The chronic disease no one is talking about

At last year's RDH Under One Roof, I had the opportunity to copresent with Dr. Mia Geisinger, current president of the American Academy of Periodontology (AAP). This was an incredible moment for me as I've been a fan of Dr. Geisinger for a long time. Our course, The Chronic Disease No One Is Talking About, focuses on an issue that's been quietly lurking in the world of dentistry but hasn't yet sparked a full conversation: PERIO…and we're not talking about the periodontal disease our patients present with. 

We are referring to "Partially Effective, Redundant Implementation Overlooking" disease. 

Yes, you read that correctly!  We are talking about the disease so many dental providers have: assuming we are doing the right thing.  We believe we are helping our patients by providing a prophylaxis for those who either decline treatment or present with disease so early, it may be challenging to move beyond the "free cleaning" their insurance covers.

The prevalence of disease 

Dr. Geisinger highlighted the concerning prevalence of gingivitis and periodontitis in adults, revealing that only one quarter of adults are considered healthy in terms of periodontal disease status. Furthermore, a significant portion of adult patients continue to receive prophylaxes¹ in the hygiene chair despite the widespread occurrence of periodontal disease. These statistics underscore the urgent need to reassess our approach to patient care; prophylaxis has incorrectly become a "one-size-fits-all" approach to early-stage or even denied disease.

Our discussion explored how a six-month recare schedule with a time-limited approach to supragingival scaling and coronal polishing alone is redundant and can oftentimes overlook the disease present in a patient's mouth. While the prophy may clean the surface, it fails to address the true underlying periodontal issues. 

Is something better than nothing? 

When a patient declines periodontal therapy or presents with disease so early that it's difficult to rationalize coding them for periodontal therapy… is a prophylaxis better than nothing?  This is a question many of us find ourselves asking.

Performing a prophy on a periodontal patient may actually worsen the condition. Studies have shown that prophylaxes in such cases can lead to an increase in P. gingivalis bacterial counts, thus exacerbating the disease.²

Additionally, a benchmark study compared two groups of diabetic patients with periodontitis: the control group received basic prophylaxis while the intensive group received appropriate and definitive periodontal therapy. The results were striking-the intensive group demonstrated a decrease in HbA1c levels, while the control group receiving supragingival debridement noted an increase in HbA1c levels.³ This comparison shows that a prophylaxis may not be enough-and could potentially be harmful-for periodontal patients with medically compromised conditions.

Dr. Geisinger and I simply couldn't bring up a discussion about periodontitis without bringing up the systemic implications of periodontal disease. We remarked on how periodontal disease is linked to a broad spectrum of systemic conditions,⁴ including diabetes, cancer (oral, lung, breast, digestive tract, and pancreatic), infertility, adverse pregnancy outcomes, obesity, cardiovascular disease, and even COVID-19, to name a few.⁵

The role of the dental hygienist 

Since most licensed dental hygienists are seen as periodontal specialists in their general practices, we needed to unpack the importance of a comprehensive periodontal evaluation. A collaborative approach between dental hygienists and periodontists is crucial for proper diagnosis and treatment planning. As such, we discussed how important proper staging and grading of periodontal disease is in communicating the severity to patients while emphasizing the need for professional intervention since periodontal disease, like other systemic diseases, requires more advanced care modalities. 

The conversation also highlighted the necessity of maintaining a timely maintenance schedule for patients with periodontal disease. Studies show that patients who do not adhere to periodontal maintenance schedules are twice as likely to experience tooth loss. The rate of pathogen recolonization in the mouth can occur as quickly as 9-11 weeks,⁶ making timely recare appointments crucial. This process is expedited in immunocompromised patients, further underscoring the need for early and consistent intervention. 

Lastly, we addressed the crucial factor influencing patient compliance: trust.

Often, patients decline periodontal treatment plans not because of high costs, but because of a lack of trust in their dental health-care professionals. But by collaborating with periodontists and using effective diagnostic tools, dental professionals can rebuild patient trust, ensuring they receive the necessary care for optimal oral and systemic health. 

Conclusion 

This program with Dr. Mia Geisinger was especially meaningful because, many years ago, before we even knew each other, she and I were paired together by a mutual client to create and present this exact program for the first time. It was a "blind date," as we always joke. What emerged from that experience was not only a provocative course but also a lasting sisterhood founded on growth, laughter, tears, celebrations, and plenty of shared moments as dear friends.

Copresenting the same program (with updated research, of course!) at RDH Under One Roof was a full-circle moment. The opportunity to work with Dr. Geisinger, a true expert in the field, and to share our combined knowledge with the attendees that day was absolutely incredible. We left the program with a renewed understanding of how periodontal disease is managed and, most importantly, how dental hygienists and periodontists can work together to offer better, more comprehensive care for our patients. 

We need to address PERIO disease head-on. Let's not overlook it any longer!

Editor's note: This article appeared in the July 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Yarbrough C, Vujicic, M, Aravamudhan K, et al. An analysis of dental spending among adults with private dental benefits. American Dental Assocation. May 2016. 

2. Westfelt, E, Rylander H, Dahlén, G, et al. The effect of supragingival plaque control on the progression of advanced periodontal disease. J Clin Periodontol. 1998;25(7):536-41. doi:10.1111/j.1600-051x.1998.tb02484

3. D'Aiuto F, Gkranias N, Bhowruth D, et al. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. Lancet Diabetes Endocrinol. 2018;6(12):954-965. doi:10.1016/S2213-8587(18)30038

4. Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006;94(1):10-21. doi:10.1007/s10266-006-0060-6

5. Lin EC, Chiang YC, Lin HY, et al. Unraveling the link between periodontitis and coronavirus disease 2019: exploring pathogenic pathways and clinical implications. Biomedicines. 202314;11(10):2789. doi:10.3390/biomedicines11102789

6. Magnusson I, Lindhe J, Yoneyama T, etl al. Recolonization of a subgingival microbiota following scaling in deep pockets. J Clin Periodontol. 1984;11(3):193-207. doi:10.1111/j.1600-051x.1984.tb01323