BOST & Microbiome

Holistic gum treatment at the Bost Clinic consists of 4 parts:

1. Oral microbiome testing & risk assessment

2. BOST gum treatment

3. Appropriate & adequate nutrition

4. Aerobic & natural oral hygiene regime

1.Oral microbiome testing

Modern periodontal treatment starts by determining which pathogenic bacteria are present in a periodontal gum infection and how many. Using the bacterial DNA and Candida test, we are able to identify exactly which bacteria are keeping the periodontal infection active. We can also test for Candida species, and viruses. In the majority of cases, the DNA test will reveal that the type of bacteria present in the gums can be attacked without the use of antibiotics. In these cases, it is preferable to avoid antibiotics in order to prevent a drop in the immune system and a reduction in protective bacteria in the body (especially in the gut).

However, because some species of bacteria are present in very high amounts and with very deep hiding places (pockets) they cannot be brought under control using the treatment alone. Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) are aggressive species of bacteria that fall into this category. If the test shows that these bacteria are present in high amounts, then appropriate antibiotics are sometimes added to the treatment in order to aid reversal to healthy state. Knowing the pathogens in the mouth can tweak the treatment and any medication, supplementation or specific food intake advice, that may be indicated. Therefor BOST is a very personalised treatment.

The bacterial DNA test is done, by putting a paper point under the gum tissue for about 15 seconds. It is safe, quick and a painless procedure. Bacteria thrive in the plaque (biofilm) that covers the tooth roots down at the level of attachment. Once the bacteria are collected on the paper point, the test gets send off to a laboratory where the bacteria will be identified by comparing their DNA with DNA profiles held in the lab's reference database. It is very interesting for dentists as it gives us a list of the main periodontal (an)aerobic pathogens present (causing the infection), which helps with the formulation of the treatment plan. Compared to culturing the bacteria, bacterial DNA-testing offers much greater accuracy as well as reduced cost. It tells you exactly what's there. Once we know the results there is a lot of effort in helping you to create a healthy microbiome to set up for success with periodontal treatment.

Why is an Oral Microbiome test necessary?

The bacterial DNA test provides a scientifically accurate way of knowing which bacteria are causing the infection. Without the test, there is only one chance out of ten of choosing the right antibiotic combination to fight the bacteria deep under the gums. When invasive bacteria are inside the tissue, on the roots and the bone, treatment can’t always reach them and antibiotics are advised to help clear them out. Without the focus given by the test, we are more likely producing resistant strains than good treatment results. Most patients find that it is very reassuring to know whether or not they have aggressive strains of bacteria in their gums. If the Aa and Pg are not present, patients feel relieved immediately. Patients who test positive for the aggressive strains of bacteria, on the other hand, gain a better understanding of why they have had such a difficult time with periodontal problems in the past. They can feel hopeful for the future because they know that they will receive properly targeted systemic advice, and sometimes antibiotics in addition to effective local treatment.

Who should take the bacterial DNA test?

• People who have symptoms of gum disease, cavities, bad breath, receding gums, coated tongue, recurrent sore throats, recurrent bouts of gut issues (bacteria are swollowed and certain bacteria can cause leaky gut and issues with proper digestion).

• Before implants. The test tells you what bacteria are there, which is great because it is essential that the mouth is correctly prepared before the implants. When implants are placed without knowing what kind of bacteria are in the mouth, peri-implantitis (gum infection around the implants) can occur. This infection around implants is notoriously difficult to get rid of. We can also do an ‘implant risk test’ before implants are placed.

• For patients who have systemic illnesses. Like (a family history of) Heart disease, Stroke, Diabetes, Arthritis, Recurrent respiratory infections (sinus/lung), Digestive or gut problems, Alzheimer's disease, Dementia, Mouth ulcers. Periodontal bacteria are linked to these disorders. The microbiome of the mouth is very much linked to the gut microbiome so it is important to check both if there are gut and / or gum issues present. This in order to support these areas of the body as much as possible before and during any gum treatment

• Prior to orthodontic treatment: With braces, force will be put on the bone and oral hygiene will be more difficult. Aerobic hygiene is also important to help prevent common post-orthodontic problems like gum recession as well as gingivitis during treatment.

• As part of a fertility program. Periodontal disease has been linked to infertility, low birth weight and premature birth. Before entering the reproductive years a bacterial DNA test is a great tool to help with prevention and/or treatment. If any aggressive bacteria are present, treatment and aerobic oral hygiene is recommended. It is vital not to pass aggressive bacteria on to the newborn baby (or young children).

• For those who are curious.

• Those with a family history of gum disease to check the genetic risk of gum disease for themselves.

