A Strategy to Help your Patients Accept Conservative Periodontal Therapy when Clinical Signs and Symptoms Indicate the Need

Intro: This is The Thriving Dentist Show with Gary Takacs, where we help you develop your ideal dental practice, one that provides personal, professional, and financial satisfaction.

Gary Takacs: Welcome to another episode of The Thriving Dentist Show. I’m Gary Takacs, your podcast co-host. We have a great episode for you today. Uh, today’s episode is titled A Strategy to Help Your Patients Accept Conservative Periodontal Therapy When Clinical Signs and Symptoms Indicate the Need. Uh, I am really excited about this episode. This will be a very granular, detailed episode. Uh, we’re gonna, uh, get, uh, really in the weeds covering details around this. I think you’re gonna find this very useful, something you can probably use today, uh, in your practice.

Hey, before we get to that episode, though, I have two quick announcements to make. Uh, the first announcement is, uh, coming up, uh, not too far after this one is published, about, maybe about a month or so afterwards. We have, uh, our annual Reducing Insurance Dependence Academy Summit. Uh, it’s a virtual summit, and, uh, it’s happening on Friday, October 24th.

Uh, it happens from noon to 5:30, so from 12 noon to 5:30 PM, uh, East Coast Time. So go ahead and do the time translation wherever your time zone is. That’s East Coast Time. That’s 9:00 AM to 2:30 Pacific Coast Time. I’ll, I’ll go ahead and do the Pacific, uh, translation since that’s where I am.

But we’re having our fifth annual Reducing Insurance Dependence Academy Summit. It’s virtual, it’s five hours. You got five hours of CE, and we are going to have some keynote, uh, presentations. We’re going to have multiple panels on different topics. Um, everybody we’ve invited to participate, whether it’s a panelist or a moderator or a keynote presenter, has specific information to help you successfully resign from PPO plans. Absolutely everyone. And it’s quite, uh, literally a who’s who, uh, in our wonderful profession of people that can help you do this.

This is our fifth annual. We did our first one in 2021. Uh, this is our fifth annual. Um, every one of these summits, uh, the attendance has doubled every year. We’re anticipating that again this year. Uh, that’s a big ask after, uh, the large attendance we had in 2024. But come join us.

And here’s the greatest news of all — there is no tuition. Uh, we’re providing that as a courtesy to you. Uh, you will get five hours of CE as long as you stay to the end. You know, the ADA, uh, AGD has requirements for the CE, um, but, uh, there is no tuition. You’re coming as our guest.

You do have to register. Go to rid.academy.  RID stands for Reducing Insurance Dependence Academy and there’ll be a popup when you land on the homepage. And the popup will, uh, give you an opportunity to register for the, uh, 2025 Reducing Insurance Dependence Academy Summit.

Come join us. Uh, it’ll be time very well spent — maybe the most important business course you attend this year. Come join us.

The second announcement I have is we have a returning guest, my co-host, uh, Naren Arulrajah. Uh, he’s gonna provide the Thriving Dentist marketing tip. And this marketing tip is titled Why Is Original Content Important for SEO? Um, many times doctors make this mistake of publishing duplicate content, and Naren’s gonna explain why you need original content.

Uh, no further ado. Here’s Naren with the Thriving Dentist Marketing Tip: Why Is Original Content Important for SEO?

Naren Arulrajah: Welcome to the Thriving Dentist Marketing Tip. This is Naren, the founder of Ekwa Marketing and the co-host of The Thriving Dentist Podcast Show. The tip that I’ll be addressing today is Why Is Original Content Important for SEO? It’s a really good question, and I think it’s a really important question.

SEO is about, you know, um, dominating Google. So whatever people type in, you show up, or you rank hundreds of times for hundreds of keywords, versus once in a while you rank. That’s not good SEO. So how do you dominate Google? There are six things Google cares about, and if you do those six things well, day in and day out, month in and month out, then you’re gonna do well with SEO.

One of those six things is what I call original content. And today, it’s original human-first content. Why am I inserting human-first?

Naren Arulrajah: Because Google recently made an algorithm change, and they said, "We are gonna punish people who don’t write content where the content is written by a human." So if you’re just relying on ChatGPT or any one of those AI tools, be careful — you’re not gonna rank anymore. So be careful on, like, using original thoughts, original ideas, original content, and Google is looking at that.

In addition to having rules around whether it’s original content or not original content, Google also has rules around how many words you have. The minimum I would recommend is 400 words. So when it comes to original human-first content, Google recommends you have 400 words and no more than 5% — meaning if, out of the 400 words, 20 words could be similar to some other webpage or some other site.

So if you or your marketing company is copying content — we see this a lot — most marketing companies know doctors don’t understand the importance of original content. So they have a template library, and they’ll just change in the Invisalign article with your name versus some other doctor’s name. That’s not original, right? Because 90% of the rest of the article is the same, except for the names being changed. Google sees it. They punish you for it.

Why? Because you are the owner of the website, and Google thinks you did something that Google considers is not the right thing to do. Therefore, you get punished. What does it mean you’re getting punished? You could go to the Google Sandbox. You may never rank — leave alone ranking for hundreds of keywords.

So if you want to have the advantage of having SEO work for you — which is a fraction of the cost of any other type of marketing — you want to make sure everything you do is original.

Naren Arulrajah: Now, we see this problem with our clients. When our clients dominate, other people take notice. So, for example, we have, you know, clients in every city where our clients are ranking 400-plus keywords. So in Phoenix, we have LifeSmiles that’s ranking for 600 keywords. You know, over the last six, seven years, while we are working with this particular client, LifeSmiles, we notice other people copy those pages.

