A Better Way to Diagnose Periodontal Disease (That Actually Catches It Early) Part 1
You know the type.
They show up on time, floss like a champ, and their chart practically glows with ticked boxes. No BOP last time. Prophy every six months. The kind of patient who makes you think, “Easy one today.”
But then you’re in there. Instruments clink, mirror fogs, and boom: bleeding. Not just a rogue spot. A pattern. And now you’re flipping back through old notes: “Light to mod BOP.” Hmm.
Are they actually healthy… or have we been missing something?
A Peek Doesn’t Always Tell the Whole Story
If we’re honest, dentistry’s been a bit obsessed with what we can see: plaque, tartar, bone loss on an x-ray. But here’s the kicker—
Gum infections start way before we see those things.
Let’s unpack that.
Gingivitis is practically universal. Up to 90% of the population has it—yes, even the flossers.
Bleeding is inflammation. Not just irritation. Not just “overbrushed.” It’s the immune system trying to fight off bacteria.
Waiting for bone loss is backwards. By the time it shows up, the bacteria have likely been partying in the bloodstream, impacting the heart, brain, even reproductive health.
So why are we still waiting until things look really bad before we act?
It’s Not About Dirty Teeth—It’s About the Body’s Response
We encounter bacteria all the time. Kissing your partner, sharing a drink, lick from your dog, normal life stuff.
What’s not normal? A chronic immune response.
Here’s what really happens:
Bacteria hang around too long.
The immune system sends backup: fluid, white blood cells, inflammation.
Some bugs, like P. gingivalis, are sneaky. They dodge detection and live in biofilm.
Gums become leaky, and toxins enter the bloodstream.
And now? We’re not just talking gum disease. We’re talking systemic disease risk.
As Dr. Daniel Sindler says, “Oral is systemic because of the pathogens.”
These aren’t just oral bacteria. They’ve been linked to 57+ systemic conditions, heart disease, Alzheimer’s, pregnancy complications, even certain cancers.
Enter: A Better Way to Diagnose
We need to move beyond the probe and mirror. The days of poke, bleed, guess are done.
Microscopy and salivary diagnostics are the upgrade we’ve been waiting for.
Here’s why:
It’s fast. Taking a slide takes 30 seconds. Showing a patient? Maybe 2 minutes. But it changes the whole convo.
It’s visual. Seeing your own bacteria squirm around? Wildly motivating.
It’s personalized. Different bacteria = different treatment. No more one-size-fits-all perio plans.
You wouldn’t diagnose a cracked tooth without an X-ray. So why rely on eyes and a probe to diagnose periodontal disease?
What We’re Actually Looking For
When you start using the microscope, you’ll see patterns. I teach teams to categorize them like this:
🔹 Green Light (Healthy):
A calm, balanced slide. Good bacteria holding down the fort. These patients are prophy or perio maintenance material.
🟠 Moderate Risk:
Bacterial shifts starting to show. Might correlate with stress, poor sleep, or a dietary slump. These patients need support and maybe a tweak to their home care.
🔴 High Risk:
Frantic movement. Dangerous bugs. Dysbiosis. The immune system’s clearly losing the battle. These folks need intervention yesterday.
Bottom line?
When you shift from looking for buildup to identifying infection, everything changes. You catch disease earlier, treat it smarter, and finally move from reactive to proactive care.
Stay tuned for Part Two—where we get into scripting, salivary testing, and how this approach benefits your entire practice.
Stay Awesome,
Tosha Kozloski, RDH
