Effective wound healing is essential, particularly in the oral cavity where the high degree of bacteria present has the potential to alter the process and infect surrounding healthy tissue.
The gingiva is lined by stratified squamous epithelium that provides an interface between the external environment and the underlying connective tissue. Damage to the gingiva involves disruption of this barrier function, which offers
opportunity to microorganisms to adhere, colonise, invade and infect the area.
Healing, as a normal biological process in the human body, is achieved through four phases that must occur in the proper sequence and time frame. The process starts with haemostasis, progresses through a destructive inflammatory phase, then a restorative proliferation stage, and fi nally fi nishes with remodelling of the wound area. However, many factors can interfere with one or more phases of this procedure and cause improper or impaired tissue repair. These can be categorised into local or systemic factors and include oxygenation, infection, age, sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking and nutrition.
Depending on the wound, the healing progress should be visible within a four week period. Lesions that exhibit impaired healing, such as delayed acute wounds and chronic wounds, generally have failed to progress through the normal stages of healing and frequently have an endogenous factor that compromises the recovery progress. Often major symptoms are accompanied that can adversely affect the patient’s quality of life. Furthermore, non-healing
wounds result in enormous health care expenditures, with the total cost estimated at more than £42bn globally every year. Dentists therefore face the dual challenge to meet patient expectations of prompt and trouble free wound healing, and to recognise and act appropriately for those patients in which recovery may be prolonged.
Bacteria play an active role in wounds, especially within the oral cavity where the normal microflora is diverse and abundant. The environment in the mouth is initially cultivated by Gram-positive bacteria and later shifts to Gramnegative anaerobes, particularly in subgingival plaque. These then have the potential to affect the healing process following the disruption of the mucosal barrier.
Research into the effect of bacteria on wound healing behaviour of oral epithelial cells has identified two main anaerobic oral bacteria: porphyromonas gingivalis and fusobacterium nucleatum. These two pathogens are found in close contact with the epithelium of the gingiva and it has been suggested that P. gingivalis and to a lesser extent F. nucleatum, impair re-epithelialisation of the barrier.
Restoration of an intact epidermal barrier through re-epithelialisation is an essential feature of oral healing. Following trauma, ulcerative oral lesions or surgery, the directed migration of keratinocytes as well as proliferation and survival are critical to wound re-epithelialisation. However, P. gingivalis and F. nucleatum have the potential to
alter the wound healing process by interacting with the keratinocytes through their inflammatory response. The bacteria invade mucosal cells, reside within cellular compartments and damage restoration of normal oral tissue by interfering with migration and proliferation. Furthermore, the capacity of these bacteria to affect cellular processes
vital for wound healing and cause a relatively long-term problem can occur after just a brief exposure.
Early treatment of oral wounds is therefore important, particularly in patients with diminished wound healing responses and in those who are susceptible to bacterial infection. P. gingivalis is also the main pathogen found in periodontitis and plays a significant role in the inflammatory stage.
Inflammation is a normal part of the wound healing process and is important for the removal of contaminating microorganisms, but when wounds become infected this stage may be prolonged since microbial clearance is incomplete. If this continues the wound may enter a chronic state and fail to heal.
The introduction of advanced therapies can result in augmented wound healing and long-term savings. One such product is Curasept ADS (Anti-Discolouration System) + Hyaluronic Acid, from leading oral healthcare expert, Curaprox. This unique mouthwash contains 0.20 per cent chlorhexidine and 0.20 per cent hyaluronic acid to effectively promote wound healing, reduce post-surgery complications, aid in plaque control and reduce gingival
inflammation.
Hyaluronic acid has been shown to stimulate the formation of new tissue, with primary closure attained in a shorter time period.
In recent years there has been advancement in knowledge and understanding surrounding wound healing and the effect of P. gingivalis and F. nucleatum on the mucosal barrier. Offering patients effective adjuncts to promote fast and effective wound healing remains essential, particularly in patients with diminished wound healing responses and in those who are susceptible to bacterial infections.
References available on request.