Judy Carroll, RDH

	He’s a 30-something professional with impeccable home care, routine professional dental care and seemingly excellent overall health. 

	He has never smoked. He eats well and gets plenty of exercise. He does everything right. Then, one day, he is told he needs full-mouth root planing to address the severe inflammation and redness in his gums; he has been diagnosed with active moderate stage periodontal disease. 

Related reading: Ignore the biofilm and calculus: It's time to think differently

	“But how could this have happened?” he asks.  “I have done everything right.” The usual answers are given. He is told he has a bacterial infection and tartar buildup under his gums and that a good deep cleaning is recommended. Three months later, following the first round of root planing, there is no change to his tissues. He is treatment planned for another round of root planing, and this time his insurance will not be covering it. No blood tests are performed to identify possible systemic health issues, and nothing out of the ordinary is suspected. The patient is thought to have bacterial infection. Several months after the second round of root planing he continues to have severe inflammation and redness, with moderate generalized bleeding on probing, and apparently no change to disease activity. He is referred to a periodontist. 

	Surely the specialist can help this patient, right?

More from the author: Bone regeneration ... in the hands of the hygienist?

	The periodontist examines him and quickly recommends another round of root planing.  He feels good to be there and feels confident that his issues will finally be solved in the capable hands of this highly qualified professional.  He will pay the out of pocket expense for full mouth root planing again.  In addition he will be paying for antibiotics to be placed under his gums in an attempt to better control his “infection.” Four weeks later he is re-evaluated, there is no response at all; he still has severe inflammation and redness with moderate bleeding throughout.     

	The fourth round of root planing is performed and more money is spent to follow some truly puzzling and insane guidance: Do the same thing over and over and expect a different result. Several months later, there is still no response and he has now spent more than $4,000 with no change to his inflammatory disease. Eighteen months have passed since his initial diagnosis of active moderate stage periodontitis with more severe localized attachment loss becoming alarming at this point. 

More from the author: Exposing one of dentistry's dirty little secrets

	The periodontist states there is no choice now but to schedule him for full-mouth osseous surgery. Yes, that’s right. After all, what would be better for this patient than to create more trauma, thereby accentuating the inflammatory response further, creating more attachment loss? Is it possible that performing surgery would be a disaster for such a patient? Let’s look more closely at why this is not the best solution for this particular patient and what might be a better solution.

A widespread lack of education and awareness


	Sadly, the above story is not unique; it is actually very commonplace and is indeed a tragedy of misdiagnosis and inappropriate care

The tragedy is in the lack of education and the oversight all of the obvious parafunctions and systemic risk factors screaming to be noticed and treated appropriately in patients like this.

Related reading: Beware! 7 traps that are destroying your hygiene schedule

	Most importantly, the tragedy is the enormous funds, time and energy spent on ineffective and potentially damaging treatment plans, as well as the emotional abuse and stress such patients endure every day all over the world.

	Mia Angelou once stated “when you know better, you do better”.  We can do better for our patients through more advanced education and awareness. Our collective unbalanced focus on local factors continues to be a serious and widespread lagging. But why? Is everyone going to the wrong continuing education courses or reading the wrong materials? Well, maybe. But the main issue is the lack of education going on in main stream CE courses and at dental and hygiene schools. One also cannot ignore the fact that this growing problem of ignorance is equally a lack of awareness and education perpetrated by the supposed leaders in

 (the experts dental professionals turn to for advice), the periodontists.

More on hygiene: Easy ways to reinforce the "hygiene habit" in your dental patients


	Osseous surgery is a foreboding treatment plan for anyone; many in the dental profession probably cannot fathom the fear these patients face, not to mention the enormous expense and continued chronic problems they endure. What would have happened to this patient had he not found proper intervention by finding the 

 of his chronic inflammatory disease? He would have had osseous surgery, eventually. Instead, this patient found clinicians who could help direct his care toward remission of disease through targeted care, without surgery. 

	A very specific list of blood work was performed prior to examination and treatment; a severe vitamin D deficiency was diagnosed and integrative care was promptly provided by his physician. Upon clinical examination, chronic mouth breathing (due to blocked nasal airway issues with a deviated septum), tongue thrusting, and bruxism parafunctions were easily observed. Sleep apnea was suspected due to nighttime snoring and obvious airway issues. Minimal local factors are confirmed and definitively addressed using a dental endoscope. Further integrative referral and definitive care was determined necessary with the following specialists: an ENT to address airway blockage, an orofacial myofunctional therapist to address life-long tongue thrust, mouth breathing and bruxism habits and a referral to a sleep medicine physician after proper intervention with other specialists had been initiated. 

