DentistryIQ “Making the Oral-Systemic Connection” Blog Links

Here are additional online articles written by key author Richard H. Nagelberg, DDS. Click on a title to continue reading on the DentistryIQ website.

BOP and gingivitis: It’s time to draw a line in the sand

In his “Making the Oral-Systemic Connection” blog on DentistryIQ, Dr. Richard Nagelberg explains why gingivitis needs to be a stopping point and why bleeding on probing is so important in turning patients around to better health.

What does BOP really mean?

Bleeding on probing (BOP) is encountered every day in virtually every dental practice. It is so common that there may be a tendency to undervalue its importance in diagnosing gingivitis and periodontitis. In his “Making the Oral-Systemic Connection” blog on DentistryIQ, Dr. Richard H. Nagelberg details how and why the gums bleed upon probing, and explains why BOP is so important with regard to periodontal disease and systemic health.

Periodontal disease: Tipping the balance in the patients’ favor

Richard H. Nagelberg, DDS, says the way to tip the balance in your perio patients’ favor is by knowing the exact bacteria you are trying to control—for each individual patient. Read more about how salivary diagnostics can make a difference in how effectively you treat your patients who have periodontal disease in the DentistryIQ blog, “Making the Oral-Systemic Connection.”

What would our patients do if they knew we were treating their periodontal disease through guesswork?

“What should our patients do if we fail to identify the cause of their specific case of periodontal disease? Perhaps they don’t know bacterial identification can be done easily and quickly, or that their treatment plan will be significantly impacted when the bacteria are identified. … If you or a loved one were in the chair, would blind therapy be good enough?”

Bacterial ID for prevention of periodontal disease

“Here’s a radical idea: identify the bacteria in patients who don’t have periodontal disease.” He goes on to explain the ideal protocol for combatting periodontal disease and how you can begin to offer diagnosis and treatment in your practice using the information that is available regarding risk factors—namely, salivary diagnostics.

Anti-inflammatory versus antibacterial

Richard H. Nagelberg, DDS, says using anti-inflammatory meds as part of the treatment plan for patients with periodontitis appears to have merit, but the primary objective should be knocking down the cause—namely the bacteria. But how do we know how effective our bacterial reduction efforts are? Read more as he discusses the role of salivary testing in treating periodontal disease.

Pocket depth reduction is not the aim of periodontal treatment

“When we provide periodontal treatment with an aim of pocket depth reduction, etc., we are treating pocket numbers rather than the disease itself. The pocket numbers are just manifestations of the disease process. How can you treat the cause of the disease without identifying it? How can you monitor disease resolution without measuring it? The aim of periodontal disease treatment is bacterial reduction! Improvement in the clinical signs of the disease will always follow.”

Pocket depth reduction: A measurable result of periodontal therapy, not the primary goal of treatment

Richard H. Nagelberg, DDS, continues his discussion of pocket depth reduction and how it is related to periodontal disease. Through a study of the scientific literature, he emphasizes that the reduction in pocket depths should be viewed as the clinical manifestation—the observable and measurable results—of periodontal therapy, rather than the primary goal of periodontal treatment.

Which bacteria are still remaining?

In his “Making the Oral-Systemic Connection” blog on DentistryIQ, Richard H. Nagelberg, DDS, continues his discussion on the role of salivary diagnostics in the fields of medicine and dentistry. He challenges his colleagues: “Are we bringing our A game every day for every patient? We’re not if we aren’t identifying the bacteria and determining which ones are still there after treatment.”

We are a weird bunch

Richard H. Nagelberg, DDS, continues his discussion about salivary diagnostics by comparing dentists and physicians. About dentists he says, “We are a weird bunch.” Read more to find out just why he thinks so!

Salivary diagnostics: The stuff of science fiction is reality in scientific research and development

Determining the presence of diseases and conditions by salivary diagnostics is not limited to those in the oral cavity. It also extends to systemic pathologies such as cancer, autoimmune diseases, cardiovascular and metabolic diseases, along with viral and bacterial infections. What does this mean for dental professionals in terms of salivary sample requests for real-time determination of the presence of various systemic diseases? Richard H. Nagelberg, DDS, discusses the progress of salivary diagnostics in scientific research and development and explains how it will directly enhance the health of our patients.

