Inspired by Dr. Carrie Labritz
“What did you do to treat this patient?”
I get this question often when I share cases on Instagram. And I understand why. You see the change, and you want to know what made the difference.
But a before-and-after photo doesn’t show the assessment, medical history, home-care changes, or how care was adjusted along the way. There isn’t one rinse, supplement, or protocol that fits every patient.
What I can share is the framework behind those decisions: what we do in the office, what the patient does at home, and how we account for the body’s ability to respond.
This three-tier framework was inspired by biological dentist Dr. Carrie Labritz. It helps patients understand their role and helps dental teams explain care with a shared language.
Care in the office.
Consistency at home.
Support from within.
Looking for the tools I recommend? Explore my Favorite Oral Care Products & Dental Tools.
Tier 1: In-Office Periodontal Care
Show the patient. Explain the findings. Build the plan.
In the framework I teach, microscopy and salivary diagnostics are part of the plan from the start. The microscope lets us show patients their living biofilm. Salivary diagnostics give us more information about the bacteria we're working with. Together with periodontal measurements, bleeding, imaging, and medical history, they help us connect the findings to the care we're recommending.
Because when patients can see what you're talking about, the conversation changes.
The treatment plan must include professional biofilm disruption, removal of calculus when it's present, and selected adjuncts to improve therapy.
And that biofilm disruption is repeated over multiple appointments. That's a central part of what I teach my teams. We plan the visits, reassess the response, and keep moving the patient toward health.
For gingivitis, that may mean a couple of appointments. For patients who need scaling and root planing, the overall plan in my framework typically includes three visits, with the number and timing guided by their findings and response.
I also train teams how to code, document, and bill for the care they're actually providing, based on their practice and the services offered. The clinical plan and the systems supporting it need to work together.
We need a plan for the infection, time in the schedule, and a team that knows how to explain the next step.
Tier 2: Daily Oral Home Care
Keep it simple. Make sure they know how.
I'm not throwing the kitchen sink at somebody. A long shopping list doesn't help if the patient still isn't sure how to brush properly or use their Waterpik effectively.
Start there. Show them where to position the brush, how to work along the gumline, and which areas they're missing. Then walk them through using the Waterpik, including the tip and technique that fit their needs. Have them show you what they'll do at home.
Owning the tool and knowing how to use it are two different things.
I like the Waterpik Aquarius and ION, along with an electric toothbrush. We build the rest of the routine around the patient's needs, including cleaning between the teeth. The goal is effective daily biofilm disruption they can actually keep up with.
At the next visit, check in. What's working? What's confusing? What needs another demonstration? Those conversations are part of treatment, too.
Find my favorite toothbrushes, Waterpiks, and home-care tools here →
Tier 3: Immune Support & Whole-Body Health
What does this person need to support their health?
We can work on the mouth, but we also need to look at the person attached to it. Food choices, sleep, stress, hydration, medical history, and medications all belong in the conversation.
PROtektin is one of my go-tos for oral microbial support. It's a prebiotic, designed to support the beneficial bacteria already in the mouth. The manufacturer's approach focuses on changing how bacteria use nutrients, helping beneficial microbes thrive while discouraging harmful bacterial growth. That's what I like about it: supporting a healthier environment alongside the care we're already providing.
My next go-to is OsteoForce by Designs for Health for vitamin and mineral support. It's formulated to support bone health. When someone has gum disease or recurring cavities, I want us asking about nutrition and possible nutrient gaps as part of the bigger picture. Those findings alone don't tell us someone is deficient, so we look at their diet, health history, and testing with their medical team when needed.
These products have different jobs. PROtektin supports the oral microbial environment; OsteoForce provides bone-supporting nutrients. Recommendations should fit the person's needs, medications, and supplements they're already taking.
Give patients a clear reason for what you're recommending, and keep the plan manageable.
Visit my Favorites page for the products and tools I recommend →
Putting the Three Tiers Together
The framework stays consistent. The care plan is individualized.
We assess, explain, treat, and reassess. At follow-up, the findings help determine what’s working and what needs to change, including professional care, the home routine, and any broader health concerns.
That’s why I can’t explain an entire case with a product name in an Instagram comment. The product may be one part of the story. The decisions and follow-through are the bigger picture.
Visit my Favorites page for the products and tools I recommend →
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For Dental Professionals: Bring This Approach Into Your Practice
Understanding the three tiers is the starting point. Knowing how to assess, explain, recommend, schedule, and reassess is where implementation happens.
Boots, Bugs & Biofilm helps your team connect the science to everyday patient care, with microscopy, salivary diagnostics, patient conversations, and practical systems.
Explore Boots, Bugs & Biofilm →
For guidance tailored to your practice, my coaching helps your team put the systems into place together, from aligned recommendations to scheduling and follow-up.
Learn about team training and coaching →
Book a complimentary call →
Stay Awesome!
Tosha, RDH
