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734: Chronic Oral Wounds in Your Dental Practice – Tanya Dunlap

Getting patients healthy is your number-one role. But are you focusing on the disease that matters most? It’s time to address the most undiagnosed and untreated condition — gum disease — and now there's an easier way. To help you start the conversation, Kirk Behrendt brings in Tanya Dunlap, vice president of Perio Protect, to showcase Perio Tray, a convenient way to treat, prevent, and manage gum disease. To learn more about Perio Tray and how it can improve your patients’ lives, listen to Episode 734 of The Best Practices Show!

Learn More About Tanya:

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Main Takeaways:

  • Patients need better home care.
  • Brushing, rinsing, and flossing is not enough.
  • Systemic antibiotics are not long-term solutions.
  • Perio Protect makes home care easy and convenient.
  • Be honest with patients about their gum disease findings.
  • You have the opportunity to change patients’ lives for the better.


“These chronic oral wounds that you mentioned are really the base cause of gingivitis, periodontitis, peri-implant mucositis, peri-implantitis, and it is a huge problem. So, 47% of American adults over the age of 30 have chronic periodontitis. It means they've lost bone already. They usually have active infections, bleeding on probing, and visible inflammation. Tens of millions more have gingivitis. And you might think, ‘It’s just gingivitis. It's just some bleeding.’ But it is not just bleeding. These are chronically infected lesions in the gingival tissue, and they need treatment. They need treatment because those infections have a systemic inflammatory implication. And we know that when you treat the disease effectively, you are really able to improve patients' lives. It affects their systemic health, their longevity, their quality of life, their wellness — it all matters. The service that dentists and hygienists and teams are providing patients matters. It is so important.” (1:47—2:58)

“It's beginning to get to that tipping point now where people understand that you need better home care. Part of the reason why you need better home care is because antibiotics don't particularly work well. We've tried those as a treatment option. Your toothbrush, rinse, and floss — they don't get deep enough. Toothbrush, rinse, or floss could get maybe to like a three-millimeter pocket, but not any deeper. And let's face it. We've been using systemic antibiotics for decades — decades — and we have half of American adults with chronic periodontitis. It clearly doesn't work very well.” (3:21—3:56)

“Caries and periodontal disease are some of the most underdiagnosed diseases in the world. They don't hurt, typically, till they get really advanced. So, from a patient's point of view, there's not really a sense of urgency until you get too far along. But those active infections matter. We need to stop them at the earliest sign. So, if you can reverse it with gingivitis, best case scenario. But when you already have bone loss and you have chronic periodontitis, we want to end the infection and inflammation and stop the progression of the disease. That's the game here. But first, we have to diagnose it. Patients can't even begin to think about the importance of their health if they don't even know they have a problem, if they don't know they have these active infections or bone loss. We're not being honest with patients if we're not even telling them what they have, of our findings. So, that's the first thing — and to focus on it — because it matters.” (6:38—7:37)

“It's important to have an option like a powered toothbrush or water flosser, an air flosser. All that is great. But those tools have been around for a really long time too. We don't get everybody to zero bleeding points with Perio Protect, but you should get to single digits if we can't get you to zero, like one to five bleeding points. Under 10, for sure. If that's not happening, there's something else going on, because you get beautiful, healthy gums. It's so easy to wear this. If you're watching the video, you take your gel and you put it in your tray. That's how long it takes. You put it in your mouth, and you wear it for 10 to 15 minutes. You start out twice a day for the first three weeks, and you drop down to one time a day. Not only will you have healthier gums after the first couple of weeks, you should have at least a 50% reduction in bleeding on probing in the first two weeks. And then, we should be able to get you down to single digits, if not zero.” (7:44—8:40)

“We did this tour several years ago. We asked doctors to bring their patients in who were Perio Protect patients, and we filmed them. We asked them what they liked about it, and we got their feedback. One guy still sits in my mind. He said, ‘Well, the kissing quality at home has gotten a whole lot better.’ You know, that matters!” (9:43—10:03)

