Perio Protect: Leading The Charge For Better Oral Health
Early in his career, Duane Keller, DMD, recognized the truth about recurring gum disease: It’s always the patient’s fault. “They didn’t brush, they didn’t floss, they didn’t do the things we asked them to do,” he explains. Treating his mom challenged him to think differently and put him on the path to developing Perio Protect.
In practice, Perio Protect seems deceptively simple. To reduce and control inflammation and the pathogenic microorganisms that cause periodontal disease, it uses an FDA-cleared custom tray, a specialized hydrogen peroxide gel, and a total of 15 minutes per day while the patient goes about their daily activities. While it doesn’t eliminate the need for scaling and root planing, it has been shown to make calculus easier to remove and to promote reduction of pocket depth and reduce bleeding on probing. All of which makes the management of periodontal disease much less burdensome and more comfortable for patients—not to mention the dental team.
Sounds almost too good to be true, doesn’t it?
How It Started
The 15-year development story of Perio Protect is one filled with “lightbulb moments.” However, the first, arguably, was not its creator’s, but his mom’s. “She had four quadrants of moderate to severe periodontal disease,” recalls Dr. Keller. “I treated the first quadrant with surgery, reduced the pockets, did everything we were conventionally doing, and we got results that were acceptable. I said, ‘OK, Mom, time to start surgery No. 2,’ and she looked up at me with her beautiful blue eyes and goes, ‘It’s not going to happen. Not in this lifetime. There are too many spaces between my teeth. I can’t eat anything cold, it’s so hard to clean. This is a nightmare. I’m not doing this three more times. There’s got to be a different way. Go find it.’”
Thus began Dr. Keller’s search for a way to treat periodontal disease that wouldn’t make patients flinch.
A New Approach to Periodontal Disease
The link to wound care was, in fact, yet another illuminating moment in Dr. Keller’s journey. “I had an opportunity to attend a chronic wound center meeting, and I think I was the only dentist in the group,” he relates. “The speaker made a comment that you cannot treat a chronic wound with acute wound modalities. You will not get the results you’re looking for. A huge lightbulb went off for me: No wonder dentistry has not been able to successfully manage this. We’re trying to treat a chronic wound with an acute disease modality. I sat in my room for, I think, three days and just rewrote the whole view of how we have to treat periodontal disease as a chronic wound.”
“A huge lightbulb went off for me: No wonder dentistry has not been able to successfully manage this. We’re trying to treat a chronic wound with an acute disease modality".
In treating a chronic wound, he explains, the first step is to control the etiology of disease—in periodontal disease, the infection—and then debride the wound. “In dentistry, we have that backwards,” he says. “We go in with scaling and root planing, i.e., debriding the wound, and we never control the etiology of disease. The Perio Protect system gives us the means to do that.”
That would involve the transformation of the wound environment from one that is conducive to biofilm creating anaerobic bacteria to a more aerobic one that is conducive to health and healing. Perio Gel is formulated to linearly release 1.7% hydrogen peroxide for almost 18 minutes, increasing the local oxygen saturation by more than 5 times. “We found that, right at 1.7%, you optimize killing the bacteria,” Dr. Keller says. “If you go higher, it doesn’t kill anymore. If you go a little lower, it’s not quite as effective.”
Benefits for Hygienists
Of course, Perio Protect is not a magic bullet to reverse the damage done by periodontal disease. Bone grafts, tissue grafts, surgical removal of granulomatous tissue, and scaling and root planing may all still be necessary in the treatment plan. However, the hygienist’s job can be made easier.
“Hydrogen peroxide denatures calculus,” Dr. Keller points out. “It makes it so much easier to remove. Also, the tray will deliver anything, so if you put in a topical numbing agent and have the patient wear it for 2 or 3 minutes before you start, they won’t even feel what you’re doing. We’ve been able to reduce the patient discomfort level to zero.”
Even if a patient’s periodontal disease has been fully addressed with an appropriate treatment plan and they are set up with Perio Protect to control it for the future, regular professional cleanings and follow-up remain essential to continued success. “Patients are going to be human,” Dr. Keller acknowledges. “They think they’re cured. They stop using the system. The periodontal disease comes back, because you don’t cure it, you manage it.”
