While some Americans are searching for the fountain of youth, millions of other Americans are dying of cardiovascular and other chronic inflammatory diseases. What most fail to realize is that there is a link between periodontal disease and cardiovascular disease: the “perio-cardio link”. As healthcare providers, we have an obligation to identify periodontal diseases, educate our patients, and treat it.

I have incorporated periodontal health into my aesthetic practice by creating standard operating procedures for our entire administrative and clinical staff to ensure that our team operates with consistency and a mindset for constant learning. Our common goal is for our patients’ mouths to be disease-free, in order to support our beautiful restorations and alert our patients to risk factors that could impact their overall health and longevity. We use a methodical approach to patient care: take time to understand our patients’ needs, gather information on all levels, visualize a solution, then choose an appropriate technique to move from problem to solution.

The first appointment: identify the problems

Each new patient completes our standard forms, including our customized risk assessment questionnaire (with detailed questions about the patient’s family history of chronic inflammatory diseases, risk of diabetes, cardiovascular disease and stroke). Once the new patient is seated for consultation, the doctor reviews the patient’s risk assessment questionnaire and medical history, and gains perspective on the patient’s desires for aesthetic outcomes by reviewing the patient’s customized aesthetic evaluation form and consultative dialogue.

In this information gathering phase of the appointment, we use several tools including the Florida Probe® (which helps us determine periodontal health), mounted study casts, full mouth x-ray, and our customized aesthetic evaluation form. The Florida Probe® is a computerized system that standardizes periodontal probings with both an audio read out and a visual chart showing probing readings, attachment loss, and other diagnostic information. This is an excellent tool for eliminating the subjectivity of manual probings, and engages the patient in an audio and visual process that reinforces the diagnosis.

The second appointment: visualize the solution

With all of the information gathered, we look at the patient’s aesthetics, function, and overall health, to build a baseline and diagnostic wax-up. We use two different visual techniques (computer imaging and direct mock-ups) to create an opportunity for a “visual discussion”. In addition, the unique patient risk profile, periodontal records, and radiographs, help us generate a conservative, nonsurgical “PointPerio” treatment plan. Our dental hygienists and aesthetic dentists work together as a team to assess the patient’s complete periodontal health before beginning aesthetic treatment.

With a solution in mind we can choose the appropriate technique for aesthetic treatment. Our starting point, however, is always focused on the patient’s periodontal health. After initial therapy, we reevaluate periodontal status and identify cases which require more aggressive treatment. Once our patient achieves total oral health, we can proceed to the next step: aesthetic or restorative treatment. Without a doubt, ensuring periodontal health before aesthetic procedures is essential. Beautiful teeth cannot be sustained in the long term without a healthy mouth.

Acknowledgments

The author would like to acknowledge Ronni Gussin for her significant contributions to this article.

Jonathan B. Levine, DMD, PC, Private Practice Prosthodontics; GoSMILE Aesthetics, New York, NY