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The concept of the Specific Plaque Hypothesis (SPH) has been advanced by Dr. Walter Loesche in 1976. 8 The significant statement is as follows:
“only certain plaques cause infections, because of the presence of a pathogen(s) and/or a relative increase in the levels of certain indigenous plaque organisms. The SPH requires that a diagnosis of infection be made so that prompt mechanical and/or chemical therapy can be initiated in order to restore the normal plaque flora.” This hypothesis is currently accepted as fact and is used to guide the diagnosis and therapy by many clinicians.

The requirement of bacteriologic diagnosis is one significant difference. When the clinician utilizes microbiologic testing, a measure of predictability of results is attained which was never before possible.
Keyes etal demonstrated that certain plaques were associated with periodontal disease and others were associated with periodontal health. He demonstrated the usage of morphotype screening using phase contrast microscopy to differentiate between health associated and disease associated dental plaques.15 Loesche developed the BANA test to detect pathogenic microbes which were statistically associated with periodontal disease. Those bacteria detected are P. gingivalis, P. forsythus and Treponema denticola. This test is used at chairside and takes approximately 10 minutes to complete including the 5 minute incubation time determined to give the best results. I have personally completed over 5000 samples with this test and I can vouch for its ease of use and practicality. 35