Salivary biomarkers and their connection to periodontal disease

Richard H. Nagelberg, DDS, says, technology has now advanced to the point where minute quantities of the same biomarkers that were previously only identifiable in serum are now detectable in saliva. Here, he explains the process of how biomarkers get from one place to another, and predicts amazing things on the horizon for dentistry in the world of salivary diagnostics. How about salivary identification of periodontal pathogens and cariogenic bacteria at chairside?

PSD and periodontal treatment challenges

Every clinician has experience with patients who do not respond to periodontal therapy. Why is it that some sites do not heal while the adjacent site does? It’s difficult to know for sure, but one possibility may be the bacterial and host processes that occur when periodontal disease is present. Richard H. Nagelberg, DDS, explains what’s at work in the microbial community and how we can address these issues with our patients. As he says, “Periodontal disease cannot be brushed away, but treatment outcomes should improve when the bacterial challenge is reduced.”

Polymicrobial synergy and dysbiosis: Impact on clinicians and patients

We know that the new model of periodontal disease is called polymicrobial synergy and dysbiosis. We also know some of the details of the mechanism of periodontal disease development and progression, but what does this mean on a clinical level? Richard H. Nagelberg, DDS, explains how we can enhance the level of care we give to our patients—i.e., who should be tested for periodontal disease, how they should be tested, and what types of recommendations we should be making to our patients. He also discusses how we should modify our approach to exploit the research conclusions we’ve gained from the new model of periodontal disease.

Even more on the new model of periodontal disease

“In addition to hijacking the genetic expression of the other members of the oral microbial community, P. gingivalis impairs the gingival immune response, and it is the gingival response that keeps other bacteria in check. The ability of the other members of the community to survive—combined with the genetic expression of virulence factors by bacteria currently understood to be nonparticipants in tissue destruction—is a gruesome development.” Read as Richard H. Nagelberg, DDS, explains why he continues his discussion on the new model of periodontal disease.

More on the new model of periodontal disease

The new model of periodontal disease indicates that low-abundance bacteria critical for dysbiosis are now known as keystone pathogens, the best-documented example of which is Porphyromonas gingivalis. Dr. Richard Nagelberg explains how P. gingivalis elevates the virulence of the entire community following interactive communication with accessory pathogens.

Salivary diagnostics: The future of health care

Is it too farfetched to envision a time in which one might drop a sample of saliva off in a superstore on a cell phone-sized device and when you’re finished shopping, the store would present you with a printout of your ailments? Was it too far-fetched to envision artificial hearts, organ transplants, or cochlear implants before they became reality? In this installment of his blog on DentistryIQ, Dr. Richard Nagelberg talks about how salivary diagnostics is certainly the future of health care.

2016: Bring it on! An e-prescribing solution and salivary diagnostics to treat periodontal disease

What would you like to see in the dental profession in 2016? Would you like the ability to make a few keystrokes, have the prescription recorded in the patient record, and simultaneously be sent to the pharmacy electronically, and say to the patient: “The medication is at your pharmacy and is ready to be picked up!” How would your patients respond if you were able to say they did not need to make two trips—one to drop off the prescription and one to pick it up?

The new model of periodontal disease

Polymicrobial Synergy and Dysbiosis (PSD) is the word salad that the new model of periodontal disease is called as revealed by research. Dr. Richard Nagelberg breaks down each component so that we can consume this salad in understandable bites. He explains how bacteria, such as Porphyromonas gingivalis, fit into the model of periodontal disease development and progression.

Seeing the forest for the trees

Jump aboard Dr. Richard Nagelberg’s blog for an exciting ride through the ever-changing world of oral-systemic science made understandable. Learn about how biomarkers, bacteria, salivary analysis, and health-span all fit together in his first post, beginning with a study of the details and a step back to survey the big picture.