pain and when blood vessels are pressed are created conditions for hypoxemia (the flow of oxygen to tissues and their cells stops) which leads to formation of oxygen free (acid) environment which in turn is excellent for more rapid multiplication of bacteria because 80% of bacteria in our body are anaerobic i.e. live and multiply best in oxygen-free environment. Follows diffuse (penetrating) distribution of the edema through and in the oral mucosa of the nearby teeth thereby the tissue around the maxilla (upper jaw) swell such as the cheek and eye or around the mandible (lower jaw) as there swells the area around and under the chin. The absence of adequate treatment leads to infection of the blood (auto-intoxication, poisoning) throughout the circulatory system and painful death within 24 hours to several days.

Even in the absence of that worst-case scenario is observed an impact of the infections in the teeth to the whole body as pathological processes occur even in the most distant from the teeth organs in our body - heart, kidneys, liver. Very often this effect manifests itself as allergic and autoimmune diseases. Another effect on the inflamed mouth full with pathological bacteria is the reduction of bone density (alveolar bone) around the teeth whereby they start to shake and finally fall one by one. This can clearly be seen on tooth radiograph especially as compared with an older one of the same tooth where it is clearly visible the "withdrawal" of the alveolar bone to the jaw.

Bacteria together with the ingredients of saliva are also responsible for a deposition of plaque (tartar) - a precursor to dental caries. It is a local accumulation on the surface of the tooth of microorganisms mixed with organic matter as a result of enzymatic degradation of food residue in the oral cavity that I mentioned earlier in the text. As I said in many other places in this book acid-base balance in the body is of paramount importance to health as it applies with full force to the health status of your teeth. In the oral cavity of a healthy person the pH of the saliva is about 7.5 i.e. slightly alkaline while in people who do not follow a healthy lifestyle it is pH 5.5 - 6. This pH value is characteristic of acidic environments where anaerobic bacteria live best. Dental plaque leads to decalcification of the enamel also the development of caries thus bacteria find a way to penetrate deep into the tooth. Remember that bacteria ensure its own energetic development and reproduction by means of decomposition of glucose (sugar) called glycolysis. So next time you reach for the sweet carcinogenic junk which brazenly mindless saleswomen at counters in the grocery store foist into your hands think about your teeth and the bacteria which you feed so willingly with your ignorance and lack of discipline!

Everyday prophylaxis for good health in the oral area requires not only pursuing a healthy lifestyle, not just a regular application of good hygiene habits but also in combating microbes the use of a substance that our leukocytes produce to defuse pathological microorganisms namely hydrogen peroxide (H2O2). The enzyme myeloperoxidase contained in leukocytes (neutrophils and monocytes) serves for provoking in them the mechanism of generation of superoxides and H2O2 which are toxic for microorganisms. The method of administration of hydrogen peroxide can be seen in paragraph "Prevention of influenza." By rinsing the oral cavity in the morning before a meal with hydrogen peroxide you help your leukocytes and generally speaking the immune system to create conditions for super oxidation of tissues thus anaerobic microbes die instantly. The concern of some people about the use of hydrogen peroxide for such purposes is merely lack of knowledge on the matter because as I said our bodies produce it constantly and to be avoided accumulation of too many free radicals in our body there exist extracellular (exogenous) and intracellular (endogenous) mechanism for removing the excess hydrogen peroxide. The exogenous mechanism is realized by the enzyme catalase and the endogenous via cellular organelles called peroxisomes. They are available throughout our organism without exception. Use pure hydrogen peroxide and never that of pharmacies where there are stabilizers as phenacetin which are cancerogenic. Pharmaceutical hydrogen peroxide can be used for external use only.

2. Granuloma

Standard dental case is the occurrence of granuloma either under a "healthy" or under a treated tooth which for example has a crown thereon. As we have explained so far the disease process begins with pain and can result in death. Even without having any symptoms for the development of inflammatory process in making radiograph can be established that at the basis of the teeth there is a latent ("sleeping") infection. What activates bacteria contained therein? The most correct answer would be - our immune system. Human body is a whole and therefore every little thing that happens in it affects the whole organism. Take for example a moment when you have a cold and your immune system is not in excellent condition. Then macrophages (monocytes) and microphages (neutrophils, eosinophils, basophils) that are part of leukocytes in our blood due to decrease in our health state and/or poor health literacy are either reduced in number or immature or insufficiently active and cannot any longer suppress this "sleeping "infection and then it just overrules the resistance of our immune forces by developing with a monstrous speed only within a few days. The immune system can be compromised in many ways as described here is just one of them.

