Editor's note: This is Part One of a two-part series. Part Two can be found here: “Pocket depth reduction: A measurable result of periodontal therapy, not the primary goal of treatment.” When a patient presents to our office with any pathological condition, we identify the cause of the pathology, address the cause and monitor resolution. Even something as simple as a denture adjustment is a case in point. Do we just apply a topical anesthetic or prescribe pain meds for an ulcer from an ill-fitting denture? No, we adjust the denture to remove the cause of the ulcer.MORE FROM DR. RICHARD NAGELBERG | Which bacteria are still remaining?
When a patient has periodontitis, we provide a comprehensive clinical and radiographic evaluation. The periodontal evaluation, however, is nothing more than a damage report of a disease process that happened sometime in the past. It is merely a snapshot of one moment in time, specifically when the evaluation was provided, despite the fact that the disease process is like a video … something that happens over time. The evaluation tells us nothing about what caused the disease in the first place and what will happen in the future.
The specific aim of periodontal treatment is pocket depth reduction, cessation of redness, bleeding, and swelling, and improvement in all of the clinical and radiographic parameters of periodontal disease that we measured in the first place, right? Not! When we provide periodontal treatment with an aim of pocket depth reduction, etc., we are treating pocket numbers rather than the disease itself. The pocket numbers are just manifestations of the disease process.
How can you treat the cause of the disease without identifying it? How can you monitor disease resolution without measuring it? The aim of periodontal disease treatment is bacterial reduction! Improvement in the clinical signs of the disease will always follow.
Much more on this topic to come.
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