Gingival Parasitic Infections as a Contributor to Periodontitis: Identification and Treatment

Objectives: Parasites play a role in the pathology of periodontal disease with the protozoan Entamoeba gingivalis frequently observed when periodontal disease is present and has been ignored as a contributor to periodontal disease. Identification of the presence of periodontal parasites and how to treat them to eliminate their contribution to periodontal disease will be addressed. Methods: The first phase of therapy is reconstituting a normal commensal biofilm with minimal supragingival calculus removal to limit potential for the parasites to invade the soft tissue lining of the pocket and potentially spread related to the bleeding capillaries. At the fourth month, a systemic antiparasitic medication (metronidazole) is added. The second phase of therapy consists of four monthly subgingival calculus removal using sonic or ultrasonic instruments. Microscopic evaluation is used to confirm the absence of parasites. Results: The Bonner Method is nonsurgical. Pocket closure and osseous regrowth, without supplemental grafting help confirm healing and continued use of the homecare regime allow the patient to maintain gingival health long-term. Microbiota microscopic examination at every visit during active treatment confirms healing and elimination of the parasites. Conclusions: Patient who have traditionally avoided dental treatment or have experienced traditional surgery in the past easily accept antiparasitic treatment, which is reached from clinical and microscopic co-examination. Many of these patients are seeking an alternative to traditional surgery and are more comfortable with the basics behind the protocol once they have seen their biofilm under video from their microscopic sampling. Clinical significance: The subject of this article has clinical relevance, as parasites are an unrecognized contributor to periodontal disease that is frequently not identified or understood. This article discusses its clinical relevance, how to identify its presence and treatment to eliminate the parasite as part of periodontal treatment. The authors feel that this will have relevance to dental hygienists as they are the practitioner who would be first to identify its presence and provide treatment in the dental practice.