“The critical determinant in periodontal therapy is not the technique (surgical or non-surgical) used for the treatment of the periodontal pocket, but the quality of the debridement of the root surface.” — Jan Lindhe, Journal of Clinical Periodontology (1984)
That statement is not philosophical; it is clinical reality. Root surfaces must be truly clean for inflammation to resolve and for periodontal stability to occur.
Multiple studies have shown that clinicians cannot reliably clean beyond four millimeters below the gumline without visualization—and often not even to that depth. This is not a failure of skill; it is a limitation of blind instrumentation.
Years ago, recognizing this limitation fundamentally changed how I approached periodontal therapy.
That realization led me to periodontal endoscopy. When we introduced endoscopy into our practice, the technology itself mattered—but what mattered more was what our hygienists could now see. Direct visualization of the root surface allowed them to identify residual calculus and remove it completely. The impact was immediate and profound.
“Visualization, not force or surgery, is what finally allows us to clean root surfaces completely.”
In fact, periodontal endoscopy virtually eliminated the need for surgical periodontal treatment in our practice.
That statement challenges conventional thinking, but surgery offers little advantage if the root surface cannot be inspected. Even with open-flap surgery, calculus is frequently left behind—particularly in anatomically difficult areas. I challenge anyone who believes otherwise to explain how they reliably clean the distal surface of a first molar without visualization. Without seeing the root, it simply cannot be done.
I say this as someone who was never hesitant to operate. I performed extensive periodontal surgeries, sinus lifts, block grafts, and subperiosteal implants. Surgery was never the issue. Chronic disease, however, demands precision. In periodontal disease, the critical detail is calculus—and calculus is biologically toxic. Its complete removal is what stops disease progression.
So where does OralDNA® fit into this process?
“Diagnosis must precede treatment. Targeted therapy is always superior to educated guesswork.”
Research has shown that aggressive periodontal pathogens are not always eliminated by mechanical debridement alone. Identifying these bacteria before treatment allows therapy to be targeted rather than empirical.
Salivary diagnostics provides insight into the specific pathogens driving disease and allows clinicians to make informed decisions about antimicrobial therapy. Antibiotics should never be prescribed indiscriminately. In my periodontal practice, they are indicated in roughly 30% of cases. But when they are necessary, I want to prescribe the correct antibiotic the first time—and confirm afterward that the pathogens have been controlled.
OralDNA testing is not required for every patient. When there is heavy calculus with minimal inflammation, testing may add little value. However, in cases involving disproportionate inflammation, combination lesions, aggressive disease with little or no calculus, or unexplained tissue breakdown, microbial testing becomes essential.
“If you believe you are successfully removing all the calculus from a pocket that is 5mm or greater, the camera will prove otherwise. I’ve seen it for over 25 years.”
The most predictable path to periodontal stability—even in teeth with greater than 80% bone loss—follows a clear sequence:
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- Microbial diagnosis when indicated
- Targeted antimicrobial therapy if indicated
- Periodontal endoscopy-guided root debridement
- Post-treatment retesting to confirm control
This approach gives patients their best opportunity not just to manage periodontal disease, but to heal—and to save teeth that might otherwise be lost.
Dr. Sheldon’s work emphasizes the roles of calculus, biofilm, inflammation, occlusion, and patient-specific risk factors—areas that are increasingly illuminated by salivary diagnostics and precision tools such as those developed by OralDNA. He has long advocated that better diagnosis, not more invasive treatment, is often the key to long-term success.
A national lecturer and educator, Dr. Sheldon challenges extraction-first and procedure-driven models of care, encouraging dentists and hygienists to rethink how periodontal disease is identified, managed, and monitored. Now semi-retired from clinical practice, he continues to teach and write, focusing on changing how dentistry thinks about healing, prevention, and patient-centered outcomes.
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