“My hygienist runs all of this,” he adds. “The results she sees are phenomenal. Because when you treat the bacteria that cause gum disease, you also treat the bacteria that cause decay, and you then decrease the instance of recurrent decay. The whole concept of the industry, as long as I can remember, has been, ‘We need to prevent the cause of disease.’ Well, we finally have it.”
Benefits for Patient Compliance
Good home hygiene continues to be the cornerstone of preventive oral healthcare. However, with an estimated 80% of the U.S. population having some form of gum disease, adequate practice, as Dr. Keller observed, is clearly lacking. Yet no one wants to undergo surgery to treat periodontal disease.
Perio Protect solves this basic problem of human behavior by removing the need to…well, behave. Rather than requiring patients to actively dedicate more time to a technique-sensitive activity, it works while they are busy with other tasks—or even just sitting on the couch. As long as the patient remembers to wear the tray for a 10–15 minute period each day, the hydrogen peroxide can do its job. Most patients begin to see results in as little as 2 weeks. And if they stop using the system, the office can get an inkling of the lapse before their next visit.
“If you use the Perio Gel once a day, you should get about 6 weeks’ worth of medication out of a tube,” says Dr. Keller. He recommends that patients get refills of Perio Gel through the practice. “That gives the office a way to monitor whether you are being compliant with recommendations. None of these tubes that I’ve seen last for 2 years, so if you have a patient who doesn’t buy one for 2 years, guess what, they’re not using the method. Then you can politely and professionally say, ‘I’m not sure you’re getting the benefits. Let’s get you back in a little earlier, and let’s see.’”
Many patients, though, appreciate the treatment and are happy to comply with it. In fact, patient satisfaction was 100% in a controlled clinical trial. “It’s almost a continuous story,” says Dr. Keller. “Patients come back on a regular basis. The standard response is, ‘I can’t live without it.’ Because hydrogen peroxide cleans your teeth so well that if you don’t wear it for a day, you begin to feel disgusting fi lm start to build up again.”
Best of all, perhaps, from the patient perspective, is the aspect that Mrs. Keller challenged her son to fix in the first place: It doesn’t hurt. Many people fear going to the dentist because they anticipate pain or discomfort, which only contributes to the vicious cycle of periodontal disease. If you can help break that cycle with a treatment that is comfortable as well as effective, your patients’ trust in and loyalty to your practice will grow accordingly.
As a bonus, the reported “side effects” of Perio Protect are fresher breath and whiter teeth. Why wouldn’t patients stick with it?
The Patient Conversation
Many patients have grown accustomed to hearing that the only way to alleviate their periodontal infection is through repetitive scaling or surgery. So, learning about a comfortable and effective treatment like the Perio Protect Method is a fundamental shift for patients, especially those who may have grown hopeless about resolving their oral health issues.
“I love using the analogy of soaking dirty pots and pans in hot, soapy water to explain the Perio Protect Method to my patients,” says Kelly J. Blodgett, DMD, NMD, who maintains a private practice in Portland, OR. “Just as doing so makes the hard, baked-on food wash away easily, the Perio Trays and Perio Gel soften tartar and plaque deposits on their teeth so that dental care—both in the office and at home—is much more predictable and easier on their bodies.”
For Dr. Ilenne Noetzel, a Perio Protect provider in Chicago Heights, IL, who practices alongside her husband, Dr. Joseph Noetzel, the oral-systemic link is an important factor in how she introduces Perio Tray treatment to her patients.
“For too long, dentistry has allowed bleeding to be ‘normal’ when brushing and flossing, even when—as clinicians— we know that this is a sign of bacterial overload and inflammation,” she said. “We explain this to our patients and educate them on the adverse systemic effects of an oral cavity that causes an inflammatory burden, as well as its connection to heart attacks, strokes, or dementia.”
Dr. Noetzel’s patients have embraced the Perio Protect Method as a treatment option, and the majority have been extremely compliant using Perio Tray therapy. Patients who had bloody 3-month recall visits are now having little to no bleeding at their 6-month recalls following treatment.
“We have had amazing results with the Perio Trays,” said Dr. Noetzel. For example, one of her patients had seen a periodontist and was told that he needed extractions, bone grafting, and implants at a cost of over $10,000. “After 10 months of wearing Perio Trays with Perio Gel and Vibramycin twice a day for 15 minutes, he grew bone around those teeth—stabilizing them without surgery. We were always told in dental school that you can’t grow bone back. Well, Perio Trays prove that wrong.”