2. treatment BOST - keep your own teeth as much as possible

BOST (Bone One Session Treatment) is a non-surgical  gum treatment alternative that supports the body's natural healing processes, helping to fight periodontal disease at its source: under the gums, and in the bone. It starts with a simple bacterial DNA test to identify the exact form of bacteria involved and their quantities. When the bacterial DNA tests became available, a DNA test was done immediately before and after treatment. The results showed that 99% of the bacteria could be removed with the BOST gum treatment.

The treatment involves (under local anaesthetic where required), gentle stretching of the gums back from the teeth (where attachment was lost already), to expose the infected gums and oxygenating these areas. This lets Suzanne clean out the infection, debris toxins under the gum line and in the pockets, furcations and other hiding places where pathogens reside, even at the level of the bone. Half mouth or even quarter mouth gum treatment has a high chance of re-infection of periodontal pockets. Edges of fillings are smoothened where needed so hiding places are reduced. With BOST treatment the whole mouth is treated in one go, so there's no chance of re-infection from areas that haven’t been cleaned (which happens when treatment is spread out over multiple appointments). To do the whole mouth usually takes around four hours in total (depending on the situation we start with), but you can take as many breaks as you need.

With BOST there is NO use of potentially harmful disinfectants NOR surgery. In Bost treatment we stretch the gum tissue to get access down to the surface of the bone and are able to smoothen it, remove the infected granulated tissue and the anaerobic bacteria trapped in the porosities of the bone. In fact, we found that stretching gives nearly as good an access to the root surfaces as a flap and is much faster and doesn't require stitching. Suzanne can even splint loose teeth to keep them firm while the mouth recovers. Bost creates the right circumstances to allow our body to do the healing. The body is allowed to reverse to healthy state naturally, very often avoid the extractions and implants so often recommended to patients.

BOST creates the right circumstances to allow our body to do the healing

After treatment you follow a simple oral hygiene regime, using a product called 'Peritip', which helps to keep the gums clean, the gums re-attach naturally to the teeth and form a strong, healthy bond. The treatment is done to try and keep your own teeth as much as possible, usually without the need for implants. BOST treatment is a great alternative to implants.

Treatment is done in one session. Patients who have the full mouth treated within 24 hours, have much better results than 2-4 sessions a few weeks apart, as bacteria in the untreated side of the mouth have every chance to re-infect the treated side. Treatment in one session is hugely beneficial, regardless if the treatment is surgical or not.

Dr Hoisington and Yvan Micholt, who developed BOST treatment explained what happens to the bone: Traditional periodontal treatment often is concerned with how to defeat the bacteria and reduce pockets, and orthopaedic surgeons look at bone as something you should heal if it is broken. Dr Hoisington started looking at damaged periodontal bone as being broken rather than just being infected. This gave him an insight into treating periodontal disease more like a medical problem than a purely dental problem. He set up a protocol of treating the whole mouth in one session rather than in sessions, where re-infection is an obvious problem. Besides this he found that when you do an open flap procedure to get periodontal access to the bone (as with surgery), you cut off the circulation to the bone, which dries it out and you actually kill the superficial bone cells. Hence he advised on 'non-surgical gum treatment' like in BOST.

Advantages of BOST

• We check what pathogens are present in the gums and how many, this is to personalise treatment.

• BOST treatment gives the body a chance to heal itself.

• Aerobic oxygenating treatment, NO surgery.

• Drainage of toxins from pockets.

• NON-invasive.

• Peritip: prevents early attachment and re-infections. Helps to create sturdy attachment of the gums to the teeth.

• Patients do not experience much discomfort during or after the treatment.

• Long-term success.

• Quick (1/2 day appointment) in a single session.

• Splinting to stabilise the mobile and moving teeth.

• Improves aesthetics / oral health / general health / function / confidence.

• Keep your own teeth as much as possible.

• Positive outcome of periodontal treatment reduces the burden on the immune system: feeling lighter and better generally

• Huge reduction of aggressive bacteria, which is good for general health too.

• Removal of toxins and tartar build up from hiding places under the gums.

• Restore balance, whole person based approach.

• Great alternative to implants.

• Cost-effective solution.

• Extensive focus on nutrition and what to use at home to establish positive microbiome for the mouth and gut.

• Guided periodontal treatment (with probiotics).

• Use of laser.

• Looking at lifestyle, body and environment.

• Usually NO antibiotics, but natural ways to re-establish balance in the oral microbiome.

• Bost combines and integrates the principles of conventional and complementary treatments.

• Work together with other practitioners to improve systemic health along side periodontal treatment.

• Re-establishing good oral microbiome for long term health.