Streamlining the treatment of periodontal disease will make 'untreaters' become treaters

Why is the dental profession failing to address the extremely high percentages of people with periodontal disease? Dr. Richard H. Nagelberg probes the question of streamlining the process of diagnosis and treatment, concluding that a radically different solution is needed to make "untreaters" become treaters.

Nov 9th, 2017
Content Dam De Print Articles Volume 107 Issue 11 Nagelbergrichardcolumn

Richard H. Nagelberg,DDS

The prevalence of periodontal disease and the extremely low percentage of dental practices providing comprehensive periodontal care is well-documented. One needs to look no further than the data research provides over the last five to six years.

A 2012 study estimated that 47.2%, or 64.7 million American adults, had mild, moderate, or severe periodontitis in 2009 and 2010. In adults ages 65 and older, prevalence rates increased to 70.1%.1 A 2016 study focused on individuals ages 65 and older by socioeconomic and geographic factors, among others. The authors estimated the lowest prevalence of periodontitis in Utah at 62.3% and the highest in New Mexico, Hawaii, and the District of Columbia at more than 70%.2 It is safe to say that 62.3% is nothing to brag about, and the difference between highest and lowest is pretty small.

Why is the dental profession failing to address these extremely high percentages of people with periodontal disease? Certainly, an indeterminate portion of these individuals who have some level of periodontitis do not have regular dental visits. Even if half of the numbers are represented by people who do not receive regular dental care, the percentages of untreated individuals are still far too high. There are several reasons for this lack of care. Indifference is likely one of them. Inadequate time on the hygiene schedule is another. The bottom line, however, is that the “untreaters” have not made it a priority.

What if there were a way to arrive at a diagnosis and treatment plan with a simple, straightforward approach that did the thinking for us? What if we didn’t have to think about the diagnosis, case type, treatment plan, adjunctive agents, etc., and we just had to do what we were told? Wouldn’t we all prefer to have things figured out for us, so we could just follow the instructions? Would that increase the number of dental professionals who provide comprehensive periodontal care for all of their patients? There is no answer to that question, since such a device is not currently available. Only time will tell.

But what if we could collect the clinical and radiographic information as we currently do (or as we are supposed to do, anyway), answer a few questions, and have the case type and treatment plan provided for us in just a few minutes, with no thinking needed? One way to make a dent in the unacceptable rates of unaddressed periodontal disease would be to design a process that is simple, quick, and accurate. What if such a system could be implemented in any dental office and had a learning curve of one patient?

There have been attempts to streamline the process similar to this in the past. Whole-arch periodontal probing systems and sonic probes were developed, but for one reason or another, many of them died on the vine. Until we have technology that can give us this type of immediacy and accuracy, we still have to collect the data the old-fashioned way, with a probe and x-rays. However, if we had a device that did the thinking for us, the challenge would be reduced to getting a probe into the hygienist’s hands and the patient’s mouth. This would be so much more manageable than getting the data and having to figure out what to do with it.

Clearly, it is going to take a seismic shift in the way things are done regarding periodontal disease. We are treading water now, not making any progress toward reducing the unacceptably high level of patients with untreated periodontal disease. Pointing out the ethical and legal requirements to address periodontal disease has been fruitless. Appeals to our professional responsibility to diagnose and treat the disease have made no headway. The mountain of evidence connecting periodontal disease and oral bacteria to vascular diseases and pregnancy outcomes, among many others, has failed to make a dent in the problem. Even focusing on the financial aspects of periodontal treatment hasn’t mattered.

It is going to take something radically different to change the way things are done with regard to periodontal disease—something so stunning in its simplicity that most of us will slap our foreheads and say aloud that we should have thought of it. It will take something that will make “untreaters” become treaters and streamline the process for everyone. Our patients will be the primary beneficiaries of no thinking at all.


1. Eke PI, Dye BA, Wei L, et al. Prevalence of periodontitis in adults in the United States: 2009 and 2010.J Dent Res. 2012;91(10):914-920.

2. Eke PI, Wei L, Borgnakke WS, et al. Periodontitis prevalence in adults ≥ 65 years of age, in the USA.Periodontol 2000. 2016;72(1):76-95. doi: 10.1111/prd.12145.

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

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