Protects More Than the Mouth
Because oral health and systemic health are inextricably linked, treatment of periodontal disease has the potential to affect and be affected by other conditions, such as cardiovascular disease and diabetes. By exerting its antimicrobial effect locally, Perio Protect avoids interaction with other drugs patients may be taking, and by reducing the presence of infectious microbes, it can help support and improve patients’ overall health. “It’s safe and reliable as heck,” Dr. Keller notes. “I don’t think we’ve had one patient who has suffered any ill effects from it. I cannot think of a patient who wouldn’t benefit from it.”
In the post-antibiotic age, non-antibiotic options become even more important. Combining peroxide-based Perio Tray therapy with laser therapy, and even adding probiotics, just makes good sense. This can be especially important for patients with comorbidities who don’t want to take oral antibiotics.
"When you treat the bacteria that cause gum disease, you also treat the bacteria that cause decay, and you then decrease the instance of recurrent decay.”
Benefits for the Practice
Despite all its advantages, Perio Protect cannot change the basic nature of periodontal disease: it is a lifelong condition that cannot be cured, only managed. Perio Protect is simply an excellent tool in the arsenal that your practice can offer as a service, in addition to existing treatments such as laser therapy and surgery. As Dr. Keller describes it, “It’s a tremendous boon. You still do the things that you’ve done. You still do scaling and root planing, etc., but this gives you the ability to give the patient the means to control the cause of disease, and maintain that long term and prevent recurrence. That’s really been the goal of dentistry since I got into the field over 45 years ago.”
Unlike initiating other services, Perio Protect does not require investment in extra overhead, whether it be staff, equipment, or even inventory. Once you’ve taken an impression and sent it to the lab, the rest is merely making sure that the patient receives their ordered trays and gel. You can also intervene earlier with Perio Protect, at the first signs of infection, and help more patients in your practice. And new patients seeking a Perio Protect provider can easily find your practice on the Perio Protect website.
Dr. Blodgett’s practice invested in a 3Shape TRIOS intraoral scanner and now only performs digital impressions. During its first year of scanning, the practice was able to add $100,000 in production by offering Perio Tray therapy alone, a process that is performed entirely by Dr. Blodgett’s dental team—from capturing the digital scan, to emailing it to the lab, to seating the trays when they return from the lab. “It was an absolute win for our patients and our practice,” he said.
“The whole concept of the industry, as long as I can remember, has been, ‘We need to prevent the cause of disease.’ Well, we fi nally have it.”
“This is one of those business deals that is a win-win-win situation,” Dr. Keller stresses. “The practice is going to win because you have a method that works, you have a product that you can sell to the patient that’s going to have long-term usage. And you can talk to them with the assurance that they’re going to get the benefits they deserve because you can deliver a medication to the source of infection.
“But the biggest winner is the patient. They now have something they can use at home, so they can control the cause of their disease and restore it to a healthy condition.”
A Proven Treatment Getting
started with Perio Protect certification is simple. Online webinars and self-study options for multiple team members are available to accommodate any schedule, and an annual CE-accredited meeting offers in-depth information on the science, implementation strategies, and more. Perio Protect’s provider website also offers marketing materials and assistance for certified providers to get the word out to their patients.
It’s an opportunity that Dr. Keller never imagined. “It’s humbling to stumble into something like this,” he says. “This was a matter of basically development by trial and error. We would do something, get a result, and have to go find out why that worked. ‘Oh, you mean hydrogen peroxide is better at controlling these bacteria than an antibiotic? Because I thought it was going to be an antibiotic.’”
And as with any new development in medicine, it has taken time to be accepted and adopted. “It takes an average of 20, 25 years for a new idea to make it into medicine. It’s a professional’s responsibility to look on anything that is new with jaundiced eye. It’s in everybody’s best interest to take a look at it and see, ‘Does this make sense?’” Dr. Keller acknowledges. “We began to go to some of the key opinion leaders and they started getting the exact same results. That’s really the truth behind it now. We’ve funded extensive studies of multiple patients at research institutes. People don’t question it anymore.”
And what about Dr. Keller’s mom? “I did not do another surgery on my mom,” Dr. Keller says. “When she died at 93, she still had all but her upper left wisdom tooth.”
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