Straight from Twitter, the 20 best tweets about dental hygienists from August

Fine tuning it all through further targeted care


	In addition to the D deficiency and rather obvious airway and parafunction risk factors, simple and affordable salivary DNA testing is performed to help determine what pathogens this patient may be harboring, as well as definitely determine his inflammatory gene profile.  His pathogen profile is squeaky clean; his active disease has nothing to do with bacteria. 

	However, his comprehensive genetic profile (Celsus One) reveals telling information: He has several polymorphisms of his acquired immune system, with IL1, IL6, TNF-alpha, IL17A and MMP3 marking as a positive mutation for accentuated inflammation. He is a genetically susceptible individual through no fault of his own; he is termed a “hyper-responder.” When his many triggers presented (vitamin D deficiency, mouth breathing, etc.) his genes expressed with hyper-inflammation; an out of control form of chronic inflammation upregulating itself insidiously like an auto-immune disease (this scenario is evident in countless of unaware individuals being treated topically every day in the traditional periodontal treatment merry-go-round

Related reading: The important of proper chewing and its relationship to health

	For his out-of-control hyperinflammation the patient is placed on host modulated therapy (Periostat™) for a minimum of six months to help 

 his inflammatory response while he is instructed to correct all

. He is also told he will likely benefit from host modulated therapy indefinitely on and off moving forward to better manage his disease due to his positive genetic profile. Thorough patient education is provided about the true etiology of his chronic inflammatory disease and how he can effectively keep it in remission long term with appropriate targeted care … he is empowered for the first time. Months later, he receives excellent news from the clinicians who initially diagnosed him; his tissues are now healthy.


	This story of misdiagnosis and inappropriate care is true and is indeed very commonplace. We can do better and we can have a lot of fun doing it! Go the extra mile to find CE courses which will teach you how to identify and treat all associated risk factors for periodontal diseases.  Talk to your periodontist and/or dentist; teach them what you have learned through this case study and what you hope to learn in more advanced CE courses in the future. If your periodontist or dentist does not agree and is close minded to the information, find a new one to work with or try even harder to educate them. The dogma of local factors alone being the cause of chronic inflammation is completely inaccurate in many cases, as with this case and the millions of cases like it.  Stop the insanity of your patients’ perio merry-go-round of expensive, ineffective and misguided treatments; teach your patient and those around you the truth. Hygienists, empower your patients and become their best advocate for more accurate diagnosis and appropriate care … you are in charge!

Hot read: Hey hygienists, it's time to stop blaming the patient

Articles

He’s a 30-something professional with impeccable home care, routine professional dental care and seemingly excellent overall health.
He has never smoked. He eats well and gets plenty of exercise

A tragic story of misdiagnosis and inappropriate care

Maya Angelou once said, “When you know better, you do better.” This quote echoes a simple and forgiving truth in all aspects of patient care; it’s about lifelong learning.

	When it comes to periodontal therapy, both clinician and patient benefit from heeding this poignant statement of awareness. Continued learning and a growing knowledge of all causal triggers (risk factors) are crucial to changing the course of chronic inflammatory periodontal disease through targeted care. While most continuing education courses continue to focus on the elimination of bacteria as the clinical goal, these narrowly focused methods and philosophies fall short in the successful prevention and treatment of periodontal diseases long term. We can do better. An evergreen Einstein quote comes to mind: “Insanity is doing the same thing over and over and expecting a different result.”

	In reality, patients with exceptional home care can actually mask active inflammatory disease still occurring just beneath the surface. Just because we cannot detect inflammation with our current limited visual diagnostic methods does not mean it is not there; we need to take a closer look and redefine periodontal health and stability. We now know that periodontal diseases are complex multifactorial diseases involving the entire host; it’s time we start learning and discussing more in-depth truths about treating and managing these diseases comprehensively for optimal oral and systemic health long term. In many cases we need to stop blaming our patients for their shortcomings in home care skills and start looking deeper into host response. Why? Because heightened inflammatory response doesn’t just come from the presence of biofilm; conversely, inappropriate inflammatory response due to host factors can actually create higher levels of thriving biofilms - furthering disease progression.

