Diabetes Screening in Dental Offices: Part 2

Posted on April 21, 2017May 19, 2021 by Richard H. Nagelberg, DDS

Diabetes is completely out of control in this country. The CDC estimates that one in three adults in the U.S. will be diabetic by 2050. Today, there are 79 million pre-diabetics in the U.S.; which is three times greater than the number of presently diagnosed diabetics. This is a diabetic avalanche; we can’t see the snow roaring down the mountainside, but it is coming. The dental profession needs to be better prepared to assist, as the medical profession is clearly overwhelmed. N...

Diabetes Screening in Dental Offices: Part 1

Posted on April 14, 2017May 19, 2021 by Richard H. Nagelberg, DDS

In 2014, the New Jersey State Board of Dentistry ruled that dentists in New Jersey could screen at-risk patients for diabetes, and although such in-office screening is within the scope of licensure in the state, this testing is not to be presumed to be the standard of care. This can be interpreted to mean that the screening needs to be followed by referral to a physician for definitive diagnosis. The glycated hemoglobin (HbA1c) screening can be performed as a finger stick and analyzed in the den...

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 ...

The True Cost of Clinical Lab Testing

Posted on March 24, 2017May 19, 2021 by Kim Miller, RDH, BSDH

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...

The Effects of Marijuana on Oral Health

Posted on March 17, 2017May 19, 2021 by Richard H. Nagelberg, DDS

There is a heightened level of interest on the impact of marijuana usage in the oral cavity given the number of states that have legalized the drug for medical and recreational uses. Twenty-six states and the District of Columbia currently have laws legalizing marijuana in some form. Several other states will soon join them. At the present time, the body of research on the effects of cannabis on the oral cavity and periodontitis in particular is very limited. A recent JADA article (J Am Dent ...

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 ...