Learning Objectives

• Shifting clinical thinking from calculus as a causative agent in periodontal disease to a bacterial infection caused by dysbiotic biofilm
• Integrating chairside tools such as microscopy and salivary diagnostics 
• Review case study demonstrating pathogenic biofilm slides and microbial reports of a non-surgical bone regeneration case  
• Developing tx plans using DNA-PCR testing, Laser therapy, GBT, adjunctive therapies
• GBT as a non-surgical periodontal therapy foundation
• By increasing standard of care in the hygiene op, bone loss can be stopped and encouraged to regenerate  

Traditional methods for treating periodontal disease, periodontal charting and SRP, have been the gold standard, but have their limitations. These mechanical removal  methods only manage to eliminate about 50% of biofilm from critical areas, leaving room for improvement. Biofilm, in balance, co-exists with the host until the immune system is challenged, allowing opportunistic pathogenic bacteria to proliferate. Microbial plaque/biofilm accumulation can kick off various host-mediated inflammatory and immune responses with clinical manifestations such as bleeding, CAL, radiographic changes to crestal bone, increased periodontal pocketing, and tooth loss. Dr. Paul Keyes' hypothesis in the 1950s that perio is a bacterial infection, has significant implications for diagnosis. If we acknowledge the existence of 11 periodontal pathogens, shouldn't we be focusing on the microbial level for diagnosis? A biofilm sample taken chairside provides a real-time view of bacteria shapes, volume, and motility. This not only confirms a perio diagnosis but be a proactive tool for diagnosing subclinical infections, allowing for a proactive rather than reactive approach. DNA-PCR testing shows presence/concentration of the top 11 periodontal pathogens; any pathogens over threshold may allude to known or unknown comorbidities. Antibiotic therapy is not the end all/be all – but as we understand, these pathogens do not stay in the mouth. The goal is not total eradication but reduction of pathogenic bacteria in excess, restoring balance, shifting from dysbiosis to symbiosis. Case studies will highlight methods including LBR, DNA-PCR, microscopy, and GBT, the current NSPT gold standard in an 8-step protocol. Bone can regenerate in the mouth, like the rest of the body, but this cannot happen in the presence of infection. Incorporating diagnostic tools and treatment protocols can set hygienists up for successful perio therapy and healthier patients while reducing the risk for systemic diseases.