Centers for Disease Control and Prevention

, the percentage of individuals over 65 who are edentulous in the United States decreased from 30% to 25% in the past 10 years. Is this because we are doing better to manage periodontal diseases and prevent tooth loss? No, actually this decrease results from dental implant placement and not from the prevention of tooth loss. In reality the prevalence of periodontal disease has not changed; in fact it has surpassed diabetes as the leading chronic inflammatory disease in the United States.1 Fifty percent of Americans over age 30 have some form of active periodontal disease, and 30% of those have moderate-stage disease; this number jumps to 70% in adults 65 and older.1,2 Since our traditional method of diagnosis relies so heavily on non-definitive technology (clinical observation), we undeniably do not have an accurate assessment of the true prevalence of periodontal disease activity or severity. In addition, the traditional solutions for treating periodontal diseases are for the most part either non-definitive or surgical––yielding short-term or marginal results in many cases, as well as being overwhelmingly cost-prohibitive for the patient. Let’s face it, what average person could afford full mouth surgery or implants, especially multiple times over?

	Could some of this be avoided by changing the way we assess and treat periodontal diseases? Are we fully practicing what the 

 outlined as Comprehensive Periodontal Therapy?3 Are we practicing daily what the 

American Dental Hygienists’ Association

 outlined in Standards for Clinical Dental Hygiene Practice?4 Many may not even know that these papers exist, yet these important publications are foundational for every clinician and if put into daily practice would likely create major change in the grim statistics.

Get support and assistance in developing a caries management protocol that works for you, your office, and your patients.

	Critical thinking vs treating disease topically

	Whenever and wherever we see periodontal inflammation, our minds should automatically assume it is not related entirely to biofilm and calculus. In fact, we should train our minds to ignore the biofilm and calculus, at least initially. Yes, there are other obvious risk factors we may easily identify such as smoking or diabetes, but we should always assume there are several more important modifiable and non-modifiable risk factors at play. This is how we determine cause instead of just treating symptoms and history of disease reactively. This is how we solve the puzzle and become proactive with targeted therapy for long-term solutions. When we learn to think critically by connecting the body to the mouth as one, we gain a new level of understanding in the etiology and progression of chronic disease. “When we know better, we do better.” So let’s definitively remove the subgingival calculus and provide adequate home care instruction, but let’s also play detective like the tenacious and inquisitive detective in “Columbo” and figure out exactly what is creating this perfect storm for chronic inflammatory disease. As Peter Falk as Columbo often said, “Oh, just one more thing ….” Dig, dig, dig for root cause until you can’t dig anymore, and then do something about it.

	So what are we to dig for and what does individualized periodontal medicine look like? True periodontal medicine is uncompromising in finding root cause by uncovering all risk factors in order to address them definitively. How often do we have patients in our chair who have not had comprehensive blood work ordered by a physician in many years, including these very important laboratory studies: prediabetes testing (hemoglobin A1c), complete blood cell count and assessment of deficiencies such as vitamin D and B12, thyroid disease (thyroid-stimulating hormone), lipids and inflammatory biomarkers? How often do we have patients who have undiagnosed and untreated airway issues, including obstructive sleep apnea, mouth breathing, tongue thrusting or tongue ties? Does our health history ask detailed questions about diet and supplementation? Do we carefully assess possible oxidative stress issues through definitive testing and nutritional assessment, or both? Do we carefully consider gut biome? Does our health history form include questions about family history of all diseases to better determine overall risk of all inflammatory diseases, including PD, diabetes, cardiovascular disease, arthritis, cancer and dementia? Are you using that information? Are we determining exactly what pathogens our patient is carrying orally and possibly systemically? Are we targeting these pathogens with systemic antibiotics and/or appropriate anti-infective measures - even if no outward signs of oral disease appear? And most important, do we know and understand our patients’ detailed genetic inflammatory profile? Do we understand how and when to incorporate host-modulated therapy into practice when non-modifiable chronic inflammatory risk factors are present? These questions take us from technicians to true clinicians.

Hot read: Hey hygienists, it's time to stop blaming the victim

	If the answer to any of the above questions is no, there is opportunity for advanced education and positive change. When discoveries are made and then shared with patients, something truly impactful begins to take place as patients become more interested and motivated in their own care; they become a co-therapist. At this point the physician or ND (and possibly other health care professionals) is also playing an integral role in vital co-therapy, with the hygienist as the linchpin director leading the way. Yes, that’s right; the hygienist is leading and directing the entire process! Periodontal diseases are multifactorial and in many cases very complex. It is the hygienist’s role to tease out risk factors with good detective work and collaborate with other health care professionals for more comprehensive care. We are fooling ourselves if we continue to think that we fully understand and can effectively treat periodontal pathogenesis by focusing mainly on local factors and teaching better home care. We can never have meaningful and lasting impact without understanding and addressing the host more definitively and individually. Learn to ignore the calculus and biofilm, at least initially, and then push yourself to think more critically. Hygienists are the most important and integral health care professional on the team - it’s time we start realizing it.

