Perio Pathogens CAUSE Rheumatoid Arthritis– Now What?

Posted on June 9, 2017May 19, 2021 by Richard H. Nagelberg, DDS

“Rheumatoid arthritis is a chronic disease affecting over 1.3 million Americans and as much as 1% of the worldwide population.” (www.rheumatoidarthritis.org) There is a growing body of research indicating a causal association between specific periodontal pathogens and rheumatoid arthritis (RA). In a 2009 study, in Compendium of Continuing Education in Dentistry, the authors indicate that a specific perio pathogen, Porphyromonas gingivalis (P.g.), produces an enzyme capable of modifying specifi...

Pregnancy Gingivitis: Test, Don’t Guess

Posted on May 19, 2017May 19, 2021 by Kim Miller, RDH, BSDH

Recently, I was training in a well-established dental practice of more than 30 years. The four woman, very talented and all out of school less than a year hygiene team, prompted the question about my opinion of pregnancy gingivitis. I answered with a question of my own, “What did you learn in school about it?” Quite frankly, their response left me speechless, “It’s caused by increased blood flow and it will go away once the baby is born.” WHAT? Is this really being taught to the next genera...

Patient Expectations in the Dental Office

Posted on April 28, 2017May 19, 2021 by Richard H. Nagelberg, DDS

Most patients seem to have reasonable expectations of the care they receive from their dental providers. It is reasonable for our patients to expect us to provide the right amount of treatment for their dental needs- no more and no less, for a reasonable fee. For the majority of patients, the dental service most often received is of a periodontal nature, such as a prophylaxis or periodontal maintenance procedure. This generally occurs two to four times a year. Restorative treatments such as ...

Missing the Boat When it Comes to Perio Therapy

Posted on April 7, 2017May 19, 2021 by Kim Miller, RDH, BSDH

During a recent national speaking engagement, a hygienist told me that they used to do clinical laboratory testing. “We stopped doing it because when we tested months later, the bacteria had come back and the patient had an active infection again. We decided ‘it’ wasn’t working so we stopped,” she explained. I thought to myself, wow, this is very interesting and a perfect example of ‘throwing the baby out with the bath water’! It wasn’t the clinical laboratory testing that wasn’t working, it ...

The True Cost of Clinical Lab Testing

Posted on March 24, 2017May 19, 2021 by Kim Miller, RDH, BSDH

As an in-office coach I often hear the following objection, “Clinical laboratory testing is too expensive. My patients won’t want to spend the money.” Taking into consideration the latest research, released in the online British Medical Journal November 29, 2016, which states that periodontal disease with high risk pathogens (Aa, Pg, Tf, Td, Fn) is causal for arterial sclerotic vascular disease, the patient can’t afford NOT to test for the presence of these dangerous bacteria. (1) As a prof...

Dental Clearance Without the Guesswork

Posted on March 10, 2017May 19, 2021 by Richard H. Nagelberg, DDS

Have you ever been uncertain when providing dental clearance for crucial treatments, such as heart surgery or joint replacement? In my practice, we look at the clinical signs and symptoms for oral disease, but we additionally observe the patient’s oral health at the molecular level. Let me share a case with you that illustrates the importance of salivary testing and its profound impact on the credibility of clearing a patient for surgery. A long-standing patient presented to my office on...

Salivary Crystal Ball – Part 3

Posted on February 17, 2017May 19, 2021 by Richard H. Nagelberg, DDS

The importance of the specific bacteria to the prognosis of an individual’s case of gum disease was known over 20 years ago. In a 1996 article in the Journal of Periodontology (Renvert et al. J Periodontol. 1996 Jun; 67(6): 562-71.) the authors concluded that the presences of Aa, Pg, and Pi alone or in combination correlated with attachment level changes. The authors further concluded that pathogenic bacteria are better predictors of disease progression than observed clinical signs. In a 200...

The Salivary Crystal Ball – Part 2

Posted on February 10, 2017May 19, 2021 by Richard H. Nagelberg, DDS

Most general dental practices are providing the same types of services: diagnostic services, restorative procedures, prosthodontic procedures, endodontic procedures, surgical procedures and periodontal procedures. Of course there are variations in techniques and complexity of cases being undertaken, but substantially a wide swath of dental practices are providing the same services. When a patient comes for an appointment, depending on where they live and work, they are traveling past several or ...

The Salivary Crystal Ball – Part 1

Posted on February 3, 2017May 12, 2021 by Richard H. Nagelberg, DDS

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. BOP is like periodontitis or pregnancy in the following regards: There is no such thing as “just a little bleeding.” You have it or you don’t. There is no such thing as a little periodontitis; you have it or you don't. There is no such thing as a little pregnant; you are or you are not. You...

Ready to Stop Being a Prophy Machine?

Posted on January 27, 2017May 12, 2021 by Richard H. Nagelberg, DDS

Is your hygiene department ready to stop the daily routine of prophy after prophy? Are you ready to have a happier dentist and hygiene team, healthier patients, and overall transform your office into a stellar perio-focused practice? Instead of limiting yourself to 30-minute patient appointments for a prophy, affording hygienists one hour per appointment, or longer if SRP is scheduled, allows you to offer comprehensive perio services, like salivary testing, non-surgical perio therapy, and...