Richard H. Nagelberg's Page

I think it is safe to say that we have all seen the following clinical scenario. Two patients, same gender and roughly the same age, both present with perio disease of about the same extent and severity. Let's say they have two sites in each quadrant with pockets of 5-6mm. We treatment plan for non-surgical therapy, including SRP with irrigation, locally applied antibiotics such as Arestin and perhaps some systemic antibiotics as well. Both patients return for re-eval, one gets excellent…

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That's not a typo. Refractory gingivitis is not a concept, it is a clinical condition we see every day in our offices. The definition of refractory is: resistant to treatment or cure, How does repetitive gingivitis not fit this definition? Of course it does, but we don't recognize it as such. Why is the term refractory reserved only for periodontitis? By the time a patient gets to refractory periodontitis they are at the end of a losing battle, not all the time, but certainly not…

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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… 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… 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… Continue