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...

Gum Disease and Alzheimer’s Disease

Posted on March 3, 2017May 19, 2021 by Richard H. Nagelberg, DDS

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...

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; “...

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...

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...