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 ...

Perio Pathogens CAUSE Atherosclerosis – Now What?

Posted on February 24, 2017May 19, 2021 by Richard H. Nagelberg, DDS

“[It is reasonable to state PD, due to high-risk pathogens, is a contributory cause of atherosclerosis. Distinguishing this type of PD as causal provides a significant opportunity to reduce arterial disease.]” This quote was cited in a previous blog post discussing the first journal article that demonstrated perio pathogens cause atherosclerotic plaques, which lead to cardiovascular events including heart attacks and strokes. The last half dozen words in the quote above are the most impactful; “...

My Staff Won’t Do It

Posted on January 20, 2017May 12, 2021 by Richard H. Nagelberg, DDS

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...

Stop Diagnosing the Pocketbook

Posted on January 13, 2017May 12, 2021 by Richard H. Nagelberg, DDS

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...

Causality: It Was Only a Matter of Time

Posted on January 6, 2017May 12, 2021 by Richard H. Nagelberg, DDS

We as dental professionals have a significant role in combating the number one cause of death: cardiovascular disease. “High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis” is a powerful piece and I recommend you read it. There is scientific evidence that [periodontal disease] PD caused by the high-risk pathogens can influence the pathogenesis triad in an adverse manner. With this appreciation, it is reasonable to state PD, due to high-risk pathogens, is a co...

Periodontal Pathogens and Rheumatoid Arthritis

Posted on December 30, 2016May 12, 2021 by Richard H. Nagelberg, DDS

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...

More Insights Provided by Salivary Testing

Posted on December 16, 2016May 12, 2021 by Richard H. Nagelberg, DDS

One of the insights gained when using salivary testing is finding that good point to stop treatment. This therapeutic endpoint may be defined by the return to gingival health, reduction of pocket depth, and a stable clinical attachment level. In other words, the therapeutic endpoint tells us when we have done all we can do for the time, and let the remaining healing occur unassisted. With the easy availability of post-op bacterial testing, the therapeutic endpoint can now be expanded to include ...

The Insights Provided by Salivary Testing

Posted on December 9, 2016May 12, 2021 by Richard H. Nagelberg, DDS

Without salivary testing we have no way of knowing the cause of the periodontal disease in the patients under our care. The insights provided by salivary testing include: Identification of the causative bacteria Therapeutic endpoint Risk assessment Outcomes assessment Risk of recurrence Appropriate antibiotic Incorporating the information from the salivary bacterial test into the perio patient’s treatment plan enables personalized care. Forget the one-size-fits-all of t...