Interesting read: Why women don't get along in the dental practice

	Author's Note: Look for our coming series of articles that will focus more in-depth on important modifiable and non-modifiable risk factors and how to effectively evaluate and treat them.

	Continuing education to consider: Scientific Session Annual Meeting (

	“Healthy Gums for Life: beyond just clean teeth”

http://periopeak.com/blog/healthy-gums-for-life-beyond-just-clean-teeth/

	LinkedIn forum: Periodontal Endoscopy and Integrative Care 

https://www.linkedin.com/groups/Periodontal-Endoscopy-Integrative-Care-6556091/about

	1. Centers for Disease Control and Prevention. Periodontal disease. 

http://www.cdc.gov/OralHealth/periodontal_disease/index.htm

	2. American Academy of Periodontology. CDC: Half of American adults have periodontal disease. 

https://www.perio.org/consumer/cdc-study.htm

	3. American Academy of Periodontology. Comprehensive periodontal therapy: a statement by the American Academy of Periodontology. J Periodontal. 2011;82(7):943-949. Published online before print as doi: 10.1902/jop.2011.11700. [

http://www.joponline.org/doi/pdf/10.1902/jop.2011.117001

	4. American Dental Hygienists’ Association. Standards for Clinical Dental Hygiene Practice. 

http://www.adha.org/resources-docs/7261_Standards_Clinical_Practice.pdf

Maya Angelou once said, “When you know better, you do better.” This quote echoes a simple and forgiving truth in all aspects of patient care; it’s about lifelong learning.
When it comes to periodontal therapy, both clinician and patient benefit from heeding this poignant statement of awareness.

Ignore the biofilm and calculus - It's time to think differently

“…In the future, regenerative therapies could be as simple as the local delivery of regenerative molecules placed subgingivally to promote repair of periodontal and gingival defects. New drug delivery systems to stimulate wound repair of soft tissue and extraction defects may be as simple as applying medicaments directly to wounds..."

While top periodontal researchers like Dr. Giannobile continue to push the envelope for ever more simplified methods to regenerate periodontal tissues, at this time, the challenges of such a simplified approach to regeneration are still present. The periodontium has unique characteristics found nowhere else in the human body. Where else do you have hard structures poking though soft tissues with the constant barrage of oral pathogens, inflammation, toxins, chemicals, food debris, and potentially damaging forces? Where else do you have hard- and soft-tissue structures so entirely dependent on their anatomical features they are crucial for symbiotic foundational health? Nowhere else in the body do you have such a unique set of circumstances and challenges for the potential goal of regeneration.

While there have been many advances in regenerative methods over the past 20 years, doctor-dedicated surgery is still the gold standard for repairing and regenerating bony defects, either with GTR, regenerative proteins placed with flap and osseous surgery, laser surgery, or a combination of these methodologies. There is one regenerative product, however, which has gained a lot of attention recently for its non-surgical use in the hands of a hygienist.

Exciting possibilities – topically applied bioactive molecules

In 1997, an easy-to-use regenerative protein gel received FDA approval for use in surgical bone and periodontal tissues repair. Porcine derived enamel matrix derivative (EMD), or Emdogain™, emerged on the scene and was readily adopted by periodontists for adjunctive use with flap or osseous surgery. 90% of Emdogain contains powerful bioactive molecules (amelogenin protein), these proteins activate the body’s own stem cells to proliferate and become regenerative cells (cementoblasts, fibroblasts, and osteoblasts) which, in turn, promotes periodontal defect repair. According to the research, the numerous therapeutic benefits of EMD also include prolonging osteoblast growth, inhibiting the growth of periodontal pathogens, delaying the growth of epithelial cells, increasing vascular growth, and limiting the release of inflammatory cytokines.

But what about the non-surgical use of these bioactive molecules in the hands of a dental hygienist? Could local delivery of regenerative proteins placed into a periodontal pocket enhance healing of certain periodontal defects without surgery? Over a decade ago, clinical pioneers set out to answer this question and today the answer is a resounding yes! While formal research for successful histologic evidence of bone regeneration using Emdogain in non-surgical periodontal therapy is limited at this time (1), many clinicians have been using Emdogain 

Additional reading:	The perio percentage KPI ... how does your practice stack up?

