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‘She Refuses Surgery, Now What?’

Award Winners: Dr. Caron Glickman & Barbara Tritz RDH. in Duvall WA.

Dr. Caron Glickman & Barbara Tritz RDH

When a patient comes to a dental office with a serious case of gum disease but refuses to see a periodontist or to accept any surgical intervention, what happens next? “You do your best,” says Dr. Caron Glickman, the first two-time recipient of the Orkos Award for excellence in case study for the treatment of periodontal disease. “After patients are diagnosed with gum disease, we create a treatment plan and thoroughly review homecare instructions. This case study patient was a real challenge because she risked losing more teeth despite excellent homecare.”

“Our patient is a lovely woman who cares deeply about her teeth,” explains hygienist Barbara Tritz, “but her homecare doesn’t correlate to her bone and tooth loss.” Two molars were lost due to periodontal disease and others were at risk for loss. A few teeth were loose and the periodontal pockets, the spaces between the tooth and gum tissue, ranged from 4-8mm (1-3mm is normal). “This is too deep. Most often these kinds of problems are due to ineffective home care, but this patient has just about the best home care a dental hygienist could ask for,” says Tritz. “She brushes meticulously, flosses daily and tried everything we recommended, short of visiting the periodontist. No surgery! She was adamant.”

The patient first came to Dr. Glickman’s office in 2001. “She had very little calculus, almost no plaque, and her tissue was healthy and pink. It certainly did not correlate with the bone loss we saw on the radiographs,” explained Tritz. To try to understand the etiology of the disease, Tritz and Glickman sampled her plaque on a phase contrast microscope and submitted genetic testing. The genetic test came back negative. Spirochetes were noted on the microscope slide. To address the microbial challenge, Tritz followed irrigation protocols and Glickman prescribed antibiotics and adjusted her occlusion. “It wasn’t enough,” recalled Tritz, “we still could not control the bone loss.”

By 2011 the patient had grown tired of the daily irrigation routine and wanted to know if she had other options. She continued to refuse help from a periodontist. Her microscopic exam showed more spinning rods and spirochetes. “We needed to make treatment easier for her,” explained Tritz, “so Dr. Glickman prescribed periodontal trays (Perio Trays®, Perio Protect, St. Louis, MO).” Perio Trays place medication deep into periodontal pockets to fight the bacterial infections that induce gum disease. The patient accepted the tray therapy and has worn her trays twice daily, 10 minutes each time, since 2011.

“Her compliance is excellent,” remarked Tritz. She still has impeccable oral hygiene with an electric toothbrush and dental floss, but “when I analyze her current phase contrast microscope slide now, it is a barren wasteland. No bacterial activity has been noted. She feels her teeth have tightened up, and she’s extremely happy with the current results. We’re thrilled as well.”

For this excellent patient care, Dr. Caron Glickman and Barbara Tritz received the Orkos Award, a recognition from Perio Protect to encourage and celebrate the contributions of individual dental professionals treating patients with periodontal disease. According to Dr. Tanya Dunlap, Managing Director of Perio Protect, “Orkos’ is an ancient Greek word associated with the ‘Hippocratic Oath,’ and with this award we want to acknowledge dentists and hygienists who share our passion and our vision for effective, comprehensive oral care.” To receive the award, doctors and hygienists provide documentation for patients with significantly improved treatment outcomes. For this case, phase contrast microscope videography showed microbial reductions, probing charts indicated 1-4mm pocket depth reductions and radiographs confirmed bone stabilization after a prolonged period of loss.

“Our goal is to provide customized patient care that fits the individual needs of patients and help them keep their teeth,” explains Perio Protect Chief Scientific Office, Dr. Duane Keller. “Patients don’t always accept or can’t always afford the optimal treatment plans. This is one of those cases. Dr. Glickman and Ms. Tritz deserve the award for the extra attention and care they provided to restore the patient’s oral health.”

Learn about Dr. Glickman’s office at The details and data behind Perio Tray delivery is available at

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