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A 'Dental Practice Hero' in the Fight Against Periodontal Disease


Michael Teitelbaum, DMD, MAGD, FACD


After graduating from the University of Pennsylvania School of Dental Medicine, Dr. Michael Teitelbaum attended first a general practice residency, then the Prosthodontic specialty program at New York University where he was an Assistant Clinical Professor of Prosthodontics for 8 years. He now has a private practice in New York focused on prosthodontics and cosmetic dentistry and is very active in organized dentistry. He is a  published author, lectures on cosmetic dentistry and occlusion, and has received many awards throughout his career. Dr. Teitelbaum believes that a strong foundation is important for any restorative, prosthodontic, or cosmetic dental procedure, and a strong foundation begins with preventive dentistry. Here, he shares his philosophy on preventing and treating periodontal disease.

Q: Why do you believe it is important to proactively diagnose periodontal disease?

In my practice, every new patient is examined for periodontal disease, and I educate each patient on the importance of a healthy mouth. Periodontal disease is a progressive infection and if you can catch it in the beginning stages (when gums are just irritated and bleeding), you may be able to prevent progression by regular twice-a-year dental cleanings. If you catch it a little later when the perio pockets are just starting, you may be able to manage the disease with scaling and root planing and 90-day recall visits. Once you start seeing a lot of bone loss, that’s when it becomes so much more work to manage the disease.

Q: What do you believe is the appropriate protocol for diagnosing or treating periodontal disease?

We follow a protocol that works for most people. After a new patient thorough exam, which involves restorative charting, a full series of x-rays and perio probing, we normally recommend a hygiene visit for either gross debridement or a general hygiene appointment. If pocket depths are greater than 3mm, we generally do a scaling and root planing, and the hygienist educates the patient on how to brush and floss and gives the patient a water flosser. After a thorough exam, I bring each patient back for a separate consultation and explain the results. Although I’ll tell patients that surgery is an option, my philosophy is to be conservative. Research shows that people who are susceptible to periodontal disease should have their teeth cleaned every 90 days, so this is our first option. About 14-21 days after the scaling and root planing, we will recall the patient and re-probe their entire mouth. If nothing has changed, that’s when I’ll refer the patient to a periodontist. Luckily, in most cases there is usually some improvement (pocket depths are mostly less than 3mm). We may recommend treatment with minocycline for the few remaining deep pockets, and we can also prescribe minocycline in capsule form to be used with a water flosser if necessary. 

Q: What treatment hurdles do you encounter? 

The two biggest hurdles to successful periodontal treatment are patient acceptance and financing. It’s imperative that we get the patient to understand and appreciate that treatment is necessary to improve their overall health. That’s why a thorough exam and explanation is so important. When I first examine for periodontal disease, I show the patient a diagram and thoroughly explain pocket depth, attachment loss, and that normal healthy gums should not bleed. If a patient can truly see and understand there’s a problem, they are much more likely to follow through on the recommended treatment protocol. 
Financing is also an obstacle that stands in the way of treatment, and it’s important that dental practices offer flexible financial arrangements for patients so that they can overcome that hurdle. 

Q: For patients you treat with perio disease, how would you describe your patient mix? 

In my practice, I’ve found that the age of adults with periodontitis really varies. It can be a patient in her 30’s or one in his 70’s. It’s generally more common for me to diagnose perio disease in new patients who haven’t received regular dental care or who haven’t received good quality cleanings in the past. Just yesterday I saw a new patient in her 40’s who has horrible periodontal disease, some of the worst I’ve seen in a very long time. She had crooked teeth, loss of attachment, several pockets greater than 10mm (which is the length of my perio probe), and lots of bleeding. We still need to review her x-rays and come up with a treatment plan, but if we can save 2 or 3 teeth in each arch, we’ll probably recommend root canals and then an attachment overdenture or all-on-4 implants.

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