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1. Q. Where does the name AirPerio come from?
   A. As proved by DNA tests, bacteria involved in periodontal disease are "anaerobic" in nature. This means that the bacteria thrive in the absence of air. Maintaining aerobic conditions is the most logical and simplest way of defeating these bacteria. The name "AirPerio" reflects this emphasis on aerobic treatment.

2. Marilyn's testimonial

   "You who changed my life for the better! Haven't had any gum problems for many years which as you know is phenomenal considering how bad they were! In fact, periodontal professionals tell me I no longer have periodontal disease! That's why I never skip even one night of the many steps that clean my teeth/gums before going to bed. Still have all my own teeth as well."

   Q. How is BOST ( bone one session treatment ) different from what hygienists do with root planing?
   A. Root planing is defined as a procedure done by a dentist or more often a hygienist that uses instruments called curettes to remove plaque and calculus (calcified plaque) from the root surfaces of teeth above and below the gum line. In standard root planing technique the effective penetration under the gum tissue is limited to 4 or 5 millimeters into the periodontal pocket that exists after attachment from the gum to the roots has been lost, exposing the bone underneath. Normal root planing only accomplishes about 1/4 of the work that needs to be done to heal the bone and create conditions where the pocket can fill in permanently with healthy new attachment. As a result, root planing does not reach the infected surface of the bone or the deepest parts of the roots. The BOST treatment, on the other hand, reaches all the way down to the infected bone and root, promoting aerobic conditions and complementing aerobic oral hygiene.
3. Q. What is the cost of the BOST technique?
   A. The cost of the procedure is based on the treatment category that the case falls into.
   Category I is beginning periodontitis with attachment and bone loss and pockets up to 5mm.
   
   

   Category II

   Category II is moderate periodontitis with significant attachment and bone loss visible on x-rays and pockets in the 5-7mm range.
   Category III is advanced periodontitis with advanced bone loss visible on rays but without advanced mobility or deep furcation involvement on molar teeth, pockets of 7-9mm generalized.
   Category IV is advanced generalized periodontitis with severe bone loss, tooth mobility requiring splinting, deep molar furcation invasions and pockets of 7-9mm generalized.
   These costs range from 1,000 pounds for category I to around 5,000 pounds for the most difficult cases. Only a complete review of documentation can determine a cost for a given case. Currently, dental insurance covers very little for this type of treatment.
4. Q. How can I have an idea of what category I am in before I come for a consultation or treatment since I live quite far away?
   

   Arden's testimonial

   "Last week I received my first dental prophylaxis and eval since our meeting just over a year ago. My gums have added back a total of 10 ml. My dentist seemed quite impressed with my improvement and your technique."

   A. If you send your x-rays for evaluation by e-mail it usually is quite evident what category generally you fall into and we will tell you this. This can be done by asking your dentist to send them in jpeg format. If you have them in hand you can take a picture of them with a digital camera by taping the x-rays up on a window for back light. Scanning them doesn't work well.
5. Q. After I had root planing, the pockets and inflammation went down for a time but then came back even when I maintained my good oral hygiene habits. Will the BOST technique need to be repeated frequently?
   A. During root planing, only the superficial bacteria are removed. This allows for a superficial reattachment from the inner gum tissue wall to the roots, called an epithelial attachment. Unfortunately, this attachment is not very strong. Since the deep roots and surface of the bone are still infected, chronic inflammation persists that eventually creates enough pressure to open the pockets up again. BOST has the ability to heal both the bone and the pockets. With good oral hygiene, the gums will stay healthy and firm. Only routine checkups and cleanings are necessary, the number of which is based on the severity of the case.
6. Q. My dentist says that several of my teeth must be taken out. Why is BOST different?
   

   Bernard's testimonial

   "It's funny, but when you go through health hassles it makes you look back and appreciate those doctors who have really made a difference. You've been one of those doctors who have truly helped me."
   

   Michelle's testimonial

   "I found your article on BOST therapy fascinating. It makes sense. I have my first periodontal appointment next week and I like to do my research. I have some bone loss and some deep pockets. I am not crazy about what I have read about traditional procedures whatsoever."

