Microscopic Evaluation

In the year 2000, I purchased a phase contrast microscope for our hygiene department. My intention was not to become a microbiologist, but I wanted to learn how to observe and identify live samples of the bacterial activity occurring in the mouths of our patients; particularly in the subgingival areas (below the gum level) where it’s difficult to clean with regular brushing and flossing.

Under normal, healthy conditions, our microscopic slides will show acceptable level of bacteria; such as rods, cocci, vibrios, white blood cells and a few red blood cells too. Compromised situations in our patient’s health will usually reveal a different picture. These slides will show a high level of bacterial activity. The bacteria, especially the rods and spirochetes, are those responsible for the bleeding and the destruction of you periodontal pockets.

When the oral cavity begins to breakdown with the presence of inflammation and disease, the tooth and body connection concept reminds me that this is a local event occurring in response to a more serious systemic complication.

As I began to learn more about the biological effects of these bacteria, the information that I discovered about oral spirochetes was quite alarming. These long, slender, thin, corkscrew shaped microbes are found in the oral cavity in various numbers and forms and have been strongly implicated as playing a role in the etiology of periodontal disease.

If these microorganisms are discovered, irrigation of the tissue with a bactericidal agent should be employed prior to any dental treatment to avoid causing a bacteremia (bacteria circulating throughout the blood stream). These include diluted bleach, chlorohexidine, or a product that I like to use in our office called Tooth and Gum Tonic. All of these will kill any active pathogenic organisms.

Antibiotics do not eliminate oral spirochetes, as in other spirochetal diseases; they only force them into a more protected spore form, thus reflecting a survival strategy only to resurface at a later date.

Even more dangerous are long term exposures of this bacteria which can develop into systemic chronic inflammatory diseases that catch up with people at later more vulnerable years. Oral spirochetes associated with chronic conditions are similar to those found in syphilis, Lyme disease and atherosclerotic heart disease. Another spirochete that is thought to populate the gingival sulcus is Helicobacter pylori, which is the bacteria that causes stomach ulcers and cancer.

Most spirochetes are free-living and anaerobic and will flourish in an environment that supports this condition. Acidosis (an acidic condition of the body) which reduces available oxygen to the cells can contribute to the increase presence of this bacteria.

The only way to fight the disease when it reaches this stage is to keep the immune system strong by practicing good oral hygiene, physical health, proper nutrition, and by appropriately handling chronic stress. My personal experience has taught me to provide a microscopic evaluation when saliva pH testing is measured below 6.5, indicating an acidic environment. At this level, spirochetal activity is often observed.

This is what biological dentistry has to offer our patients. We must learn not only to treat the mouth but understand that the entire body also needs the appropriate attention to support and maintain our overall health and well being. If oral spirochetes are detected during an examination, appropriate measures will be taken to avoid this insidious bacterium from causing any further ill effects to our patients.

The introduction of the phase contrast microscope has made a significant contribution to our practice. It has always been my intention to create a valuable service for our patients when they come to our office for a cleaning appointment with our hygienists. Regular checkups along with a microscopic evaluation should be the norm for each and every patient that has their teeth cleaned.

We offer this examination to our patients once a year and at no charge. It provides a quick, easy and painless evaluation of oral bacteria, offers immediate information that can be used to service our patients before they leave the office and it becomes an excellent patient motivator to promote healthy lifestyle changes if needed.