They think by copying the information that’s ranking, they will also rank. But what ends up happening is now Google penalizes both parties — the one who copied and the one who was copied from. So even if somebody’s following the original content rule, I wouldn’t just sit on my laurels. I would go and see if anybody else copied me.

So every few months, we look at every one of our pages that our clients have on their website and see if others are copying.

Naren Arulrajah: You can call a lawyer and threaten to sue them if they don’t take down their content. That could cost you thousands of dollars and months before you get a reply. Or you could just go and rewrite that page, rewrite that paragraph that was copied.

So there’s a tool called Copyscape. Um, if you’re interested, you know, ask about it in the marketing strategy meeting. You can use that tool to see: Are you compliant? Are you making Google happy when it comes to its human-first versus AI-written original content rules?

So that’s the tip for the day. If you are interested in learning more about marketing — specifically your marketing — and how to take it to the next level, book a marketing strategy meeting. It’s ekwa.com/td . It’s a one-hour meeting. You will learn a ton on how well you are doing, how your competition is doing. We’ll give you a report card and a roadmap — a plan.

So take advantage of it. If you find this tip useful and have other questions, we would love to help.

Naren Arulrajah: Welcome back to the Thriving Dentist Coaching and Action segment. This is Naren, your co-host. I’m really excited about the topic today, and that’s because I have seen this in action. But before I jump into that, I just wanted to, um, mention the tip that I covered, uh, in my marketing tip — Why Is Original Content Important? It’s more important than ever in 2025.

So if you wanna learn more about: Is your marketing team using original content or not using original content? And how do you make sure you are on the right track? Book that marketing strategy meeting — ekwa.com/msm.  

Gary, the topic about, you know, how can we improve, um, patients who accept conservative periodontal therapy is a topic that is near and dear to me because I have seen this in action.

As many of our listeners know, you and I started working together at least seven years ago, and since we have a lot of mutual clients — you help them on coaching, and we help them with marketing.

Naren Arulrajah: And I know some of these clients intimately because we partner together to help them grow and thrive. And, um, some of them, when they come in, only 15% of their overall collections is from hygiene/perio, right? Or even 10%. And that’s something very normal. But then you coach them and you help them. And then I see that number changing, right? Instead of it being 10 or 15% on a million-dollar practice — let’s say $100,000 to $150,000 — it goes to 35% on a million-dollar practice — $350,000.

And the beauty of this is the doctors are not doing the work here. You know what I mean? This is done by the team. So all of a sudden, imagine 15% of your collections coming from your team. I’m talking about team outside of doctors, right? Like the regular, you know, hygienist and so forth. Thirty-five percent is coming from the team. So this is a wonderful technique.

And I know you can’t crack this unless you go deep into perio therapy. I’m even thinking, thinking of this one client in New York, right? You, you know who I’m talking about — he crushes this. And of course, he — you helped him grow, and now he’s just made it into a system, and, and he does so well. It’s a big practice with multiple offices, and it doesn’t only work in one location — it works in every location. So…

Gary Takacs: Well, you know, a cornerstone to our coaching, um, is benchmarking — scientifically benchmarking, right?

Um, the renowned management consultant Peter Drucker — you recognize that name, Naren, of course — and I imagine there are, all of our listeners, many of our listeners will recognize his name. He’s considered by many to be the father of modern-day management theory.

And what Peter Drucker said is, "You can’t manage what you don’t measure," right?

And think about that for a minute. You know, that applies clinically too. I mean, you know, think about what you’re doing every day clinically, doctor — if we’re not measuring things, then it’s, it’s kind of, you know, blindfold. Well, same thing on the business side of the practice — you can’t manage what you don’t measure.

And one of the goals we have for our, for our clients is: ideally, we’d like one-third of the total practice collections to come from the hygiene department. One-third, right?

And, uh, I will say, that requires a sharpening your pencil to do that. Because our average when a client comes to us — it’s in the very low 20 percentiles. Twenty-one percent.

Naren Arulrajah: I just wanna ask you this question. You have been doing this for 45 years. What’s the difference when you have one-third coming from hygiene, uh, and, you know, perio?

Gary Takacs: The, the — you know, I don’t know that we have time, you know to cover in this podcast interview…

Because I could go on for that for hours, but let me just hit the high points.

First of all, if you have one-third of your production coming from hygiene, it means that we’ve got more of your patients engaged in regular recare. Uh-oh, right? I think the words we use are important there, and I’ve never liked the word "recall." Recall is something that Detroit does for bad health.

Gary Takacs: Like, we have to recall this ’cause it doesn’t work. Um, I like "recare." Uh, right? It’s, it’s — yeah — it’s a euphemistic way to say it, but I like that.

But if you’re hitting a third, that means more of your patients are involved in active care, right? That means your patients are healthy. So let’s start there — your patients are more likely to be healthy.

I mean, we all know what happens to a patient’s mouth if they start to stray. I like to tell patients, "Hey, one of the reasons we wanna see you on a regular basis is we know if we see you on a regular basis, we accomplish two things: we keep you as healthy as possible, and we reduce your future dental expenses because we can find things early before it becomes something more complicated." So now they’re on board.

So one of the byproducts — if a third of your practice comes from hygiene — it means more of your patients are drinking the Kool-Aid about seeing you on a regular basis, which means they’re healthier. Which I hope, on a philosophical level, that makes you feel good, right?

Naren Arulrajah: Absolutely. 