   A. Before BOST, there was no reliable method to get the bone to heal and to seal up the pockets to control the infection. Our research has shown that we can save about 90% of the teeth that are deemed "lost" in traditional treatment plans. A study of 25 patients seen for a second opinion where 153 teeth had been planned for extraction by other dentists showed that BOST therapy succeeded in saving 135 of them, (88%) followed for 8 years. Most of the teeth that were lost were from people who continued to smoke after the treatment. The very first case treated this way had 4 lower front teeth programmed for extraction. They were all saved and followed up for 22 years. The case can be seen in the x-ray before and after section.
7. Q. Can anything be done for esthetic problems and loose teeth?
   
   
   A. Loose front teeth can be saved but generally must be joined to other stronger teeth around them (splinting). This allows the forces to be better distributed and gives the bone a chance to heal. When teeth are splinted, a full range of esthetic corrections can be performed. Loose back teeth can be similarly stabilized making chewing more comfortable and distributing forces evenly on the healing bone.
8. Q. My dentist says I have some 8 mm pockets and others of 5-7mm and is proposing surgery. Is the BOST treatment for me?
   A. Pocket depths of this level heal very consistently with the BOST method, thus avoiding surgery. When evaluating pockets, there are a number of other factors that must be taken into account. These include bone density, bone loss, oral hygiene habits, nutrition, and overall health. Many of these factors are under the patient's control and, in BOST, we consider that the patient plays an important part in the healing process.

9. Michael's testimonial

   "I came from Boston to Seattle to try to save my teeth after my dentist told me I had to have them all out. Seven years later now and I still have all my teeth."

   Q. What if I just can't quit smoking? Can BOST still save my teeth?
   A. Even smokers save their teeth with BOST. However, since their healing potential is so compromised, the technique may need to be repeated every two to three years to avoid losing teeth. People who do quit smoking see their immune function and healing potential restored in about 6 weeks. When these cases are then retreated they heal normally.
10. Q. My teeth are very sensitive and I have a lot of discomfort with root planing. Is BOST different?
    A. Teeth are sensitive after root planing because bacteria left in the bottom of the pockets quickly repopulate roots and bathe them in acid. The BOST technique removes the bacteria all the way to the bottom of the pockets and from the surface of the bone. This allows a firm clot to form on the bone and new attachment to seal to the roots. As a result, sensitivity is reduced and the roots are covered with protective tissue. In addition, our aerobic oral hygiene techniques prevents significant bacterial population so that acid production is minimal. Bone healing after BOST also reduces the jarring of teeth, another cause of sensitivity.
11. Q. Are bone grafts and lasers effective?
    

    John's testimonial

    "When I found Dr. Hoisington I had already been to three other dentists in Houston and Phoenix who told me to have several teeth extracted before they would even start to treat me. I didn't stop smoking like I should have but still have my teeth. Dentures are my worst nightmare since my parents had them."

    A. Grafts and lasers can be effective, but they are both problematic. Bone grafts are very unpredictable. Statistically, only about a 50% success rate can be achieved, possibly because the invasive surgery required cuts off circulation to the bone resulting in bone cell death and necrosis, unfavorable conditions for graft survival. Lasers, on the other hand, do not consistently set up the conditions where the bone can heal. On the contrary, there is peer reviewed evidence, both in vivo and in vitro, that use of lasers for regeneration procedures and/or gingival curettage may place patients at risk for damage to root surfaces and the supporting bone that, in turn, could render these tissues incompatible for normal cell attachment and healing. The laser kills bacteria but can also kill bone cells when used indiscriminately because of a lack of accurate feeling feedback far under the tissue. As a result, we recommend BOST as a starting point for natural healing before attempting treatment with bone grafts and lasers.
12. Q. MY dentist says I have gum recession that requires gum grafts. Can the BOST technique avoid this?
    

    Angela's testimonial

    "MY treatment plan called 11 teeth hopeless. After 10 years I have only lost one."

    A. Gum recession is often the symptom that you can see for the bone recession that is happening underneath that you can't see. With the BOST technique thqt gets the bone to heal, this stops the gum recession and often leads to reversing it to the point where no graft is needed. One typical case on the lower anteriors was programmed for grafts. After the BOST technique, the gum tissue recovered several millimeters up the roots and became thicker to where no graft was needed. This case was followed for 10 years and remains stable.
13. Q. How has the effectiveness of BOST been measured?
    
