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The importance of addressing gingivitis aggressively

It is likely safe to say that patients with gingivitis are in every dental office every day. It is also likely safe to say that gingivitis is not given a significant amount of importance in some dental offices for a variety of reasons including its reversible nature. As clinicians we may put more emphasis on periodontitis, caries and other disease entities that require some form of active therapy.

Progression from gingivitis to periodontitis does not occur in every patient, does not occur in every site and is not automatic. When it does progress; however, the person is now burdened with a chronic, non-curable bacterial infection requiring a lifetime of management.

The most common reason why patients get gingivitis is poor home care. Risk factors such as medication driven xerostomia, smoking and diabetes are certainly contributing factors. Risk factors do not guarantee that an individual will convert from health to disease, but they do elevate the likelihood. Home care efforts and careful dietary choices are important for all, and more so for those with multiple risk factors.

Preventing the progression of gingivitis to periodontitis is among the most important and most predictable ways we can help our patients. The array of tools in our toolbox has never been greater, and other diagnostic and therapeutic modalities will be available to us in the near term. It is not too bold to say that virtually no one should get gingivitis, nor should those with it progress to full blown perio disease. Consider professional and home care items currently at our disposal. We have all manner of cleaning devices to recommend to our patients for essentially any defect requiring biofilm removal. New technologies such as DNA testing (OralDNA Labs.com) give us a lot of important information including; a quantifiable risk assessment, a means of monitoring the effectiveness of our treatment plan, and an outcomes assessment. Proven, incredibly effective biofilm removing tools such as the Philips Sonicare toothbrush tip the balance greatly in the patients’ favor, and give them a real chance of preventing gingivitis from developing and returning those already afflicted to excellent health. Most importantly, our knowledge of the mechanisms and events occurring with perio disease is expanding at a rapid pace, presenting many potential opportunities to intervene.

We now know that the oral contribution to the total inflammatory burden is significant and the effect of inflammation on the entire body can carry significant consequences. We are treating people, not oral cavities and keeping them healthy is literally in our hands. As always, input is welcomed on this and any other posts.
Richard H. Nagelberg, DDS
Every patient, every time, any level of periodontal disease

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Comment by Kimberly Miller on October 23, 2009 at 10:13pm
Great Blog Rich!!! I agree we do need to treat Gingivitis more aggressively and when we suggest treatment for it that involves office visits we should be prepared to dialogue with the patient about the lack of insurance assistance for this treatment. Currently, insurance companies are not providing any assistance with Gingivitis since there is no jaw bone damage. The RDH and DDS should present the treatment as fee for service, until bone loss occurs. Ask the patient... do you want to wait until bone damage is present or treat it now. Some patients will want to role the dice. Thanks for reminding us how important it is to treat early!
Comment by Richard H. Nagelberg on October 23, 2009 at 8:42am
Thank you for your kind words Sarah. It is great to hear from other providers such as yourself, who are of the same clinical opinion......namely the importance of preventing disease progression. I address gingivitis so much more diligently than I used to. I previously underestimated its importance. Thanks again. R
Comment by Sarah on October 23, 2009 at 8:33am
What a fantastic post, this is exactly how I am trying to address each and every patient in our practice. Thank you for writing this!
Comment by Richard H. Nagelberg on October 21, 2009 at 7:50pm
Thanks for your kind words. Vicki. It is easy to get caught up in the minute details of dental procedures and materials and lose sight of the real reason we are doing what we are doing. It is always about the person.
Comment by Vicki Cheeseman on October 21, 2009 at 1:36pm
Dr. Nagelberg,
Thank you for your blogs. I read them regularly and learn from them all. The best part -- from a patient's perspective -- is that you remember you are "treating people, not oral cavities..."

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