"...My second story relates to this column, so please bear with me as I share one of my success stories with an appreciative patient. About two years ago, I saw a middle-aged, male patient for the first time. Mr. Ed (fictitious name) was friendly, but a bit anxious and ready to tell me his woes. I’m a good listener and was eager to find out what was troubling him. He had already been through two rounds of periodontal surgery and was an active patient with a local periodontist. The periodontist had diagnosed him with aggressive periodontitis, and he was taking Periostat b.i.d. as directed. I questioned him about his home care and he rattled off the usual names of several oral hygiene home-care implements that hygienists associate with good oral hygiene, such as the interdental brush, rubber tip, dental tape, and power brush. This patient was new to me but had been in this particular general dental practice for several years.
I reviewed the recare letters from the periodontist’s hygienist, and she noted that he was maintaining well with good home care on each of about a dozen reports. The patient was very nervous in my chair and was convinced he would lose his teeth in spite of two rounds of full-mouth periodontal surgery. Mr. Ed cried when he told me that he feared losing his teeth, and he wanted me to give him hope. In performing a comprehensive periodontal exam, I noticed immediately that he was still healing from the second round of surgery.
What shocked me the most, however, was my immediate impression that his home care was poor. Upon disclosing, I found significant amounts of biofilm along the gingival margin and interdentally, though he insisted that he was using his brushes and rubber tip according to directions. I told him I thought I could help but that I would need to see him a couple of times for detailed home-care instructions. My immediate thought was to focus on a new home-care procedure that would be easy to implement. So I sent him to the pharmacy for an oral irrigator and told him to purchase a bottle of 10 percent povidone iodine. I also told him to irrigate with a diluted povidone
iodine solution (one part povidone Iodine to nine parts water) once a day and return in a month. (I prefer diluted povidone iodine to other antimicrobial agents because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and affordability.)
A gamble with povidone iodine
I was a bit concerned about recommending povidone iodine because I had heard it was not approved by the FDA for intraoral use, and its safety as a self-applied adjunctive irrigant was not established. I decided to recommend it for a short time in an effort to heal his surgical wounds. When giving oral irrigation instructions, I always recommend a cannula-type tip for patients with moderate to deep pockets rather than the standard tip that does not penetrate as deeply into the pockets.1
When Mr. Ed returned the next month, there was marked improvement in surgical wound healing, and for the first time in a very long time (I’d say 10 years or so), Mr. Ed felt encouraged. Neither he nor I could fully comprehend the dramatic change from inflamed, bleeding gingival tissues to a healthy and firm condition.
What caused this change in tissues from diseased to healthy in such a short time? Most of us understand that elimination or adequate suppression of periodontopathic bacteria in subgingival microbiota is absolutely essential for wound healing. According to the literature, conventional mechanical root debridement (and pocket reduction surgery repeated twice in this case) does not eliminate all periodontopathic bacteria from the subgingival ecosystem.2 Sites with deep periodontal pockets, grooves, furcations, and concavities are difficult to access with periodontal instruments, and periodontal bacteria can even invade dentinal tubules and live on the mucosa, tongue, tonsils, and gingiva.2
In Mr. Ed’s case, I theorized that the povidone iodine (which is a broad-spectrum antimicrobial) suppressed the bacteria that assist in the formation of soft-tissue biofilms. Supragingivally, biofilms form on a single surface, but subgingivally they form in three areas: on the tooth side of a pocket, on the epithelium lining of the pocket, and within the pocket, which is the loosely adherent plaque zone where the antimicrobial can easily destroy and wash away periodontopathogens that are not caught up in thick intracellular matrix.
I explained to Mr. Ed that we were trying to remove “gum bugs” that make up a sandwich between the teeth and under the gum line. These periodontopathogens live in and around the two slices of bread in a sandwich. (Not very appetizing, that’s for sure!) The tooth side of the pocket is one slice of bread, the pocket epithelium is the other slice of bread, and the loosely adherent plaque is located between the two. You can call it peanut butter or jelly, but make sure the patient understands it’s a layer filled with bacteria..."