Overcoming challenges for the successful use of Emdogain in non-surgical periodontal therapy involves several important considerations, such as complete removal of calculus and associated toxic biofilm from the root surface, removal of the smear layer using Pref Gel (edetic acid), sufficient removal of granulation tissue from the defect, exposing connective tissue fibers, controlling inflammatory response and bleeding via the adjunctive use of host modulated therapy and/or antibiotics, synergistically promoting regenerative cells with adjunctive use of host modulated therapy, and using periodontal dressing materials. Clinicians routinely using Emdogain with success have developed methods they have observed deliver more predictable results in their hands.

The undisputed holy grail of successful clinical outcomes following any form of periodontal therapy is seeing bone-fill on the X-rays, especially with advanced bony defects compromising structural integrity. While healthy tissues and remission of disease is traditionally the basic goal of non-surgical periodontal therapy, bone regeneration could become an exciting new objective, with radiographic bone-fill more routinely and intentionally achieved by the dental hygienist; promoting a healthier, more stable foundation for the patient. The time has come to dispel some of the preconceived notions about the clinical limitations of non-surgical approach. Scientific advances in regenerative proteins have created a new world with more options for the patient with advanced bony defects and even hopeless prognosis. Surgery and extractions are no longer the only option. Non-surgical bone regeneration at the hands of dental hygienists placing proteins via local delivery is not only possible, as Dr. Gionnobile had envisioned, it is fairly predictable in the thousands of cases carefully observed by the many clinicians routinely witnessing it.

Additional reading:	The comprehensive assessment is critical in diagnosing periodontal disease

While more formal research, and even further product development and protocols are needed, it is already an exciting time to employ adjunctive regenerative methodologies in the dental hygienist’s ever-expanding armamentarium – the future is NOW! 


	Literature for non-surgical use of Emdogain
	

http://www.periopeak.com/_media/pdf/Emdogain/Enamel-Matrix-Deriv.pdf

“Periodontal Disease: Engineering the Future of Care”
	

http://www.nidcr.nih.gov/Research/facingthefuture/periodontal.htm

Case studies of non-surgical bone regeneration
	

http://periopeak.com/blog/category/case-studies/how-rpe-works/


	1. Clinical and Histologic Evaluation of Non-Surgical Periodontal Therapy With Enamel Matrix Derivative: A Report of Four Cases James T. Mellonig,* Pilar Valderrama,* Holly J. Gregory,* and David L. Cochran J Perio September 2008 volume 80, number 9)

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About the author: Judy Carroll, RDH, is the founder and clinical director of PerioPeak Innovations, an independent non-surgical periodontal therapy practice exclusively focused on providing Regenerative Periodontal Endoscopy (RPE) and integrative treatment methodologies. Her clients fly in from around the globe seeking her pioneering treatment and comprehensive approach to periodontal care. Ms. Carroll’s 25 years in clinical dental hygiene has fueled her determined focus in providing and teaching definitive clinical treatment strategies and more personalized oral-systemic periodontal medicine.

Ms. Carroll currently lectures and teaches advanced endoscopic techniques and integrative care utilizing multi-disciplinary approach to Periodontists, Dentists, and Registered Dental Hygienists. She offers valuable hands-on and didactic training and is available by appointment for her interesting and informative lectures. She can be reached at 

 “…In the future, regenerative therapies could be as simple as the local delivery of regenerative molecules placed subgingivally to promote repair of periodontal and gingival defects. New drug delivery systems to stimulate wound repair of soft tissue and extraction defects may be as simple as applying medicaments directly to wounds..."

Bone regeneration ... in the hands of the dental hygienist?

	Warning: What you are about to read will not be candy coated to be politically correct or apologetic about exposing the truth about a dirty little secret that is so widely accepted in the dental profession that it has become an accepted and even comfortable inconvenient truth. The purpose of this article is to shed some light on a defective methodology so pervasive and unchallenged in dentistry it is the gold standard … and yet is not even common sense. It’s time to raise the bar by raising awareness about this dirty little secret.