    
    A. To measure the effectiveness of the therapy, 31 cases were treated and then followed up to six years. There were 17 women and 14 men between the ages of 35 to 70 years. On these patients, 550 sites on single rooted teeth with pocket depths originally in the 5-7mm range were evaluated. Follow-up times ranged from 8 months to 6 years. All post-treatment probings were done by the same hygienist. Of the original 550 sites, 479 (93%) had healed to within normal limits of pocket depths with no bleeding on probing and a firm attachment. Smoking was a key factor in cases that didn't heal. Results were maintained with 60% fewer maintenance cleanings. The key is never letting down on the aerobic oral hygiene techniques. Other research showed that the reason for the BOST success was the density and resistance of the attachment.
14. Q. There are so many products out there promising benefits, like Co Q 10, tea tree oil, chlorhexidine rinses or chips for under the gum, local antibiotic placement, tissue breakdown inhibitors, and more. How to know if they are worth using?
    A. All these products offer some benfeit but the question to ask is , "Will using this create all the conditions where the body can heal back a new attachment to allow the bone to heal and fill in the pockets with healthy tissue?" None of these can answer yes to this so they are all limited in what they can do. That is why we recommend to use the BOST technique first to try to get complete natural healing before resorting to anything else besides the aerobic oral hygiene techniques.
15. Q. The BOST method seems very logical. Why aren't all dentists and hygienists treating this way?
    

    Precious' testimonial

    "As an actress and singer I was horrified when they told me I had to have my front teeth out. When my agent heard about Dr. Hoisington in Seattle a flight up from LA was nothing compared to saving my teeth."

    A. The BOST method is difficult to learn due to the fact that it done without surgically opening the gums for direct vision. We estimate that it takes roughly 20 supervised cases treated to learn the technique.
16. Q. Are dental and hygiene students being taught this method?
    A. Currently, most additions to the dental school curriculum are items that have been sponsored by drug, laser and implant companies that have paid for the treatments to be researched and published. Promising techniques that don't involve the use of drugs, lasers or implants are often not researched in the University. As the treatment gains popularity, we expect that it will one day be taught in core dental school curriculums.
17. Q. Can the BOST method offer any hope for a loose, infected, painful implant?
    

    Stephanie's testimonial

    "My mouth has almost entirely stopped bleeding when I use the sticks and floss and brush. This is the first time in around 25 years that my gums do not bleed readily!"

    A. The conventional wisdom says that such implants must be taken out. However a recent case of two loose infected implants was treated with the BOST method plus antibiotics according to the results of the bacterial DNA test that showed the presence of the most aggressive "red zone" bacteria. Nine months later the implantologist and prosthodontist checked the implants carefully. There is evidence of bone healing on the x-rays, no clinical signs of inflammation or infection and the implants have stabilized. There is no longer any plan to remove them. This case points up the importance of obtaining a bacterial DNA test before implants are placed with appropriate periodontal treatment.
18. Q. Can I have a resume of the points of comparison between surgical, non surgical and BOST treatment?
    

    SURGICAL TREATMENT	NON SURGICAL TREATMENT	BOST
    Slow, months of treatment, many patients drop out	Slow, months of treatment, many patients drop out	Fast, one session in one day, everyone finishes
    Often very painful, takes months to heal	Can be painful, takes months to heal	Very little discomfort, heals in a few weeks
    Hygiene blocked by sutures, not aerobic	Hygiene routine complex, many products, not aerobic	Hygiene routine simple and aerobic
    Frequent antibiotic use	Frequent antibiotic use	Limited antibiotic use
    Frequent cleanings, bone, pockets may not heal	Frequent maintenance, bone, pockets may not heal	Less maintenance, bone, pockets consistently heal
    Frequent re-infections, unstable attachment, chronic inflammation	Frequent re-infections, weak attachment, chronic inflammation	Infrequent re-infection, strong attachment, little inflammation
    Very sensitive teeth, unstable bite	Sensitive Teeth, Unstable Bite	Little sensitivity, stable bite
    Often severe recession, esthetic compromise	Often severe recession, esthetic compromise	Limited recession, esthetics protected
    Often many extractions, implants to improve prognosis	Conserves more teeth, prognosis uncertain	Very few teeth lost, prognosis more certain
    Cost can be very high	Cost is low	Cost is moderate

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William Hoisington DDS