Here’s a radical idea: identify the bacteria in patients who don’t have periodontal disease. Why would we do that? Patients who already have periodontal disease are presumably undergoing treatment and maintenance. Ideally, they have had salivary diagnostics completed preoperatively to identify the bacteria involved so as to offer treatment guidance, and then again postoperatively to provide prognostic information.
The hallmark of prevention is to identify risk factors for disease and then to manage those risk factors before the disease, condition, or event occurs. This is why there is so much information available regarding the risk factors for cardiovascular disease. Periodontal disease is no exception. Identify the biggest risk factor for periodontal disease—namely, the specific bacteria a patient harbors in his or her mouth—and then manage it with an antimicrobial protocol before periodontal disease rears its ugly head.
Patients who have a strong family history of periodontal disease would be an ideal place to start. Since you can reasonably predict that these individuals have some level of elevated risk for periodontal disease, why not find out which oral bacteria they have? And the same for patients with gingivitis who have not yet progressed to periodontitis. If the test shows very few bacteria at low levels, we can conclude that, at this time, the patient is not at risk for the development of periodontal disease, and vice versa. This just makes sense.
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