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Pocket depth reduction: A measurable result of periodontal therapy, not the primary goal of treatment

Sept. 21, 2016
Richard H. Nagelberg, DDS, continues his discussion of pocket depth reduction and how it is related to periodontal disease in his “Making the Oral-Systemic Connection” blog on DentistryIQ. Through a study of the scientific literature, he emphasizes that the reduction in pocket depths should be viewed as the clinical manifestation—the observable and measurable results—of periodontal therapy, rather than the primary goal of periodontal treatment.

Editor's note: This is Part Two of a two-part series. Part One can be found here: “Pocket depth reduction is not the aim of periodontal treatment.

The reduction in pocket depths, BOP, etc., is the clinical manifestation, the evidence, the clinical signs, the observable and measurable results of periodontal therapy, rather than the primary goal of treatment.

The researchers who originally identified the periodontal pathogens—Anne D. Haffajee, DDS, and the late Sigmund (Sig) S. Socransky, DDS—stated, “The ultimate risk factor for an infectious disease is the causative agent of that disease. Without that agent, no disease will take place no matter what [their emphasis] other risk factors the subject may possess.” (1)

The causative agent is the specific bacteria causing each patient’s case of periodontal disease.

Drs. Haffajee and Socransky further stated, “The most appropriate control of these diseases is through the control of the microorganisms that cause them. Nevertheless, those of us who are clinicians often treat periodontal diseases in a fashion that is minimally influenced by the microbial agents that caused the problem. … Rarely do we focus on the real culprit, the organisms [again, their emphasis] that caused the disease in the first place!!!” (1)

The chapter “Rationale for Periodontal Treatment” from the 11th edition of Carranza’s Clinical Periodontology reads, “The removal of plaque and all the factors that favor its accumulation is the primary goal of local therapy.” (2)

Pocket numbers, bleeding on probing (BOP), swelling, redness, and bone loss are not plaque, nor are they factors that lead to plaque accumulation. Rather, they are the clinical manifestation, the evidence, the clinical signs, the observable and measurable results of periodontal disease.

Carranza’s Clinical Periodontology goes on to state, “However, local factors, particularly plaque microorganisms, are the most common deterrents to healing after periodontal therapy.” (2)

Does debridement of necrotic tissue need to occur? Yes. Do we need to reexamine the periodontium postoperatively? Yes. The reduction in pocket depths, BOP, etc., is the clinical manifestation, the evidence, the clinical signs, the observable and measurable results of periodontal therapy, rather than the primary goal of treatment [my emphasis].

READ MORE OF DR. NAGELBERG’S BLOGS . . .

References
1. Socransky SS, Haffajee AD. Evidence of bacterial etiology: a historical perspective. Periodontol 2000. 1994;5:7-25.
2. Carranza FA, Newman MG, Takei H, Klokkevold PR. Rationale for periodontal treatment. In: Carranza’s Clinical Periodontology. 11th ed. St. Louis, MO: Elsevier Saunders; 2012:387.

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 protected].

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About the Author

Richard H. Nagelberg, DDS

Richard H. Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He has served on many advisory boards and as a consultant and key opinion leader for a variety of companies and organizations. Dr. Nagelberg is the Director of Medical Affairs at OraPharma, a division of Bausch Health US, LLC. His practice and other professional activities are centered on the impact dental professionals have beyond the oral cavity. Contact Dr. Nagelberg at [email protected].

Updated May 2022