Which bacteria are still remaining?
In his “Making the Oral-Systemic Connection” blog on DentistryIQ, Richard H. Nagelberg, DDS, continues his discussion on the role of salivary diagnostics in the fields of medicine and dentistry. He challenges his colleagues: “Are we bringing our A game every day for every patient? We’re not if we aren’t identifying the bacteria and determining which ones are still there after treatment.”
Are we bringing our A game every day for every patient? We’re not if we aren’t identifying the bacteria and determining which ones are still there after treatment.
When a patient is being treated for hyperglycemia or hypertension, medications are commonly prescribed along with lifestyle recommendations. But how does the physician know if the right medication was prescribed the first time? He or she doesn’t, which is why the patient has to return for a blood test or blood pressure reading. If sufficient improvement is achieved, the patient will return in three or six months for another reading. If sufficient improvement has not been made, then the physician prescribes another medication. This process goes on and on until the right medication for that individual is discovered.
When we identify the bacteria that cause an individual patient’s case of periodontal disease, treatment is undertaken. The patient is then reevaluated in one to three months, during which time the clinical parameters of periodontal disease are measured. The patient is either congratulated or encouraged to ramp up his or her home care, depending on what we find.
What about the bacterial result of treatment? Why wouldn’t we provide a post-op bacterial salivary diagnostics test? We need the information it provides primarily as a predictor of the risk of disease recurrence. Wouldn’t that knowledge be incredibly valuable and impact the monitoring and maintenance interval? Wouldn’t it have a direct effect on home-care recommendations for the patient in the chair versus the one in the reception room? Of course it would. Why are we content only to measure a portion of the result of treatment, especially when the specific bacteria the pre-op test identified caused the periodontal disease in the first place? Don’t we want to know which bugs we knocked out and which ones are still remaining?
Sometimes we need to step back from what we do and ask ourselves if we are truly doing the best we can. Are we bringing our A game every day for every patient? We’re not if we aren’t identifying the bacteria and determining which ones are still there after treatment.
Richard H. Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations. He lectures on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Contact Dr. Nagelberg at email@example.com.