Archive for the ‘Perio’ Category

Perio Considerations

Wednesday, May 14th, 2014

From Guest Blog Contributor: Dr. Michael Rethman

I concur that 80% (or more) of perio therapy can and should occur in the GPs office: the trick is knowing what should occur where and when — in other words when to refer and why. Chronic periodontitis is usually site-specific and often progresses slowly which can trap GPs in situations where they fear referring later on because things went downhill early-on. Furthermore, most dentists (me included, and I’m a perio) aren’t good at blind scaling and root planing, many RDHs aren’t either. So assuming that you or your RDH are somehow good at this is foolish — unless, of course, you are using an endoscope or surgical access, the latter of which may be overkill.


As noted by Dr. Fazio, sites that show no plaque yet persist with BoP suggest strongly for getting help. One trick to a happy practice is to establish a good relationship with a nearby periodontist or two and ask them to help you refine your treatment skills and referral paradigms as well as be involved in multi-disciplinary treatment planning and execution — that may include optimal periodontal or implant placement/maintenance skills that you simply don’t have. (Not all perios are stars either, but they have nearly double the formal dental education of most GPs and if the ones you contact don’t want to help or don’t seem all that informed, find others.) Also, there exists a publication entitled Management of Patients with the Chronic Periodontal Diseases that may help you too, I think it’s available at Finally, remember that your state grants you a license to practice dentistry and patients consent to your “touching” because both the state and your patients expect that you will always hold their interests paramount — over yours especially. Part of that responsibility entails not only doing what you think is ethical and correct but also learning more and more over the years so you get better and better at doing knowing what’s “right” — and I’m not talking about your practice gross income here… I am talking more about sleeping well at night…. Aloha all and have fun!

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Dr. Rethman is a board-certified periodontist with over five years of general practice experience. He is also a dental research scientist and a former Director of the U.S. Army Institute of Dental Research, as well as a past-President of the American Academy of Periodontology. Dr. Rethman also recently chaired the ADA’s Council on Scientific Affairs for an unprecedented three years and has recently chaired and/or served on numerous expert panels that systematically assessed the scientific literature to provide up-to-date information regarding a variety of important clinical topics.

Perio Advice for New Dentists

Wednesday, January 15th, 2014

In building the new practice, the key, notes Dr. Robert Fazio, is establishing a strong relationship with the patients and demonstrating that the dental team is committed to providing the best care for them, which includes providing Phase I periodontal treatment.


New Dentists want to think in terms of establishing a perio-management program to treat people with both gingivitis and periodontitis. I firmly believe that 80% of all periodontal therapy should happen in the general dentist office. That’s because I believe that the majority of periodontal problems can be treated with good oral hygiene instruction, solid recall, and scaling and root planing.


I find that oftentimes newer practitioners will refer patients with periodontal disease too soon. The key, is determining which patients are “winners”. The patients that every general dentist should treat are those with enough plaque and calculus in their mouths to account for the levels of soft tissue inflammation and bone loss. The problem patient that might need to be referred to a specialist is the one who doesn’t have a lot of plaque or calculus, and you are asking yourself why the patient is breaking down. That also applies to extraordinary disease in a young with a family history of diabetes is 2.5 times more likely to be an undiagnosed diabetic themselves. The questions that new dentists need to ask on the medical history form are: Does the patient have diabetes mellitus and also does the patient have a family history of diabetes.


If the conditions are not appropriate for local factors and patient age, those are special circumstances that probably require referral. Patients with systemic diseases, such as diabetes and those taking calcium channel blockers, also are more difficult to treat and should probably be referred. The others, general practitioners should treat in their practices.


The sidebar benefit is you are establishing rapport with the patients for those three or four visits. And the cost of that therapy is comparable to the cost of one or two crowns. So you are not asking the patient to spend an enormous amount of money.





Periodontal Guru, Dr. Robert Fazio is co-author of The Ultimate Cheat Sheets™ – The Practical Guide for Dentists, along with Leslie S.T. Fang, MD, PhD, and Tracey Menhall, BS, MS, CPA. He is currently Associate Clinical Professor of Surgery at Yale University School of Medicine. He is also co-author of Oral Medicine Secrets and author of the textbook Principles and Practice of Oral Medicine. A 1971 graduate of Harvard College and a 1975 graduate of Harvard School of Dental Medicine, he also completed Clinical Fellowships in Periodontology and Oral Medicine at Harvard.


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