Gary Takacs: Forget……the money for just a minute. Forget the economics for just a minute. But — also, if we’re gonna experience a third coming from hygiene, it means that our perio department — with conservative periodontal therapy within the hygiene department — is firing on all cylinders.

This is an area — that’s where we’re gonna get deep on this podcast — because many practices have seriously untapped potential on what percent of their patients should be treated with conservative perio therapy.

The data that we use — and it’s been well published and well supported — is we’re looking for 30% of the adults in your practice. Remember, we can’t manage what we don’t measure, right?

We’re looking for 30% of adults. Perio disease is largely a disease of adults. There is such a thing as juvenile periodontitis, but that’s really an outlier — you know, an unusual situation.

Naren Arulrajah: Do you see this as early as, you know, twenties, or usually like 30s, 40s?

Gary Takacs: No, it can be late teens. Okay? Late teens. It’s an adult — you know, we think about who’s an adult. We classify an adult as 17 and older, right? We use a different definition than the conventional definition of adult as being 18 or older, right? But yeah, it can be late teens — especially late teens that, that don’t have a relationship with the toothbrush.

Naren Arulrajah: I know some of those.

Gary Takacs:I bet you do. Yeah. You might have had a couple of those in your house.

Naren Arulrajah: I’m exaggerating, actually. They’re pretty decent, but yeah. But I’m sure they can do better.

Gary Takacs: They can do better, yeah. But we’re looking for 30% of the adults. And now we have a benchmark.

And recently, I’ll give you a perspective — a client of ours, a newer client starting in coaching — I said, "How do you think you’re doing with conservative periodontal therapy?" And he says, "You know, Gary, I think we’re doing pretty good. You know, we went to one of those courses a few years ago, and we kind of — it gave us a chance to all get on the same page and, and have protocols in place, and have a system for treating it. I think we’re doing pretty well."

I said, "Well, I actually have the data. Would you be interested in the data?"

You know, we’re looking for 30% of the adults in your practice being treated with some mix of four codes. By the way, the four codes — just for the nerds that are listening to this — which I think it’s safe to say that all of our listeners are nerds, right?

Naren Arulrajah: I mean, they like to learn, Gary. That’s why they listen to the—

Gary Takacs: That’s why they’re listening. Yeah. I’m using "nerd" as a term of endearment, right?

So 4341, 4342, 4355, and 4910.

So 4341 — quadrant of root planing.

4342 — is quadrant, but three teeth or less.

4355 — is debridement.

And 4910 — is perio maintenance.

It doesn’t matter what the mix of those codes are, but we’re looking for 30% of adults experiencing those codes.

So the doctor said, "I think we’re doing pretty well." Well, I had the data, and I said, "Doctor, let me tell you, I pulled this for the last six months in your practice." So six months is a long enough time to take out statistical anomalies. If I just did it for a month, there could be some, you know, statistical variation. But six months gives us a long enough time to sort of get a good benchmark.

And remember — the goal’s 30%. And, uh, his practice was at 8%. Eight percent.

Gary Takacs: And to his credit — we’re on Zoom — and he looked at me and he goes, "Wow, we suck at that."  

I loved his answer because it was honest, you know?

And so I went back, I said, "By the way, the two hygienists you have there — were they part of the training you did years ago with a perio consultant?"

He goes, "No."

And we started to kind of debrief this, and he said, "You know, I’m afraid that all that training we did has kind of slipped away." And he said, "I might be at least part of that."

You know, and so — so yeah. Well, we have — here’s the good news. The bad news is you’re at 8%. And the good news is we have untapped potential.

Naren Arulrajah: The good news always is like — the problem is an opportunity, isn’t it?

Gary Takacs: Nothing but blue sky ahead of us, man. We’ve got great potential. See, I’ve got two really good hygienists. They’re really good at this.

So that’s how we look at this analytically.

Well, I wanna recognize something. Um, and I have to tell you — I wish this was changing at a faster pace among the public. I wish the public had a greater understanding and interest in perio, and, uh, you know, how it affects them.

One of the realities of perio is that it doesn’t hurt.

Naren Arulrajah: Right?

Gary Takacs: It doesn’t hurt.

Gary Takacs: Let me, let me go on that for a minute. If it hurt—I don’t wish pain on anybody, right? But if it hurt, might we have a better response? They wanna get rid of pain. But if it doesn’t hurt—and there are some people that think, “Oh, everybody’s gums bleed.” Actually, that’s not true. But some people think that, right?

But here’s the other thing that gets in the way of it, and it’s another reason why the insurance companies are the bad guys. So now we present SRP—you know, scaling and root planing—and what the patient hears… That’s not the words we use, but can I tell you what the patient hears, Naren?

Naren Arulrajah: Yes.

Gary Takacs: “Oh, that’s a fancy cleaning. I just want the regular one.” So they’ll ask, “Does my insurance cover it?” Isn’t that like the phrase that causes every dentist to wanna pull their hair out?

Naren Arulrajah: Yeah.

Gary Takacs: “Does my insurance cover it?” Right? Okay. And you know, the answer is, “It depends. We’d have to look at your policy.”

“But if it doesn’t cover it, I just want the regular cleaning. I don’t want the fancy cleaning. I just want the regular cleaning.” Right? That’s the reaction that we get from a lot of patients. So how do we—

Naren Arulrajah: Can I—I have kind of an interesting perspective, because this is something real to me. I am one of those patients who’s on a, you know, quarterly perio plan. And once in a while, you know, they have done the laser treatment and stuff. So this is very personal to me.

And a couple of things I noticed, and I don’t know—I wanna ask you—is this true for the wider population?

