Communicating with Patients about Nicotine and Perio

During a recent in-office team workshop, we were discussing nicotine use and its dramatic effects on the progression of periodontal disease. To help the team fully understand the consequences of nicotine use, we talked about vasoconstriction and how smoking masks the true level of periodontal infection. The vasoconstrictive properties of smoking reduce blood flow and, in turn, oxygen to the tissue, resulting in gums that do not bleed or have reduced bleeding. Smoking patients have pockets th...
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Assessing Risk with Salivary Diagnostics

The development of commercial laboratory tests utilizing the collection of saliva is, in my opinion, an important step forward in understanding and managing inflammatory periodontal disease. There are, in fact, no tests available that will predict the onset of attachment loss. However, by gathering information on a patient’s genetic inflammatory profile as well as periodontal pathogen profile we have access to objective data when ascertaining risk, or the possible onset of periodontal disease ...
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Perio Pathogens CAUSE Rheumatoid Arthritis– Now What?

“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...
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Pharmacogenetics: Many medicines work differently on different people, Why?

Insights into the structure of the human genome have taught us much about the genetic basis of disease. But what about the genetic nature of health and more specifically, how we as individuals deal with medication? We are, as a species, 99.5% genetically the same. But that last 0.5% difference serves to explain the wide diversity we experience as people in general, including why some respond to medications, and others not as well, or not at all. Here is an example. People who suffer from ...
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Gum Disease and Pregnancy

In recognition of National Women’s Health week that begins May 14, I encourage all readers to view the 3 minute attached video. Kim Miller has recorded a highly informative video on pregnancy and periodontal disease. Among the central points in this discussion is that healthy gums do not bleed. Kim makes the point that periodontal bacteria can enter the mother’s bloodstream, cross the placental barrier and potentially have an adverse effect on the developing fetus. There is also a recommendati...
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Patient Expectations in the Dental Office

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 ...
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Gum Disease and Alzheimer’s Disease

A 2016 study published in PloS One1 examined the impact of periodontitis on the rate of cognitive decline in individuals with Alzheimer’s disease (AD). Sixty community dwelling patients with mild to moderate AD were cognitively assessed and blood samples were taken for detection and quantification of systemic inflammatory markers. Initial clinical assessments of periodontal health were conducted and the same assessments were repeated six months later. The study data revealed that periodontit...
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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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