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effective solution to periodontitis and peri-implantitis Introduction by Dr. Peter Blijdorp Infection control is one of the most challenging and complex problems in dentistry today. The mouth is a sea of bacteria normally living in balance with the rest of the human body. Under certain conditions, disease causing bacteria can become dominant, creating infection. These bacteria live together in the biofilm, which supports a mixture of bacteria, viruses, fungi and even parasites. The complication is that each of these require a different drug to eliminate its dominance. Bluem active oxygen technology for oral wound healing, tissue regeneration and oral disease management is based on my experience over the last 25 years as a Maxillofacial Surgeon and Implantologist. wound healing Wound healing requires a variety of cells to increase their metabolic activity, resulting in a high oxygen demand. Oxygen at the wound site has been shown to promote wound healing by stimulating several processes including the following: • • • • • • Anti-bacterial activities. Neo-vascularisation. Collagen production. Epithelialisation. Phagocytosis (engulfing of micro-organisms, cells or debris by macrophages or neutrophils). Degradation of necrotic wound tissue. Severe and destructive processes can also be caused by deficient oxygen efficiency. An optimal uptake of oxygen is necessary to maintain the bio reactions of the body and for a healthy life. Interestingly, oxygen saturation of the blood and oxygen partial pressure (pO2) have been found to reduce with age, thus reducing the optimal healing environment *. Bluem can provide the oxygen necessary to allow these processes to proceed effectively. oral wounds Peri-Implantitis and periodontitis are bacterial infections with chronic inflammation characteristics. It has been shown that the pO2 value in areas of peri-implantitis is significantly lower than in healthy tissue*. Moreover, the pO2 value correlated with pocket depth; the deeper the pocket, the lower the pO2 value*. These lower oxygen levels reduce the body’s resistance to bacteria and healing potential. However, changing this chronic wound to an acute wound through curettage, together with a local application of Bluem oral gel on the wound bed, will greatly aid in the repairing process and accelerate healing. why bluem? Often, products like chlorhexidine digluconate, hydrogen peroxide, triclosan and other local or systemic antimicrobials are used to support periodontal treatment. These products are known to have beneficial effects. They also have their limitations, disadvantages and side effects. The topical application of oxygen as a support for tissue regeneration and wound healing is a much safer alternative which benefits the human body. Bluem increases the local active oxygen† available in the wound area. It contains low concentrations of sodium perborate, and the enzyme glucose oxidase (GOX). On application, and in the presence of moisture, the sodium perborate converts to sodium borate and H202 (hydrogen peroxide), while the normally inactive GOX causes a gradual conversion of glucose into gluconic acid and H202. These low levels of hydrogen peroxide (0.003 – 0.015 %) act as a disinfectant and is present along with the ROS (Reactive Oxygen Species) during the respiratory burst of neutrophils found in normal body fluid. This has a chemotactic effect on leucocytes. The concentration of oxygen is not comparable to the higher concentrations (1.5 – 3.0%) of H202 commonly used in other oral disinfectants. It has been proven that tissue damage can occur at these higher levels of oxygen due to the production of free radicals in the wound. Research has shown that a continuous presence of a low concentration of hydrogen peroxide, such as that found with Bluem, kills pathogenic bacteria much more effectively than a single high concentration without damage to fibroblasts*. tel: 01535 656 312 | www.swallowdental.co.uk/bluem case study A 39 year‐old man signed up as new patient in our practice. Intra-oral examination showed peri-implantitis at 36 with bone loss and some mobility (Fig. 1). After oral hygiene advice we curetted the pyorrhoea around 36, which was then treated with Bluem gel. The oral gel was injected deeply around the implant with a syringe, at first weekly, then bi-weekly. The gel was rinsed away with NaCl after one minute and a further application made and left in situ. The patient was instructed to brush twice daily with Bluem toothpaste, to rinse twice daily with Bluem mouthwash and to rub Bluem oral gel around the implant once a day (in the evening after rinsing). After three months, we reduced the professional application of gel to once every three months, while the patient continued with the procedure described above. After a year, we took another X-ray (Fig. 2). This clearly shows new vertical bone growth. Pocket depth fell from nine to four mm. Tissue around the implant was no longer red and swollen. The gum again fit tightly around the implant. There was no bleeding during examination and the implant showed no mobility. Dr. R. Muts, Apeldoorn, The Netherlands Fig 1 Fig 2 *References supplied upon request. bluem contains: • • • • Sodium Perborate – a reaction occurs after contact with fluid (saliva/blood) which releases active oxygen that kills anaerobic bacteria. Honey – Anti bacterial & Anti-Fungal – also releases oxygen/peroxide Xylitol – Natural sweetener that eliminates the need for fluoride in the product. Lactoferrin – Thickens the mucosa and accelerates bone growth benefits for you and your patients Bluem accelerates wound healing, implant integration and bone regeneration in a safe, effective and non-invasive way. • • • • • • • • • Oxygen is released within 30 seconds and penetrates approx. 0.5 cm into tissues. Effective on all micro-organisms. Unlike anti-biotics, no immune resistance is developed. No side effects known. No toxic ingredients. Unlike chlorhexidine, Bluem only kills bad bacteria (anaerobic) not the good bacteria. Quick and easy to apply. Simple concept. Low cost treatment. In addition, Bluem is fluoride free. Fluoride has been shown to attack the passive layer of titanium implants. available in: • Mouthwash - 50 ml & 500 ml • Toothpaste - 15 ml & 75 ml • Oral Gel - 15 ml Oral Gel can be used post-surgery to enhance tissue healing as well as in periodontitis and peri-implantitis cases. † Active Oxygen - Molecular oxygen only contributes to cell metabolism but does not function as a bio-signal for the growth of cells. By contrast active oxygen, derived from Reactive Oxygen Species (in this case H202), does function as a bio-signal for cell growth. Low dose H202 (below 1.5%) thus has three major functions in the wound healing process: • Playing an important role in the antimicrobial host defense. • Has a chemotactic effect on neutrophils as a first response to injury. • Plays an important role in the redox signaling and as a gene regulator (e.g. VEGF and IL-8) tel: 01535 656 312 | www.swallowdental.co.uk/bluem