I’m older, right? I’m 50 this year, so I’m not this 25—

Gary Takacs: You’re—you’re almost—are you using a walker yet?

Naren Arulrajah:   So I really care about my health because I think I’m at the phase of my life where my kids don’t wanna talk—I mean, they’re good kids, but they have their own life. They wanna do their own thing.

Gary Takacs: They don’t wanna do it with you or your wife, Dad.

Naren Arulrajah: Exactly. So I need to think about myself and what’s important to me. And definitely health is at the top of my list. And I assume a lot of people in their 40s and 50s—health moves up.

And also, I think after COVID, we really got attuned to health. And you know why? Like, I mean, who died of COVID or who got sick? The people who had other illnesses, right? Comorbidities, right, like they call it.

So I’m extremely aware of the connection between dementia—my dad had it—and gum disease. I’m extremely aware of heart attacks and gum disease, right? I’m very aware of it.

So they had me at hello. Like, they didn’t have to convince me. I don’t care if my insurance pays for it. I don’t care about any of this. Like, I’m like—they showed me something, and like where it should be in terms of numbers and what it is, and it was real. They took the time to measure everything and show me.

Like, they don’t have to convince me. I’m sold—even though it didn’t hurt.

Gary Takacs: You are the anomaly, Naren.

Naren Arulrajah: Okay.

Gary Takacs: It’s one factor. What do you think that factor is? What do you think it is?

Naren Arulrajah: Yeah, I guess, um, being able to afford it? Like not having to worry about money, right?

Gary Takacs: You’re a mortgage.

Naren Arulrajah: But I’ll challenge you, Gary, right? These are the people who are going on vacation and spending thousands of dollars. So they do have money too.

Gary Takacs: People spend money on what they want before they’ll spend money on what they need.

Naren Arulrajah: What they need. So we just have to make it what they want, right?

In other words, for me, not having dementia is a big deal. For me, not getting a heart attack is a big deal. So… well.

Gary Takacs: Let’s talk about the connections. There’s science—there’s massive science behind this, right?

I now know that if a patient has an infection in their gums—by the way, that’s how we should refer to it to the patient, right? “Naren, you have an infection in your gums,” right? And that infection isn’t just here—it isn’t just here—now I’m circling my mouth. It isn’t just here, it’s here—it’s circulating through your circulatory system.

And so, we know for sure there are five systemic issues that can be connected to an infection in your gums: heart disease, stroke, diabetes, preeclampsia/early-term birth, and certain cancers—oral squamous cell, but also pancreatic cancer.

There’s some emerging evidence—we have to be careful with language use here—there’s emerging evidence that shows there could be a connection to three more things: Alzheimer’s disease, dementia, and fertility.

Gary Takacs: So if your patient is of childbearing age—female—or they’re family planning, wanting to have kids, then having an infection in your gums can reduce the likelihood of fertility.

And it’s interesting because what we’ve found is, when we’re talking to patients about this—we talk about those things—and it might be the first time they’ve ever heard: heart disease, stroke, diabetes, early-term birth, cancer, preeclampsia. It might be the first time they’ve heard that.

And they still wanted to say, “Does my insurance cover it?”

And so we figured out, through our work with our clients, how to work around this. Let me get to that. And it’s cool, because it’s a way forward.

If a patient is coming to your office, we have at least one good thing in our favor, right? They’re coming to your office.

Naren Arulrajah: They’re—

Gary Takacs: They’re showing up.

Naren Arulrajah: That means they care about their health to some level. I mean, they—it took the level of time.

Gary Takacs: Yeah. At some level. Well, they wouldn’t be there otherwise. Yeah. Yeah. They’re here.

So we don’t wanna just say, “Well, you have to do this or go somewhere else,” because that would not make any sense, you know?

So here’s what we do: if they’re not ready to move forward with this, we have an honest—so I’ll roleplay as if I’m the hygienist, Naren, and you’re the patient.

“Naren, I’m concerned. You have an infection in your gums, and I’m concerned about that. And I understand you’re not ready to move forward with treatment. I understand and I respect that—it’s your mouth. You get to decide. I understand.

But can we agree that if something doesn’t change, then this condition isn’t going to get better by itself?”

And what will most people say? “Well, that makes sense.”

“Here’s what I’d like to do. I’d like to send you home with a power toothbrush. I happen to like, you know, the Sonicare—Philips Sonicare toothbrush. I’d like to send you home— you’ll have to buy that. Have you…"

Naren Arulrajah: Bought—I use one of those things that has lights. Now, I don’t know if you know what I’m—

Gary Takacs: It’s amazing.

Naren Arulrajah: Amazing. I love it.

Gary Takacs: So we tell—and it’s up to you, doctor, to decide as a listener—but I recommend you provide those toothbrushes to your patient at your cost. So if you know your cost is around $100, then they don’t have to go to Target and pay $189 for it. So you just say, "We can provide that to you at our cost. We buy them wholesale, it’s about $100. That’s what you would pay for it. We don’t mark those up."

"I’ll spend some time today showing you how to use that. And next time when you come in, we’re gonna revisit those measurements that we used earlier today, and hopefully we’re gonna see some improvement and celebrate that."

“Naren, are you willing to do that?” And if the answer is yes, then we send them home with a toothbrush.

Gary Takacs: If the $100 is still too dear, they don’t wanna do that, say, “I understand. We’re family people—we understand budgets.”

