Missing the Boat When it Comes to Perio Therapy

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 ...
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The True Cost of Clinical Lab Testing

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...
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Dental Clearance Without the Guesswork

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...
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Salivary Crystal Ball – Part 3

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...
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The Salivary Crystal Ball – Part 2

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 ...
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The Salivary Crystal Ball – Part 1

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...
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Ready to Stop Being a Prophy Machine?

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...
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My Staff Won’t Do It

There are many justifications, rationalizations, and excuses in non-testing practices, all of which signal some level of disinterest in enhancing patient care. One of the most difficult to understand is; “My staff/hygienist just won’t do it.” If the doctor is the driving force behind testing implementation and one or more team members are resistant, a staff meeting is in order. Leadership comes from the top and it is the doctor’s responsibility to set the direction for the practice, including th...
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Stop Diagnosing the Pocketbook

Cost is a consideration for all of us, which we take into account when deciding whether or not to purchase a wide variety of goods and services. Our responsibility as clinicians is to make recommendations to help patients achieve the best health possible, without letting our preconceived ideas about the patient’s ability to afford treatment get in the way – what I refer to as diagnosing the pocketbook. One of the things we do not know and cannot predict is how much value the patient puts on thei...
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Periodontal Pathogens and Rheumatoid Arthritis

In December 2016 researchers from Johns Hopkins University published a study in Science Translational Medicine indicating an identified link between periodontal disease and rheumatoid arthritis (RA). It would perhaps be more accurate to indicate that rather than periodontal disease being the causative agent, the perio pathogen Aggregatibacter Actinomycetemcomitans (A.a.) was found to be involved. The link between A.a. and RA involves a process called citrullination; which is the conversion o...
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