Free On Demand Webinar: Understanding Medical Billing and its relationship with 3D

The biggest dirty little secret most widely accepted in daily clinical practice is working blindly in one of the most filthy, biofilm-infested areas of the human body … the periodontal pocket. In hygiene and dental schools, we are taught to perform blind root planing, which is an impossible task with no definitive end point (other than the clock on the wall). We are taught to grope around under the gums with various instruments to determine how well we removed calculus. Sometimes it even helps to close your eyes to enhance tactile sensitivity … or so we think. And yet the insanity of this time-honored tradition is that burnished subgingival calculus cannot be detected … even with the most sensitive of instruments.

HOT READ: The 9 craziest ways people have pulled teeth

The first step to recovery and change is admitting there’s a problem. What we are often not taught or even discuss openly at meetings is that the research is replete with evidence demonstrating that blind root planing is only effective to 4mm. Beyond 4mm, 30-50% of the subgingival root surface is still covered with 

. Rather than discussing this problem openly and hitting it head on, we are taught to learn how to perform blind root planing better. This advice is like telling a blind person to drive better. Instead, we are expected to ignore this foundational issue and to enhance our inept blind technique by using equally blind adjunctive therapies such as air polishing, lasers, or local delivery antimicrobials to more effectively disrupt and alter biofilm, with no mention of the source of the problem … the very home of the biofilm, the

. The foundational problem with all of these BAND-AID methodologies is that mature biofilms will reform within a matter of days wherever subgingival calculus exists. Thorough removal of calculus is the cornerstone to excellent periodontal therapy due to the more permanent removal of, and prevention of, the formation of mature biofilms. Toxic biofilm, growing and changing into an even more toxic soup with every day it goes undisturbed. Toxic biofilm, with complete freedom to infect its hosts systems further through tiny capillaries in the walls of inflamed periodontal pockets with direct access to the entire vascular system, and hence all systems of the body. Our “dirty little secret” has ever more serious consequences than we may fully understand or even think about.

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The idea of thorough calculus removal is such an integral aspect in arresting disease progression that flap surgery often follows blind root planing in order to achieve a definitive end point more conducive to periodontal health. So what is wrong with this picture? Is it true that if we could see into the periodontal pocket that most periodontal surgeries would no longer be necessary (as many leaders in periodontal medicine have suggested through the years)? Is it a conspiracy by dentists and periodontists to keep the dental hygiene profession in its proper place of antiquity and unchanged darkness? Or is it possible that the dental hygiene profession is not taking on the important responsibility of working to change this dirty little secret? Why are 

 collectively allowing this lag in our progressive clinical ability to continue?

Click on the next page for the author's solution...

 out of the darkness. For the first time in history, the subgingival environment could be viewed in real time and burnished subgingival calculus could effectively be removed without surgery. Considering that medicine has incorporated endoscope technology for more than 100 years, it was about time. This led to more than sufficient research demonstrating that visual root planing could result in periodontal health without subsequent surgery … even in advanced cases. Now 99% of burnished subgingival calculus could be removed and biofilms would have nowhere to flourish and multiply. Blind root planing could finally be abolished and replaced with 

root planing. The dental hygiene profession would be able to eliminate its “dirty little secret” and truly have profound clinical and systemic impact in patient care for the first time in history.

HOT READ: The worst at-home dentistry mistakes you've seen

Secrets are no good for anyone. Let’s be honest with ourselves. Who are we serving by continuing to ignore this inconvenient truth? Are we truly serving our patients and our profession in the process? Now is the time to demand more from ourselves and our profession. Make as much noise as possible about the absurdity of not having the proper tools to achieve health in your patients. Tell your professional associations you are fed up with being taught how to perform blind root planing better (a nonsensical idea at its core). Create a buzz and bring this secret into the light of meaningful discussion. There is power in numbers. The only way to create real change is to believe that change is possible … and it is.

Watch videos of residual calculus on roots after blind root planing

https://www.youtube.com/watch?v=ysqfYpBrQQQ

https://www.youtube.com/watch?v=Ow6VYa5cu2o

Learn more about the current research and clinical significance of endoscopic visual root planing over blind root planing

 to listen to the author talk more about this article on the Cross Link Radio podcast.

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Author's Note: We’re anxious to hear your comments! Please post below to voice your opinion about blind dental hygiene practice and our dirty little secret.

 Warning: What you are about to read will not be candy coated to be politically correct or apologetic about exposing the truth about a dirty little secret that is so widely accepted in the dental profession that it has become an accepted and even comfortable inconvenient truth. The purpose of this article is to shed some light on a defective methodology so pervasive and unchallenged in dentistry it is the gold standard … and yet is not even common sense. It’s time to raise the bar by raising awareness about this dirty little secret.