“Naren, I’m gonna send you home—free from us, a gift from us—an irrigator. A syringe with a tip, simple tip, with a sample-size bottle of Peridex—it’s Chlorhexidine, 0.12% Chlorhexidine—and I’m gonna show you how to irrigate those areas in your mouth where the pockets are deeper.”

“Doesn’t cost anything. I’m gonna ask you to be faithful about doing that morning and evening. And then next time when you come in, we’re gonna measure the results. And hopefully we’ll be celebrating progress. How does that sound?”

So one way or another—we’re either gonna send them home with a toothbrush or with an irrigator.

Gary Takacs: Now, next time when they come in, let me use a baseline. Let’s say the first time we had 20 bleeding points, there are 5s and some stray 6s, okay? Which would indicate disease.

Next time they come in, if they’re faithful, do you think we’ll see improvement? If they’ve been faithful, the answer is yes.

But it’s sort of, you know, we’re moving inches, and we need to move miles.

So next time they come in—remember, the baseline was 20 bleeding points, 5mm pockets, and some stray 6s. Now maybe we have all 5s, with maybe one area in the 4s now, and we have 14 bleeding points instead of 20.

So I can show you that side-by-side. I say:

“Naren, look at this. Progress. We’re making progress. You’re doing a great job with your home care. You’re better—you’re healthier today than the last time I saw you.”

But if I saw you the first time with those numbers—14 bleeding points, 5s, and an occasional 4—it still indicates disease to me.

And I would like to revisit doing scaling and root planing. What do you think?

Gary Takacs: And now, if you weren’t ready yet, we would alternate. So if you took the toothbrush the first time, then we’d send you home with the irrigator. And we’d have you use both, right? If you did the irrigator last time, now we’re gonna promote the toothbrush and say, “Next time when you come in, we’ll see.”

And maybe next time, we now have 12 bleeding points and mostly 5s and three or four 4s. And we say, “It still indicates disease.”

And what we’re doing is, we’re moving them incrementally along. And at some point, we say:

“Naren, I’m still concerned, because if I saw you for the first time today, it would still be showing disease. And I don’t want you to have disease in your mouth.”

Gary Takacs: Especially if we now knew a little bit about family history—family health history.

Naren, can I—if I knew about your father, right? Having dementia?

I might say, “You know, we also have to recognize your family heredity here.” And we’d ask:

“Let me understand more—anyone in your family have heart disease? Anyone have stroke? Anyone have diabetes? Any of the women in your family had early births? Any cancer?”

And now, when they start thinking about people that they—you know—are near and dear to, it hits home, right?

And so I think, like anything, some people will follow your recommendations just on the first—

Naren Arulrajah: So let’s say I’m a new patient. You guys find out there’s some disease, right? The very first contact we are having—and I’m in my 40s—and, you know, more than likely, I know you remember telling me, most people will have somebody in their family with one of these diseases.

Well, actually—how would you have that conversation, Gary? Like…

Gary Takacs: Those five things—heart disease, stroke, diabetes, early-term birth, and certain cancers, in particular oral squamous cell and pancreatic—statistically, 19 out of 20 say yes to at least one of those. Right? Nineteen out of twenty. That’s—

Naren Arulrajah: Can we role-play this, Gary? Like, let’s say you and I are having that conversation. How would we have it?

Gary Takacs: We actually have that conversation with them in the interview—when our new patient coordinator is going through the interview with them, right?

We say, “Hey, we know about your dental health—you’ve shared with me about that—but I want to know about your family’s medical history.” And when I’m talking about your family there, I’m talking about your blood relatives, right? Your parents, your grandparents, your aunts, your uncles, cousins, and so on—blood relatives.

“Is there any history of…” and we go through the five: heart disease, stroke, diabetes, early births, and cancer.

Now, you could do that—if you’re not doing that in an interview format, the hygienist can have that conversation.

“Naren, I want to know more about your family’s medical history because of the systemic connection between your mouth and your overall health.” And just have that conversation.

“Is there anyone in your family that has experienced heart disease, stroke, diabetes, early-term birth…”

Naren Arulrajah: I’m gonna say yes for dementia, and, you know, as well—

Gary Takacs: I didn’t ask dementia on those—

Naren Arulrajah: Dementia, okay. Heart disease—

Gary Takacs: Stroke, diabetes, early-term birth, and cancer.

Naren Arulrajah: Right.

Gary Takacs: I might go further and say, “How about dementia? Alzheimer’s? And has there been any history in your family of having trouble conceiving?”

There’s the eight questions.

Naren Arulrajah: And you can customize it, right? Depending on if the patient is a young lady—definitely bring up early birth. If, you know—so you can change it—

Gary Takacs: You can change it around, but I would bring up the five for sure: heart disease, stroke, diabetes, early-term birth, and cancer.

Naren Arulrajah: Do all of them—are all of them connected to gum disease?

Gary Takacs: That has been scientifically determined.

Naren Arulrajah: Oh, interesting.

Gary Takacs: They have a connection. It’s no longer that we have to tap dance around that and say it’s a possible connection. We do have to tap dance around the next three—because we don’t have the depth of the evidence yet—but we will have it on dementia, Alzheimer’s, and fertility.

We have to tap dance around those: “There could be a connection.”

Naren Arulrajah: So, like in my case, you’ll find out, you know, we have heart disease in the family—as well as, you know, we have, uh, dementia in the family.

So you would say, “Hey, is this something you want to work on preventing?” Right? And then you can really get into that and say, “Okay, here’s how we’re going to do that.”

Gary Takacs: And it hits home—because now we’re talking about people that they know and love.

