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Questioning periodontal disease dogma

March 22, 2019
We think we have this periodontal disease thing figured out—it’s a local infection with systemic effects, right? Then, along comes Dr. Richard Nagelberg saying, “What if it is the other way around?”

Periodontal disease is most commonly considered a local infection with systemic effects. What if it is the other way around? Is it really a systemic condition with local site-specific presentations?

Among the earliest manifestations of periodontitis are the ulcerations in the gingival epithelium. It is through these portals that live bacteria, along with their toxins, enter the general circulation. It is at this point that they have systemic distribution. So, periodontal disease manifests locally, and the resultant host response is systemic.

What about the dogma that the goal of treatment is to save teeth? Is that really what we should be focusing on? The spread of live bacteria and their endotoxins—with the potential impact on a variety of systemic diseases and conditions—is at least as important as saving teeth. So, what do we do?

Most importantly, we identify the specific areas that have active gum inflammation. Then, we make sure the patient is acutely aware of these areas, and we provide the education and tools to enable the patient to disrupt the biofilm in these areas more than once per day. If we shift our attention to lifelong, consistent control of biofilm, saving teeth will be a by-product of that effort.

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What do we do about those areas that harbor bacteria and are difficult or impossible to adequately address? These areas include the CEJ, the dentinal tubules, and the interior of the gingival epithelial cells where no scaler can reach. We use locally applied antimicrobials to knock down as many of these bacteria as possible, tipping the balance in the patient’s favor.

A shift in our thinking may seem unimportant, but it precedes a change in attitude and action. Making our patients aware that the bacteria and inflammation associated with periodontal disease are traveling around the entire body may jolt them into action.

Just something to think about.

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].