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Something to Smile About

Dentist Bruce Smith talks about the most significant happenings in dentistry since he opened his Montrose practice in 1981

by Janice Stensrude

With an unfocused, general interest in some sort of career in healthcare (to “work with people and make a difference”), Bruce Smith earned his Bachelor of Science degree in biology, with an emphasis on microbiology and a minor in chemistry. So when a summer job in a dentist’s office stimulated his interest in dentistry as a career, he was prepared to follow his star.

“I’m really good working in three dimensions and have fine motor skills, and just really thought it was the perfect combination of art and science and helping people and biology and all of that,” Smith explains. “My hobby is sculpting, so to be able to make somebody a beautiful smile, it’s like a little mini work of art, a mini sculpture.”

Today he bursts with enthusiasm for a new dental technique that effectively fights gum disease and promises to help prevent heart disease, stroke, and other diseases. This focus on his present practice and his vision for the future is eons removed from his early years as the first dentist in Houston to agree to treat AIDS patients.

“This fellow had a horrible toothache, and he was in a local hospital and his physician couldn’t find any dentist to take care of his toothache, and he called me. And I thought, well, why not? Let’s get this guy taken care of. . . . Every dentist in the city was refusing to care for people, but with my background in microbiology, I knew that if we followed universal procedures, which basically means that you sterilize everything, you wear gloves, mask, protective eye wear . . . Because you don’t know, for example, if a person has hepatitis and they don’t know it, or tuberculosis and they don’t know it. We finally found a couple more like-minded people. So for a number of years, there were about three of us here in Houston that would consent to see those patients.”

Treating AIDS patients—or patients with the “gay disease,” as they called it in those days—wasn’t all that Smith did. He also involved himself in educating the health profession about universal precautions that made treating HIV-infected individuals as safe as treating any other patients who presented themselves to a medical or dental practice. He put together presentations that he delivered to healthcare professionals in the U.S. and “a little bit abroad.” Smith worked toward establishing a standard of care that, he felt, should have already been in place long before anyone had heard of AIDS.

“I never felt like it was all that dangerous or scary,” he says in a matter-of-fact tone. “I always felt like this had to be a communicable illness of some kind, thinking it was probably a virus, and if we followed the usual precautions that we would follow for somebody with the most easily transmissible illness in a healthcare setting—which at that time was Hepatitis B—if we followed those protocols, everything should be fine.”

Another significant development in his field since establishing his Montrose practice in 1981, says Smith, is the materials used in filling cavities. The silver filling material (actually an alloy of silver, mercury, copper, and tin, he explains) has given way to the new so-called “composite” materials. These newer tooth-colored restorative materials have become increasingly durable. “So now people can have not only nice-looking restorations,” Smith says, “but restorations that can be superior to the metal ones.”

“Another fairly significant change” is in the fitting of false teeth. “If somebody has a missing tooth,” he says, “an artificial tooth root can be placed in the bone, made from the same metal that they make artificial hips or knees out of [medical grade titanium], and you can mount a tooth on that.”

With a dental practice that focuses on prevention—“Let’s try to keep bad things from happening in the first place”—Smith fosters a cooperative dentist-patient relationship. “We’re heavily involved in home care procedures, education, teaching people about the value of effective brushing and flossing and regular cleanings, education about why gum disease occurs, why cavities occur, and what you can do at home to reduce your problems.”

He is quick to qualify that he has considerable experience with cosmetic dentistry. “But if there’s a less invasive, less expensive way to do something, that’s my preference. . . . My fundamental philosophy is very strongly prevention oriented and education oriented. So it’s been rather frustrating over the years that nothing has come along that has had a truly significant impact on the treatment of gum disease, which is one of the leading causes of tooth loss in adults. What frequently happens is that we can slow down the deterioration from gum disease, but we can’t really effectively control it or reverse it. And so that’s why I’m so excited about this new Perio Protect system.”

If Perio Protect does what it says it will, Smith has reason to be enthusiastic. Gum disease doesn’t just cause tooth loss. There’s a large body of research into the relationship between oral bacteria and systemic disease. One recent study concluded that people with gum disease are almost twice as likely to have coronary artery disease. Another study showed a relationship between oral infection and stroke. Other studies have found relationships between gum disease and premature birth, low birth weight, and complications with diabetes, as well as connections with dementia and Alzheimer’s.