Naren Arulrajah: Yeah. And trust me—the number one fear I have is getting dementia. And number two fear I have is getting a stroke or heart attack. I mean… well…

Gary Takacs: I think so. If you guys wanna—if our listeners wanna know more about this—read the book Beat the Heart Attack Gene. right?

It was written by a physician, Bradley Bale—Bradley Bale  is the physician. And in the book, it has a quote—one whole page of a quote—that says:

“All good health begins with the mouth.”

Naren Arulrajah: Right?

Gary Takacs: Now, here’s the bonus tip for all of our listeners—and have your daughter or son do this for you, ’cause you might not be able to do it.

Have your daughter or son go online and find a source that can print that up as a decal. As a decal:

“All good health begins with the mouth.” —Bradley Bale, MD.

And put that somewhere in your office—on a wall. Yeah. Put that decal up on the wall.

What do you think that’s gonna do, Naren?

Naren Arulrajah: It’s gonna change— I have a personal story, Gary. I had a friend of mine—this guy is 58. He works out 20 hours a week. I mean, you talk about healthy—he’s healthy. And he was five minutes away from dying because he had that heart attack gene.

And he was pissed—supremely pissed—that nobody told him about this. And then he went on a research binge and he literally met Bale, you know, the gentleman—it’s—

Gary Takacs: Bale and Doneen.

Naren Arulrajah: Bale and Doneen, yeah. He literally went to their clinic because he was just—he couldn’t believe this. Like, it just showed up from nowhere. And he had no idea, because nobody told him.

Gary Takacs: In fact, a good thing to do is to do that as a book club, doctor—with your team. Not just yourself—with your entire team.

Beat the Heart Attack Gene. You may be saving their lives. You may be saving their family members’ lives. And you’ll certainly be creating a practice where perio has a higher level of importance.

Well, Naren, this is something I’m passionate about. There’s been a great discussion in this Coaching and Action segment. Let’s amplify it by going into the Q&A segment.

Naren Arulrajah: Welcome back to the Thriving Dentist Q&A segment. This is Naren again. I learned a lot, Gary, from our topic today: A Strategy to Help Your Patients Accept Conservative Periodontal Therapy When Clinical Signs and Symptoms Indicate the Need.

Now, I have four questions for you. Let me jump into question number one:

There are times when my hygienists are providing regular prophy when the patients really need SRPs. How can I change this?

Gary Takacs: Well, first of all, what I want to tell the doctor who asked this question—he or she—is that this is probably happening in every practice, given the incidence of perio disease, and given the variety of how practices approach it.

You know, some offices are really, really committed to it. And other offices—it’s not even on the radar screen. So I think it’s highly likely, for any of our listeners, that you may have your hygienist cleaning teeth in a pool of blood and filing a prophy.

What’s the definition of a prophylaxis according to the CDT code?

It’s a cleaning in the presence of healthy gum tissue.

If we have blood—it’s not healthy gum tissue.

And I think sometimes it’s well-intentioned. The hygienist is wanting to help the patient. "Well, they’re not ready to do SRP, so I’ll just spend more time over here." It’s like putting a Band-Aid on a cancer.

What we need to do is—don’t beat up your hygienist. Don’t berate them for doing that. But say, “Let’s agree—maybe by adopting what we talked about in the Coaching and Action segment—let’s agree to be more candid with our patient about what’s going on in their mouth. And let’s nudge them forward. Let’s hopefully create change over time where they’re willing to move forward with this.”

But it’s very common.

Gary Takacs: In fact, if you read that book together—Beat the Heart Attack Gene—we did this as a book club in one of our clients’ offices. I was doing a one-on-one meeting with one of the hygienists. She scheduled a Zoom meeting with me, and the purpose of the meeting was to talk about their perio program.

So I wasn’t sure what was coming. But she comes to the meeting and says:

“Gary, I only scheduled this meeting so I could say thank you. Thanks for the work you’re doing with our practice—you’ve completely changed me.”

I said, “Wow, well first of all, thank you for doing this meeting. That makes me feel really good.”

She said:

“Yeah, I was one of those hygienists. I thought I was doing the patient good by spending more time over here. But I realized—I was part of the problem.”

And as she’s talking to me—we’re on Zoom, so I could see her—her eyes started to get glassy, and it got more serious. She said:

“Gary, after reading that book…”

She took a deep breath—

“…I am not going to let one of my patients die on my watch.”

And a tear rolled down her cheek.

She said:

“I need to change. I was the one that thought I was helping—I was an enabler.”

That was her word—not mine.

“I enabled it. Because by saying ‘I’ll just spend more time over here’—when they have a disease—and that time over here isn’t going to change that.”

Gary Takacs: But here’s what she said next:

“Another reason why I wanted to schedule this meeting is… these patients have been coming to me for years. I’ve been in this practice for 15 years. I’ve been taking care of some of these people for that whole time.

How do I now tell them they have perio disease when they’ve been under my care for 15 years?”

Do you think that’s a fair question, Naren?

Naren Arulrajah: Absolutely, Gary. That’s a great question.

Gary Takacs: I said, “That’s a great question. And first of all, I want to recognize your self-awareness. You said, ‘I need to change.’ So good for you.”

And then I gave her the verbal skills. I said:

“You look the patient in the eyes—because they love you—and say:

‘We’re constantly taking courses to learn the latest advances in dentistry.

And based on what I see in your mouth now, I have an obligation to share with you what’s going on.’”

And I said, “I don’t think any patient’s gonna say, ‘Hey, why didn’t you do something about this before?’”

But that’s how you respond to it. And by the way, no one ever said that. They just got on board. They said, “Oh, okay, that makes sense. Here’s what I would do now.”

