Low-tech grunt work

Oct. 1, 2018
Dr. Richard H. Nagelberg says the level of care for patients may be enhanced with new technology and procedures, but simply having new equipment should not distract the dental team from its primary goal of disease identification and management.

Is the grunt work of diagnosing and treating periodontal disease getting lost in the bling of high-tech dental equipment and procedures? Regardless of the therapeutic approach to periodontal disease, it is necessarily preceded by diagnosis and treatment planning, risk factor identification and modification, radiographic evaluation, and so on. At this point, diagnosis is still largely reliant on a methodical process of six-point probing, observation of recession, clinical attachment level notation, furcation involvements, and bleeding on probing, among other clinical parameters. All this data collection isn’t particularly interesting or intellectually stimulating, but it is mandatory prior to proceeding with any
therapeutic protocol.

Is the abstract notion that oral health and overall health are intertwined getting lost because, for the most, we cannot actually see it? When atherosclerotic plaques are building up in a patient’s arteries, we cannot see it happen with our own eyes in the dental office. When a patient is experiencing poor glycemic control due to periodontal disease, we cannot see it. When the contribution of periodontal disease to the total inflammatory burden is increasing the risk for a cardiovascular event, we cannot see it. These events can be observed on a Doppler examination of the carotid artery or evidence of them can be revealed by blood testing. However, these are not tests that we routinely conduct in the dental office.

The priorities in the dental profession appear to be illogical. Salivary bacterial testing is an underutilized technology that is not expensive, does not have a large learning curve, and does not require the acquisition of any equipment. Its high-tech aspect is housed in the laboratory. All one needs to do is send a sample of saliva to the lab to have the specific pathogens that are causing an individual patient’s case of periodontal disease identified. With this knowledge in hand, we can formulate a treatment plan tailored specifically to that patient, rather than employing a dogmatic approach to periodontal disease in which all patients are treated exactly the same.

The primary driver of oral cancer is human papillomavirus (HPV), having replaced tobacco usage and alcohol consumption as the primary causes of oral
cancer. Routine oral cancer screening is vital, but aren’t we missing a big chunk if we are not checking for the presence of HPV? No fancy expensive equipment is needed to do that.

Getting a new high-tech piece of equipment—such as a laser, scanner, CBCT, or CAD/CAM—is exciting, but its acquisition may divert a lot of time and attention to setup, training, and the learning curve. No doubt the level of care for patients may be enhanced and it is important to keep up with technology, but simply having new equipment should not distract the dental team from its primary goal of disease identification and management.

Many of the technological advances—including implants, imaging equipment, regenerative material and procedures, lasers, rotary and reciprocating endodontic equipment, and CAD/CAM machines—were originally developed to fix problems with the gums, teeth, and bone. There was a time in virtually every patient’s life when health prevailed, or problems were of a degree such that improved home care or simple restorative procedures would have been sufficient to return the patient to health. Barring accidents and systemic causes, it is largely through neglect that dental needs become advanced to the point that high-tech, high-cost dental procedures are required to return patients to good health, function, and appearance.

Patients expect that the dental office they choose is taking care of their oral and overall health, and they put a tremendous amount of trust in the team members. High-tech equipment and services enable clinicians to return patients to excellent health and function; however, the reasons why patients need these high-end services should be considered and addressed.

The case can be made that the single most important thing we can do for our patients is to show them how to properly care for their teeth and gums on a daily basis, and then recommend the items they need to do so. Our patients are not being properly served if the emphasis in the office is on all the fancy, expensive equipment we have, rather than recognizing the importance of the lowly periodontal probe.

Richard H. Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations. He lectures on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Contact Dr. Nagelberg at [email protected].

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