The enemy of optimal patient care is complacency. Why would anyone settle for good results when optimal results are so easily achieved? Put yourself in your patient’s place in the exam chair: would you then want only good enough? Patients trust their dental professionals to provide the voice in decision regarding their care. If given the choice between practicing blindly, with no information about the specific bacterial cause of their individual case of periodontal disease, and having the bacteria identified and the therapy targeted to those bacteria, patients would uniformly choose the latter. Wouldn’t we?
Every clinician has refractory cases of periodontal disease. According to a 2010 American Academy of Periodontology position paper, 25-35% of treated perio patients have refractory or recurrent disease. Do we ever stop and consider the reason for the failure to achieve health? There are a number of reasons but one of the biggest is the virulence of the causative bacteria. Bacterial identification before providing treatment gives us a crystal ball view of the predictability of the treatment outcome. Patients with highly virulent bacteria have a lower likelihood of a favorable treatment outcome, and higher incidence of refractory disease. That information is very impactful for treatment planning and deciding in advance how non-responding sites will be addressed.
Is guessing at the right adjunctive antibiotic to give each patient the best we can do? Wouldn’t identification of the correct antibiotic for the bacteria causing each patient’s periodontitis have the potential to enhance treatment outcomes? Of course it does. The enemy of optimal results is good results.
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