Gary Takacs: It was such a cool meeting. Her self-awareness was amazing—I wish we all had that level of self-awareness. And her commitment to want to change herself.

Where did the change have to start? It had to start with her.

“I have to confront my patients. I have to deliver the bad news: they have periodontal disease.”

Of course, the doctor does too—diagnostically—but yeah, that’s the first step.

Naren Arulrajah: Gary, while you were speaking, I just Googled a question.

And my question was: Is there a link between gum disease and high blood pressure?

And Google says:

Yes, there is a link between gum disease (periodontal disease) and high blood pressure, with research showing that gum disease increases the risk of developing hypertension, and treatment of gum disease can help control blood pressure.

Gary Takacs: Yeah. That’s the link to heart disease, you know? Blood pressure.

Naren Arulrajah: High blood pressure is what creates heart disease, right?

Gary Takacs: It’s a contributing factor.

Naren Arulrajah: Contributing factor, yeah. I mean—there are so many ways to make it a need for people.

Like you said—people spend on what they want more than what they need. So we have to help them want it. It’s no longer a “nice to have,” right?

Gary Takacs: Yeah. Good point. Thanks for looking that up.

Naren Arulrajah: Thank you, Gary. Let me go to question number two.

Do you recommend having the patient sign an informed consent form if they reject periodontal therapy?

That’s a great question too.

Gary Takacs: It is a great question. And, um, I think the answer can be a little bit gray. I wish it was perfectly black and white, but it can be a little bit gray.

I don’t think there’s anything wrong with having an informed consent form that you ask the patient to sign. You tell the patient:

“I need you to sign this form to document that you’ve been informed.”

Because then it’s signed, it’s part of your file. You digitally scan that into your record, and you keep that as part of your legal documentation.

By the way—do you know what the number one reason why dentists are sued today, Naren?

Go ahead. Take a guess.

Naren Arulrajah: Uh… non-diagnosis of perio?

Gary Takacs: Exactly. Non-diagnosis of perio.

Naren Arulrajah: Wow. I didn’t know that.

Gary Takacs: There’s a significant amount of case law on this—where patients ended up losing their teeth because of periodontal disease and ended up suing their dentist for never diagnosing it.

And the evidence that was presented?

All the patient ever received in this dental office was cleanings.

And a cleaning—by the definition of the CDT code—is a cleaning in the presence of healthy gum tissue.

So yes, I think you do need to have a consent form.

Naren Arulrajah: So you’re saying it won’t be too long before somebody gets a heart attack and they sue the dentist?

Gary Takacs: Well… it would not take a very aggressive attorney to take that approach. Right?

Naren Arulrajah: Because there is science, right? I mean, they can just Google it—I just Googled it two seconds ago—and they’re like:

“Okay, what causes heart attacks?”

“This is one of the contributing factors.”

“Let me see if the guy had gum disease…”

“Okay—he did.”

“Was he ever told?”

“No? Okay…”

Gary Takacs: “Never told me.” Yeah. Now, that one’s a little bit loose because—

Well, if your office takes blood pressure—I do like taking blood pressure as part of a screening for patients—then you have the evidence.

“I’m concerned. We got a high blood pressure reading…”

But even asking the question: “Is there a history of high blood pressure?”—and if the patient says no—you document it. It’s documented, right?

Naren Arulrajah: Yeah, yeah. Exactly.

Gary Takacs: So yes, I would do that informed consent form. Have the patient sign it.

Because at least then, there’s no “You never told me” discussion. It’s there. You know it’s there.

Naren Arulrajah: Yeah.

Gary Takacs: Good question.

Naren Arulrajah: Question number three:

What is the best way to attract patients who understand the oral systemic health connection and therefore want to treat gum disease?

Gary Takacs: Well, Naren, I’m gonna toss that one to you—as the marketing authority.

What keywords and key phrases would you encourage being part of our landing pages around treating conservative perio therapy? What keywords and phrases would you put in there?

Naren Arulrajah: This is a great question, Gary. I think a lot of people are very aware of the oral systemic health connection. I’m aware of it…

Gary Takacs: I’ll challenge you a little bit on that one. I think it’s growing.

Awareness is growing—but I still think it’s a minority. It’s less than 50%.

If we did an interview on the street—you’re near Toronto—if we went to downtown Toronto and said, “Have you ever heard of the oral systemic connection?” I bet…

Naren Arulrajah: I mean, I think they may not know the phrase “oral systemic connection,” but I think people are starting to understand—hey, at least I did—heart attack and, you know… gums.

Gary Takacs: What about a phrase on your landing page that says:

“We’re an office that understands the oral systemic connection.”

Right?

“What that means is that the health of your mouth has an effect on your overall health.”

Just a phrase like that.

Naren Arulrajah: I mean, even like “oral systemic connection dentist,” “oral systemic connection near me,” or “gum disease and heart attacks,” you know?

Gary Takacs: Or “my gums bleed when I brush.”

Naren Arulrajah: Yeah—“my gums bleed when I brush.” And you can educate them on that.

Gary Takacs: So help our listeners understand how that might translate to a phrase or a word or a paragraph on the landing page.

Naren Arulrajah: Absolutely, Gary. I think I would take an all-of-the-above approach. So it’s not like one particular keyword—it might be a dozen of them.

Gary Takacs: Gimme one. “My gums bleed…”

Naren Arulrajah: Yeah—“gums bleed,” you know…

Gary Takacs: Gimme what’s on the landing page.

