Andrew Mogelof, DDS, and his team in Statford, CT, will never be accused of not being thorough. They take a comprehensive approach to all aspects of patient care, including routine oral maintenance. Take their protocol for new patients, which includes a full evaluation with the hygienist that covers:
- Biomechanics (tooth structure, restorations, erosion, attrition)
- Function (occlusion, sleep-related issues, airway issues, wear and wear patterns)
- Periodontics (probing, pocket evaluation, bleeding on probing, recession, biotype, bone profile on films)
- Dentofacial issues (incisal edge position, smile, incisal plane, alignment of teeth)
- Orthodontic and skeletal discrepancies that can affect the patient's ability to perform effective oral hygiene.
In addition, new patients either provide a full series of x-rays taken within the past 18 months or Dr. Mogelof’s team will take a full series. “If the provided films are of diagnostic quality for periapical, bitewing, and periodontal bone anatomy, we will accept them,” says Dr. Mogelof. If needed, the practice takes supplemental diagnostic x-rays at the new patient visit.
The practice offers 4 recare intervals: 12 months, 6 months, 4 months, and 3 months. “For patients who have bone loss, recession, bleeding upon probing, periodontal pockets more than 4 mm, and for those who present with poor oral hygiene and poor ability to maintain their periodontal health, we will begin to educate and place them into one these intervals,” explains Dr. Mogelof.
Care for these patients includes scaling and root planing (SRP) by quadrant, arch, or left/right sides and, if needed, antibiotics (everything from rinses to systemic). For resistant or isolated areas, Dr. Mogelof uses Arestin, a concentrated, locally applied antibiotic that can be used in conjunction with SRP that targets bacteria and remains active in the pocket for up to 9 months. “I have found that with consistent home oral hygiene, Arestin has made a difference,” says Dr. Mogelof. “The pocket depth is reduced, the surface appearance of the tissue loses its red tone, and the bleeding is eliminated, provided the pocket depth is reduced below 5 mm.”
If the first placement of Arestin doesn’t produce enough change, Dr. Mogelof treats the pocket with another dose. “We don't expect to resolve all pockets without surgery,” says Dr. Mogelof. “Sometimes surgery is needed to take the improved tissue the remainder of the way to health.”
Dr. Mogelof stresses the connection between oral and systemic health with his patients and staff. “We occasionally use a lab to test saliva samples for inflammatory markers and then target our treatment with specific antibiotics,” says Dr. Mogelof. “This reinforces the connection between oral health and systemic health for the patients.” In addition, Dr. Mogelof’s hygienists join the practice’s dentists at courses that reinforce the connection of periodontal disease and systemic health. They also discuss the topic and new evidence in their staff and hygiene meetings.
Dr. Mogelof’s comprehensive approach to care—including education and new treatment options—can decrease the need for surgery. “Many years ago, patients who needed SRP would go from that modality to surgery,” says Dr. Mogelof. “We’ve found, over time, that Arestin or systemic antibiotics have reduced that percentage.”