Richard H. Nagelberg's Page

So it turns out that gingivitis is not really an early form of periodontitis. I am beginning to think my nickname should be Dr. Heresy. I have done a fair amount of research recently on this topic and gingivitis is actually the gate keeper to periodontitis, not a mild or early form of it. We know this through several avenues of information. From a tissue level perspective, gingivitis is primarily a T cell mediated response and periondontitis is primarily a B cell and plasma cell mediated respons… Continue

My previous post indicated that I approach gingivitis in my general dental practice, as a non-reversible disease entitiy. I have conluded from professional reading, dialogue with other practitioners and my clinical judgment and experience, that it is not a separate disease entity from periodontitis, just an early manifestation. Think about other conditions such as diabetes. When an individual is diagnosed with Type II diabetes, which accounts for 90-95% of all cases, they are commonly put on die… Continue

Gingivitis not reversible? Before you roll your eyes and think this is a crazy idea, read on and let me know if you agree or not with the thought process on this. We all go through our working day with certain facts we take for granted. One of these is the reversible nature of gingivitis. Sometimes, though, it is worthwhile to think about it, especially if it has the potential to enhance the level of care we provide for our patients. I am addressing the patients in my practice with the thought p… Continue

The oral systemic links, or mouth-body connections are now well established concepts in the dental and medical professions. I speak about these links in my presentations as I will this afternoon at the Cleveland Expo and at a symposium on Friday in New Mexico. Sometimes we are all able to step back from the minute details of the events and factors involved in these relationships, and see the whole forest, not just the individual trees. When a person has diabetes, there is no concept that areas o… Continue

Previous postings have discussed the importance of preventing the development of periodontitis since it requires a lifetime of disease management and contributes to the total inflammatory burden in the body. A recent white paper by heart surgeon Dwight Lundell, MD puts an exclamation point on this issue. Dr. Lundell states that decades of knowledge, recommendations and treatments focused on elevated blood cholesterol as the cause of heart disease is completely inaccurate. The only accepted thera… Continue