Naren Arulrajah: Yeah. So you could write an article about how bleeding gums could cause a heart attack or dementia.

That article would contain those keywords—and obviously, we’re going to mention the city you’re in, the town you’re in, and so forth.

Gary Takacs: I’d do it more directly. Maybe something like:

“Maybe you’re someone that experiences bleeding gums when you brush.”

That’s a match. That’s a 100% match.

Naren Arulrajah: Yeah, exactly.

Gary Takacs: It’s simple.

“Maybe you’re someone who experiences bleeding gums when you brush.”

Naren Arulrajah: Yeah—so “bleeding gums” is the keyword. And Google nowadays is very smart. So you can even search for related words or phrases to what you’re trying to find out—and then your content shows up.

Gary Takacs: Have blog posts around it. Have articles that you’ve written. You could cite scientific sources. You could also have…

Naren Arulrajah: We’re very big on blog posts and Google stories—where we can educate people on these topics.

Gary Takacs: Now here’s why I’m so excited about this:

How many websites have any information about this in the universe of dental websites?

Almost none.

Now you’re gonna be number one.

Naren Arulrajah: Exactly.

And not just in your town—but in so many other towns around you.

Gary Takacs: People will travel two or three hours to come to your office.

Naren Arulrajah: Exactly. If this is important to me—I’ll travel anywhere I need to go. Because you’re the one who’s talking to me about it.

Gary Takacs: But work with your marketing company. I’d recommend Ekwa—Ekwa knows how to do this. Build landing pages around the oral systemic connection. Build that out.

It’s not just one-and-done—you keep adding to it. So pretty soon, you’re the obvious choice.

And Google recognizes that—and makes you number one organically. You don’t have to pay for it. It’s organic.

Naren Arulrajah: 100%. I think that is a brilliant way to do this.

And if you want us to review how you are targeting patients who care about the oral systemic connection—or gum disease, especially severe gum disease—then talk to us. We’ll do a complete review at no cost.

We’ll tell you: Are you crushing it? Or do you need work? And if so, what you need to do.

The link again is ekwa.com/msm  for a Marketing Strategy Meeting.

Naren Arulrajah: Let me go to the next question, Gary—the last one:

I have four hygienists, and I feel the need to recalibrate my hygiene department so we’re all on the same page. How can I do this?

Gary Takacs: Oh wow, what a great question. This is like the bonus question—for extra points, extra credit.

If you have more than one hygienist—if you have two—it’s easy to be inconsistent between one and the other. You have four? Now it’s geometrically more difficult to always be on the same page.

So, anytime you have more than one hygienist, you need to recalibrate every once in a while and get everyone doing the same thing. Everyone understanding the protocols.

What’s our spot probing protocol?

How often do we do that?

What’s our new patient probing protocol?

Do we all agree on the case typing?

You know, there are four different case types. AAP—by the way, the American Academy of Periodontology—revisited the guidelines in 2018, and those guidelines are really, really good.

So I’d encourage you to follow those.

And then, once we’ve identified the case type, we all agree: this is the treatment that we’re going to do when we see this case type.

We train everyone on the verbal skills.

What about the ancillary services?

Do we recommend a site-specific antibiotic like Arestin?

Do we recommend a power toothbrush?

Do we recommend something like using lasers subgingivally to further decontaminate bacteria at the root surface?

Are we going to use something like salivary diagnostics to help educate our patients?

That’s where they swish in a cup and we get a bacterial sample, and we can use that as third-party validation of what’s going on in their mouth.

And you just have to spend some time with your hygienists and do a recalibration exercise. That might be a two-hour meeting between you and your hygienists—to get everyone on the same page.

Gary Takacs: Just understand: that’s not dysfunction if you’re not on the same page.

But what would be dysfunction is continuing to be uncalibrated.

Where—if they go to one hygienist, they get this, and if they go to another hygienist, they get that.

That wouldn’t be consistent with the way you’d want your practice to operate.

By the way, we do this all the time. This is one of the things that we do.

I do Zoom meetings with doctors and hygienists, and I lead the recalibration exercise with them. It’s a passion of mine.

And it’s amazing to see the difference—when that office that’s at 21% of practice collections coming from hygiene starts getting serious about perio, and we move up into that ideal of 33%.

But more importantly—our patients are healthier.

And you know—we talk about dentistry being life-changing.

Gary Takacs: This could be life-saving. I mean—how cool is that?

Well, get on board.

By the way, if you want to know more about our coaching, or want some help on this, I’d love to lead your hygiene team—along with your doctors—on recalibration. It’s a passion of mine.

Go to thrivingdentist.com/csm. 

That stands for Coaching Strategy Meeting.

It would be a one-on-one Zoom meeting between you and me. I get to learn about your practice, and we talk about our coaching and see if there might be a good fit.

But I’d love the opportunity to meet you on Zoom—if that’s your wish.

Well hey, Naren, this has been a fun, fun episode.

I hope this is one that goes viral. Maybe our listeners can help us make that go viral.

Gary Takacs: Share this with your colleagues.

Share it with the doctors you consider friends.

And maybe we’ll make this one go viral.

On that note, I want to take a minute and thank you all as listeners for the privilege of your time.

A quick reminder—coming up on October 24th is our 2025 RIDA (Reducing Insurance Dependence Academy) Annual Summit,

from noon to 5 PM Eastern Time.

Go to rid.academy to register.

No tuition.

You’ll get five hours of CE as a gift from us.

Come join us.

On that note, thank you all for the privilege of your time.

Naren and I look forward to connecting with you on the next Thriving Dentist Show.