“[Telling patients about their perio breath is] a particularly hard conversation. I would not tell someone they smell bad, directly. I would say something like, ‘I'm concerned about the bleeding that we've seen in your gums.’ You have the chart up and you have some photos. You show them the provocation of bleeding after probing, and you tie it to their health history, whatever that could be. You're always going to start with health, is the number-one point I'm trying to make here. So, let's say they're a type 2 diabetic. I would say, ‘I'm concerned that you have so many bleeding points, but I'm especially concerned because of your type 2 diabetes. Gum disease places chronic inflammatory burden on your immune system, and your immune system is like a battery. You can only have so many things plugged into it before the power fades. If we get your gums healthy, your body will be better able to regulate your blood sugar.’ Then, I would stop talking, because you said a lot right there and they need some time to absorb what you said. Once they have that, you can say, ‘This tray therapy,’ and explain what it is. We have a video. It takes 40 seconds. I've got talking points for it. Once you know those talking points, it's so easy to present it to a patient. And then, ‘Not only are we going to get your gums healthy’ . . . You could say, ‘Patients have the freshest breath of their life. You can get closer to the people you love.’ I would do it like that. When I mean honest, I mean, if we're not telling them they have infections and infected gums — it's not unusual to have like 50 bleeding points out of 168. That's a lot of bleeding.” (10:56—12:44)

“Periodontal disease is divided into gingivitis or periodontitis, and the differentiation factor is bone loss at a certain level. If you have gingivitis, most people agree you can reverse it. You can get back to a state of health. You don't have enough bone loss. There's some degree of bone loss that people even consider to be healthy and okay. But once you get to periodontitis and you have bone loss, okay. Treatment, fine. But you can treat the infection. You can stop that inflammatory process — and you need to. It's so important because we are focused on their gums, we're focused on their teeth, the oral cavity — all that is important.” (13:06—13:48)

“The ramifications of that chronic, low-grade burden [of gum disease] on the immune system are significant. Research is now showing that if you successfully treat gum disease — and I'm not talking about how to do it, just that it's successful. The treatment is successful — for a type 2 diabetic, the reduction in hemoglobin A1C from the successful periodontal therapy is as significant as adding a second medication to metformin. That's a big deal. They're saying that treating periodontal disease for patients with cardiovascular disease decreases blood pressure and arterial stiffness. That's super important. And if you leave these gums infected, you have a much higher risk for tiny brain bleeds, higher risk of heart attack and stroke, rheumatoid arthritis is harder to manage, dementia progression speeds up. You have a higher risk of some cancers. What you are doing in the dental practice is so important! And they don't know it. You can't expect a patient to know this. But going to work every day as a clinician, you have an opportunity to significantly change someone's life for the better.” (13:49—15:02)

“We want to put periodontal disease into remission. So, address the infection, address the inflammatory response. Most of the time, it's bacterial based. Not always, but most of the time, it is. Sometimes, you have a sleep apnea situation that exacerbates it. Sometimes, you have medication that's drying out the tissue. There are a lot of things to factor into this. But if it's a bacterial based, inflammatory response, Perio Protect is what you want because the tray delivers medication into shallow pockets and the deep pockets. It holds the medication there long enough for the medication to be effective, and it's easy to use at home. You stick it in, take a shower, walk your dog, watch TV, whatever. It's 10 to 15 minutes, and you can wear it longer than 15 minutes.” (15:12—16:04)

“[Perio Protect is] convenient. And you need a convenient solution. You need something that effectively and reliably works. There's lots of research on this. would be the place you go if you want to see the claims and pull up some of the data of the independent studies because it's important that people have that information also. But the goal is to end the cycle of infection and inflammation. That is the hardest part. The chronic oral wounds that we're talking about is that chronic bleeding you see when patients come in and they're bleeding at the same sites appointment, after appointment, after appointment.” (16:30—17:06)

“I talked to a periodontist. I said, ‘Gordon, why do you think it's hard to get dentists to focus on periodontal disease? A lot of it is just directed to the hygienist.’ He said, ‘Well, Tanya, it’s like a black hole. We don't know what to do with it. We don't have particularly great success rates. We refer people out to specialists’ . . . He deals with us, and he uses Perio Protect to help people exhaust their non-surgical options before they accept surgery. So, that's a different way to think about it. But then, you're concerned. Are you going to lose the patient? Are they going to be mad at you because you sent them there and there's a big bill at the potential end of the specialist’s treatment recommendation? There are a lot of different things that go into that and it's like a black hole. You’d just rather not deal with it. We need to deal with it. We need to deal with it.” (17:07—18:02)


0:00 Introduction.

1:32 Why this is an important topic.

6:24 The problem of diagnosis and treatment planning.

10:10 How to be honest with patients about gum disease.

12:46 Health benefits of treating gum disease.

15:04 Put periodontal disease into remission.

18:03 The Perio Protect process.

19:32 More about Perio Protect.

Tanya Dunlap Bio:

Tanya Dunlap, PhD, is the vice president at Perio Protect, where she has worked since 2005. For several years, she served as the research liaison for the company, working with researchers and investigators who were testing Perio Tray® therapy in controlled clinical trials and microbiological studies. Her expertise on this adjunctive periodontal therapy is grounded in data, explaining how the prescription trays work and which patient candidates can benefit from them.