The antibacterial properties and uses
of iodine-povidone in medicine are well
established. The natural element, iodine,
has been used for more than
150years in mucosal antisepsis, in the
therapy of skin infections and burns,
and in wound management. Yet, only
after the introduction of povidoneiodine
in the 1960s, was it possible to
employ this highly efficient microbicide
to a wide variety of bacterial, fungal
and viral infections. Short durations of
povidone-iodine contact with various
periodontopathic bacteria provides
effective in vitro killing (21, 22). Also,
povidone-iodine exhibits marked anticytomegalovirus
activity (23), a herpesvirus
implicated in the pathogenesis
of periodontitis (24). Emergence of
povidone-iodine resistance microorganisms
has not been reported to
have been detected to date. Despite its
impressive antimicrobial properties,
povidone-iodine is not widely used in
the prevention and treatment of oral
infections in the USA and Europe.
Povidone-iodine is water-soluble,
does not irritate healthy or diseased
oral mucosa, and exhibits no adverse
side-effects, such as discoloration of
teeth and tongue and change in taste.
Along with S. sobrinus, S. mutans plays a major role in tooth decay, metabolizing sucrose to lactic acid. The acidic environment created in the mouth by this process is what causes the highly mineralized tooth enamel to be vulnerable to decay. S. mutans is one of a few specialized organisms equipped with receptors that help for better adhesion to the surface of teeth. Sucrose is utilized by S. mutans to produce a sticky, extracellular, dextran-based polysaccharide that allows them to cohere to each other forming plaque. S. mutans produces dextran via the enzyme dextransucrase (a hexosyltransferase) using sucrose as a substrate in the following reaction:
n sucrose → (glucose)n + n fructose
Sucrose is the only Sugar that S. mutans can use to form this sticky polysaccharide.
Conversely, many other sugars—glucose, fructose, lactose—can be digested by S. mutans, but they produce lactic acid as an end product. It is the combination of plaque and acid that leads to dental decay. Due to the role the S. mutans plays in tooth decay, there have been many attempts to make a vaccine for the organism. So far, such vaccines have not been successful in humans. Recently, proteins involved in the colonization of teeth by S. mutans have been shown to produce antibodies that inhibit the cariogenic process.
Suppression of Streptococcus mutans in the mouths of humans by a dental prophylaxis and topically-applied iodine
P. W. Caufield and R. J. Gibbons
A prophylaxis followed by three topical applications of an iodine-potassium Iodide solution significantly reduced the levels of Streptococcus mutans in fissure and approximal plaques and in saliva. Reductions persisted 20--24 weeks after treatment in salivary and approximal samples. A prophylaxis alone exerted a small and temporary reduction of S. mutans in occlusal fissure plaque, but did not reduce the levels of this organism in approximal plaque or in saliva. A significant relationship existed between the levels of S. mutans in saliva and the proportions of this organism in plaque. The dorsum of the tongue does not appear to constitute a significant reservoir for S. mutans following disinfecting procedures.
Effect of povidone-iodine on Streptococcus mutans in children with extensive dental caries.
PURPOSE: The purpose of this pilot project was to determine the effect of a 10% povidone-iodine solution on plaque Streptococcus mutans and on incidence of new caries in young children following dental rehabilitation under general anesthesia. METHODS: Twenty-five children ages 2 to 7 years, scheduled for dental treatment under general anesthesia, were enrolled. Children in the experimental group (N = 13) had povidone-iodine applied 3 times at 2-month intervals. Control children (N = 12) had no treatment. Plaque samples were taken from all children at baseline, 6 months and cultured for total bacteria and S mutans. Dental examinations were conducted at baseline, 6 months, and 1 year. RESULTS: Experimental and control children had similar dietary habits, caries experience, and S mutans levels at baseline. All children's S mutans counts decreased significantly at 6 months (P = .003). The difference between the 2 groups was not significant (P = .58). At 1 year, 5 of 8 children in the control group had new caries compared to 2 of 11 children in the experimental group (P = .06). Povidone-iodine was well accepted by participating families. CONCLUSIONS: Extensive one-time restorative dental treatment resulted in a significant suppression S mutans levels at 6 months. Further exploration of the role of povidone-iodine in caries management is indicated.
Iodine is a great killer of bacteria
It is a disinfectant
It will kill off mouth bacteria
Since the human mouth has more bacteria than a dogs mouth (imagine that!) it could be a great-expensive- mouth wash
I used cloth diapers well into the age of the plastic ones, and II hung them on the line to dry in the sunshine. As children get older, and diapers are older, amonia builds in the diaper.
My peditrician suggested I throw Betadine and Iodine compund in the was with the overnight diapers. Although the color was brown and a bottle was semi expensive and I used the whole bottle in the wash it did not turn the diapers brown and it worked!
It was far less expensive than buying a whole load of cloth diapers anew, especially when we were getting close to potty training