What to do in case of granuloma?

The options are few. The first is to remove immediately the problematic tooth but only after removing the infection with an antibiotic course of treatment because otherwise removing the tooth until the infection is ongoing will induce blood infection and it will cause sepsis (general purulent Infection the body). Any hesitation whether to drink or not antibiotic is useless! About the damages that antibiotics cause I have mentioned below in the text but the biggest trouble would be the lethal (deadly) end that awaits you if you do not start taking them immediately.

The course of antibiotic treatment is conducted in the following manner:

Should be used the broad spectrum penicillin antibiotic Duomox 500 mg from the group of beta-lactam drugs bearing the general name amoxicillin. The dosage is one tablet Duomox of 500 mg every 6 hours for the first 5 days and 1 tablet every 8 hours for another 2 days. Total duration: 7 days.

Other preparations based on the same active ingredient and the same group are Amoxicillin, Ospamox and Upsamox. Their action is directed against the aerobic microorganisms. They are designed to treat periodontal mixed infections. They prevent the microbes to built its cellular wall thus remain unprotected by the phagocytic activity of leukocytes (absorption of one cell from another cell) and are killed. This type of antibiotics are least harmful having greatest therapeutic range because the cells of our body do not have such structure. In turn, they often cause allergies in patients accompanied by severe diarrhea. In this case, the administration should be discontinued. The effect of all antibiotics is generally associated with extermination both of "foreign" microorganisms in our body and of our "own". Therefore, in order to protect ourselves from the harmful effects of antibiotics and for support of our own microflora it is mandatory along with their intake and at every meal to eat yogurt (with lactobacillus bulgaricus) and vitamins B-complex (but especially vitamin B12).

Some dentists will prescribe together with the antibiotic to have parallel intake of metronidazole chemotherapeutic agent that prevents the DNA synthesis of microorganisms. Its action is directed against the anaerobic microorganisms. According to pharmacotherapeutic guides co-medication (simultaneous administration of two or more drugs) with the said two kinds of preparations against acute bacterial infections in the teeth gives almost in all cases a 100% positive results. Note however also the fact that unlike antibiotics metronidazole preparations interfere with the proper synthesis also of human DNA (except the bacterial one) which can result in severe genetic changes and cancer. Some of the more popular metronidazole preparations bear the following names, Trichomonacid, Flagyl, Arilin. The dosage for Flagyl 250 mg constitutes in administration 3 times a day of 1 pill every 8 hours for 7 days.

The idea of using co-medication consists in the fact that by killing only aerobic microorganisms we provide space for the development of the anaerobic one and vice versa. It's a fact also that against some anaerobic pathogenic bacteria developing in the oral cavity like trichomonas, for example, the body is not able to produce immunity. Therefore the emergence and re-treatment of a bacterial infection in granuloma must complete with the removal of the problematic tooth because it is unacceptable month after month to submit your body to the destructive influence of these drugs.

Is it necessary, however, to take out the tooth?

Aren't there other considerations that must be taken into account? Of course there are and I am going to explain them to you now. The second possibility is to not remove the tooth but to wait and see over time whether the process will develop again. It can happen literally in a month and then naturally you will need to perform intake of antibiotic and then to remove the tooth. Still development of reinfection could not happen if you follow strict rules for oral hygiene according to the described methods in this paragraph namely to rinse oral cavity with hydrogen peroxide, with baking soda and with Cotinus with duration and dosage as I have already described in the book. Switching to a healthy lifestyle is also one of the mandatory conditions. Only through daily care for prevention of the development of pathological microflora in the oral cavity could be avoided repeated inflammation. The last way is to take out the crown for cleaning the tooth canals and for flushing granuloma in order to be cleared the pathological microorganisms and everything to be closed in reverse order.

Cleaning of the dental plaque at the dentist is a procedure that takes about two hours but it ensures for about six months excellent removal by mechanical means of the adhered bacteria to the teeth. After this period do not forget to re-clean the plaque.

The other event which is mandatory is periodic X-ray photographing of the problematic tooth at every 2 years in order to be monitored whether the granuloma developed into a cyst which can be extended to the adjacent teeth. In this case the treatment requires surgical intervention.

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