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As a general dentist practicing in a northwest suburb of Philadelphia, PA, I have seen our profession change dramatically since finishing school 27 years ago. As is the case with many professionals practicing for a significant period of time, our skills and interests evolve. Periodontal disease has become a passion of mine both clinically and scientifically. When I was in dental school, microbiology was my least favorite subject. I did not find it nearly as interesting as anatomy and physiology or pathology. Now; however, the details of biofilm, periodontal pathogens and the body’s response to oral bacteria is one of the topics I lecture on around the country.

The dental profession is changing essentially every day and it is so exciting to be practicing at a time in which knowledge is expanding at an unprecedented rate. Our understanding of the mechanisms of disease development and progression is greater than ever before. The unraveling of the details of periodontal disease is leading to diagnostic and treatment options that significantly enhance our ability to predictably improve treatment outcomes and provide personalized patient care. We are now in an era in which a “one size fits all” approach to patient care is becoming obsolete, which is something we have been awaiting for a long time. In my practice, our therapeutic approach to perio disease is also evolving. Our toolbox has more to choose from now. In addition to the perio evaluation, each individual’s risk factors are scrutinized, paying particular attention to the two biggest risk factors, diabetes and smoking. Risk factors are modified whenever possible. A treatment plan is developed for the individual which may include DNA analysis of the perio pathogens, locally applied antibiotics, systemic antibiotics, host modulation with sub-antimicrobial dose doxycycline, and others. Mechanical biofilm removal is accompanied by irrigation with an antimicrobial such as chlorhexidine or 10% povidone- iodine. The treatment plan is not written in stone. It is modified if the patient is not responding as anticipated. By evaluating the patient thoroughly before, during and after therapy, treatment outcomes improve and become more predictable. Of course, if a patient is best served by a periodontist they are referred without delay.

I invite all to share your thoughts on any topic you find interesting, impactful or if you just want to talk shop. We learn from and support each other. Thank you and welcome to Nagelberg’s blog.
Richard H. Nagelberg, DDS

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