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Since extensive data indicate plaque bacteria can be transmitted between persons1-7, it is logical to conclude that infected family members or other persons outside the family can transfer the infectious bacteria to a treated patient rendering our treatment ineffective. Thus all persons who intimately contact our patient are screened with microscopic analysis and with BANA testing for disease associated bacteria and are treated simultaneously whenever possible.

The infectious disease nature of periodontitis is critical to understand and implement in clinical practice. We have noted many cases where spouses can reinfect each other and published data support this finding. Failure to account for this factor will reduce success rates considerably.

In our practice, all adults are screened and children with any symptoms are screened for anaerobic infections. Culture testing is not used routinely for screening but can be helpful for refractory or nonresponsive infections.

Newer tests are now available such as the Diamond Probe which measures sulfides in the periodontal pocket environment which can indicate proteolysis or active tissue destruction. As this and other testing becomes available and economical, the microbiologic risk analysis should become easier and less disruptive to the clinical routine. Patients will benefit because health professionals will make better prognostic decisions. Treatment will become more predictable and outcomes will be better than previous modes of treatment.