A federal researcher has outraged specialists in treating gum disease by saying he has developed a treatment method that is less painful, less expensive, and just as effective as the surgical methods currently in use.
The researcher, Dr. Paul H. Keyes of the National Institute of Dental Research, has been studying methods to control the bacteria that cause periodontal disease, which attacks the gum and underlying structures that support the teeth.
Gum disease, which plagues 9 out of 10 adults in the United States, results in more tooth loss than all other causes combined.
Although gum disease cannot be cured, Keyes says the progress of the disease can be held in check with a specific home care program and less than $100 in dental fees.
In discussing his methods publicly, Keyes has earned the emnity of many periodontists -- dentists specially trained to treat the gum disease -- because he says his inexpensive treatment brings results as good as those for which the periodontists charge from $800 to $5,000 after repeated, painful surgery.
"Congratulations. You have set dentistry back 10 years. You are about 15 years behind the times. You are obviously not a clinician, just a misinformed talker," a Naperville, Ill., periodontist wrote Keyes after a column by one of his patients appeared recently in several newspapers around the country.
"I classify this sort of thing with Laetrile..." a so-called cancer treatment that virtually all medical authorities call useless, said Sheldon Holen, a Washington periodontist who is a Diplomate of the American Academy of Periodontology.
Keyes says he has been misunderstood. "It's not a question of surgery or no surgery," he said during a recent interview. "It's a question of controlling the bacteria... This is like the situation you have with a gastric ulcer. Get into the hands of one man and he wants to operate. Get into the hands of another, and he uses more conservative management."
Keyes' treatment for the disease, best known to the public as pyorrhea, is basically conservative and old-fashioned. First, he cleans and scrapes the patient's teeth, as any periodontist would, removing as much bacterial build-up along the root surfaces as he can. Then patients are taught a program of home care, and many are given an antibiotic for two weeks to kill the remaining bacterial build-up.
Patients are taught to brush carefully, floss between their teeth, massage a paste made of baking soda and hydrogen peroxide into the gums and use a Water Pik with salt water to flush and shrink the gums, all of which Keyes says helps to prevent the recolonization of the micro organisms that caused the disease.
Several Washington-area dentists have begun using Keyes' methods, including one in Falls Church who asked that his name not be used for fear he would be deluged with patients who have been told they need surgery.
"We don't think this is a cure for every case," this dentist said. "But I do a lot less surgery now than I did. It was a considerable drop in income. One year we billed $30,000 and the next we billed $800."
Traditional treatments for the disease of the gums and underlying tissue involved first scraping the root surfaces, as Keyes advocates, and then, if necessary, performing surgery to cut back the gums to the point where they are healthy and adhering to the teeth. In some cases the surgery includes reshaping the bone around the teeth.
Traditionalists, like Holen, argue that no home-care method can clean out the deep bacterial pockets in the bone, and they say that surgery is necessary to remove the pockets and surrounding gum.
"We will not cure you," Holen said of the surgery he performs, "but we will arrest the process. There have been no great break-throughs in the field, and I've been doing this since 1962."
The Falls Church dentist, who has been using Keyes' method for the last two years, says he is getting as good results using the nonsurgical treatment as he was when using surgery.
The main difference, he says, is that a patent now pays about $18 a visit for three cleaning sessions and then pays a one-time fee of $15 to be taught the home-care methods and returns as many times as he or she likes to have his or her progress monitored.
Keyes and the dentist in Falls Church use a microscope hooked to a videotape camera and screen to show patients the live growth on their teeth at the start of the treatment and, they hope, the lack of growth as treatment progresses.
According to Keyes, "less than one percent" of the approximately 100 patients in his experimental program have lost teeth since entering treatment, "and many of them came to us having been told they needed teeth removed."
Holen, who says Keyes' study lacks scientific validity, says "the long range measure of treatment is whether you keep your teeth or not." The three years of the study, he says, do not constitute "long range."