Why Do Bacteriological Testing?
The question is often raised: Why do bacteriological testing when amoxicillin and metronidazole effectively address most periodontal infections? I don’t disagree with the efficacy of these medications, but there are compelling reasons to incorporate bacteriological testing into your clinical practice.
Targeted Application
First, it’s important to clarify that I don’t perform bacteriological testing on every patient. For cases characterized by heavy calculus and firm gingival tissue, our approach focuses on thorough calculus removal. Using periodontal endoscopy enhances the root planing procedure by visualizing the root surface, ensuring more complete calculus removal. Research, including articles published by our group, has highlighted the toxicity of calculus. Additionally, the use of EDTA has been shown in well-designed in vitro studies to further enhance calculus removal.
However, not all cases are straightforward calculus issues. Many patients present with inflammatory tissue, suppuration, and bleeding – what I consider mixed infections. These often involve aggressive organisms that warrant a more diagnostic approach.
Diagnosis Before Treatment
Bacteriological testing aligns with the principle of diagnosing before treating. Through testing, we can identify the bacteria present and use this information to guide treatment decisions. Post-treatment testing confirms whether the infection has been controlled or requires further intervention.
This dual approach-clinical evaluation supported by bacteriological testing-adds another layer of assurance for both the patient and the clinician. Clinical signs alone can sometimes be deceptive. Testing provides an objective measure of success and helps reinforce the importance of maintaining bacterial control.
The Role of Antibiotics
While some argue that the efficacy of amoxicillin and metronidazole makes testing unnecessary, I believe otherwise. In medicine, we routinely perform diagnostic tests before prescribing antibiotics. Dentistry should be no different. Rather than relying on empirical prescribing, I prefer to know exactly what we’re addressing.
Notably, many of our cases don’t require antibiotics. When antibiotics are necessary, testing ensures that we prescribe the most effective one from the start. For instance, clarithromycin or fluoroquinolones may be more appropriate in specific cases, depending on the type and distribution of bacteria.
Preserving the Microbiome
Another critical factor is the impact of antibiotics on the microbiome. If I’m prescribing an antibiotic, I want to make sure it’s the right one the first time. Testing allows us to minimize disruption to the microbiome while maximizing treatment effectiveness.
Preventing Recurrence
There are instances where controlling one bacterium leads to the proliferation of another. Bacteriological testing at reevaluation helps identify these shifts early. This proactive approach prevents demotivating scenarios where a patient appears to improve, only to experience deterioration three months later due to unchecked bacterial growth.
Conclusion
Ultimately, the decision on how to practice is a personal one. I choose to prioritize diagnosis before treatment. This approach has served my practice well, and patients appreciate the transparency and thoroughness it provides.
Furthermore, bacteriological testing offers an opportunity to educate patients on the broader implications of periodontal bacteria for their overall health. With the growing recognition of the connection between oral health and chronic degenerative diseases, the educational component attached to the test that we use (MyPerioPath™ from OralDNA® Labs) helps the patient to understand the possible correlation between periodontitis and overall health.
References:
He was the Chairman of the dental department at Holmes Regional Medical Center. He has chaired the Brevard Study Club since 1995, bringing dental continuing education to Brevard County dentists. As an associate clinical professor in the University of Florida College of Dentistry’s graduate department of periodontology for over eight years, he helped train periodontists of the future. He, along with our office manager, Danyel Salmela, are founders of the Institute for Dental Specialists. They have lectured at national and regional periodontal meetings in nearly every area of the U.S.A.
Dr. Sheldon was the first dentist from central Florida to use computer-guided surgery for implant placement. He was also the first to use the dental endoscope to assist in the effective nonsurgical treatment of gum disease. These innovations have led to the Solid Bite concept, providing beautiful, functional and efficient dental restorations.
As an author, Dr Sheldon has answered questions such as “Do you feel that there are no dental answers for you?” "The Ultimate Mouth Manual,"is authored by Drs. Sheldon, Sheldon, and Furtado and the book available in book stores, which contains information patients need to make dental decisions in the 21st century!
Dr. Sheldon is also a regular contributor to the column, “Focus on Seniors,” in the Senior Scene Magazine. His topics range from dental care to overall health care. He is also a regular panelist on the Focus on Seniors programs on radio and television, as well as a sought-after speaker on health care and nutritional topics.
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