“And the more research that is done,” says Smith, “the more we’re finding these connections, because it’s been found that the bacteria that are found nowhere else in nature but in the human mouth get into the blood stream through the gums, and the bacteria enter your central circulation and create all sorts of problems through a variety of mechanisms.”

The Perio Protect system is a patented method of delivering germ-killing medicine deep into the pockets of the gums. The dentist makes molds from the patient’s teeth and gums from which a set of trays (upper and lower) are custom made by a dental laboratory. When the tray, loaded with anti-bacterial medication, is fitted over the teeth and gums, the medicine is forced between the teeth and into the gum pockets. Perio Protect’s manufacturer went the extra mile, proving its effectiveness through research studies using FDA protocols, so that they are able to promote Perio Tray7 as an FDA-approved medical device.

When he first heard about it, Smith was skeptical. “I just couldn’t imagine that something like this would be truly effective,” he says. But after spending a day attending a seminar in St. Louis, he decided it was something worth further investigation. “All the case studies made absolute sense. And my background in microbiology helped a great deal, because the types of bacteria he was talking about and the nature of what they do and what they’re susceptible to and all of that was absolutely right on. . . . So we decided to do a little internal study in our own office.”

Smith and his entire staff tried the system on themselves. “You would think that somebody who is a dentist or a dental hygienist or dental assistant would be this paragon of virtue with brushing and flossing and none of us would ever have a gum pocket or a bleeding spot.” Apparently, that is not the case. “In every single instance, we got dramatic results in the first two weeks,” he says. With that success under his belt, Smith decided to run another study, this time on patients. “We asked about 20 of our patients with gum disease that we had not been able to bring under control if they would be willing to let us give them this system in exchange for being a test subject for us. And once again, in every single instance we got dramatic results.”

Smith’s in-house studies measured gum-pocket depths before and after using the new system. During measurements, Smith says, “if you touch on the gums with the instrument by sliding it between the tooth and the gum and you withdraw the instrument, if you don’t get a spurt of blood or a bloody spot, that’s a good sign.” In addition to noting the presence or absence of bleeding, the examination also looks for the presence of redness or puffiness in the gum tissue, loose teeth, and other signs of periodontal disease.

One 68-year-old patient, who has battled gum disease during the entire 12-year period as Smith’s patient, entered the study with gum pocket depths of seven to nine millimeters. “He was not a candidate to go to a gum specialist, a periodontist, for a couple of reasons,” explains Smith. “First of all, he’s a smoker. And he openly and honestly said to me, ‘There’s no way I’m going to quit. I know myself too well.’ Smoking does make gum disease much worse. If you’re a smoker and you have gum surgery, your chances of success are pretty slim.”

Smith reports that, after three weeks of treatment, the patient’s “9 mm pockets reduced to four, and his 7 mm pockets reduced to anywhere from three to one.” All patients in the test group experienced improvement in the condition of their gums. Today Smith has nearly a hundred patients using the trays, with a success rate that he estimates to be more than 90%.

Who can benefit from this new therapy? During the initial assessment, Smith explains, “If the gum-pocket measurements are between 1 and 3 mm, and if there’s no pus coming out, there’s no blood, there’s no odor, there’s no soreness, there’s no redness or swelling, we declare that place healthy. . . . Depending on how deep those measurements are and how many of these other things are present, we can score the severity of the periodontal disease.”

Diagnosing the need for the treatment is just the beginning. Smith also judges whether or not the patient is likely to take a disciplined approach to using the system on a daily basis. “If we encounter somebody who says, ‘No, quite honestly I’m just not the kind of person who’s likely to do that regularly,’ then we say, ‘Well, this is not a good idea for you.’”

Despite describing Perio Protect as “the first thing that I have found that makes a significant difference in the realm of prevention since fluoride,” Smith is cautious of making lavish claims about its health benefits. “It’s way too early to even suggest that if you, as a person with gum disease, start using the system and improve your gum disease situation that it’s going to somehow magically cure you of diabetes or prevent Alzheimer’s. The studies just don’t go that far.”

Janice Stensrude is a frequent contributor to OutSmart magazine.

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