Joel J. Piehl, DDS


I am still seeing repercussions from the news report several months ago from England saying that “flossing your teeth had no proven benefit” since there was “no published research” or “evidence based studies” to support its use. Coming from the UK, a nation not known for flawless smiles, this news report should never had been taken too seriously. Human nature being what it is saw many people latching on to this wonderful news that the chore of flossing was no longer necessary.

There’s no question that flossing makes a huge difference in your oral health.  Gum disease is almost always an inevitable consequence of not flossing. Further, we now have many studies that show a strong correlation between gum disease and medical conditions such as coronary heart disease, diabetes, premature births, stroke, cancer, osteoporosis, respiratory disease and premature births.  Examples can be found on the Academy of Periodontics website and

But not all floss is created equal.  Avoid the flavored and thick types of floss and stick to the thin, unwaxed versions that will do a significantly better job of removing the bacterial film or “plaque” that adheres to the teeth. You can actually feel the difference if you experiment with both.  Do not ever rely on the water jet devices to replace floss. When used improperly they can do damage to your gums! Please feel free to call us if you ever have any questions about any of this. 310-274-1428. Please encourage your loved ones to floss daily for their health sake!

The PinHole Technique can rejuvenate your smile. Patients love it because its quick, easy, scalpel free and suture free!

There has been quite a lot of chatter on the internet and the news media about a revolutionary method of reversing gum recession called the Pinhole Surgical Technique (PST) We constantly have people calling us who have heard about PST after finding us on the web and learning we were one of the first practices to offer this procedure which can reverse gum recession without incisions, sutures or the need to take tissue from other sites as grafts. The response from our patients who have had this procedure is always one of amazement at the immediate results and the relative ease of the experience. This has changed the way we look at gum recession because of how much easier and faster the process is for our patients.

The question most often asked is, “What is the difference between PST and the traditional method of dealing with gum recession?”

If you are one who has noticed a tooth seems longer then another, or there’s an unsightly discoloration at your gum line, often that is the most obvious sign of gum recession, which can directly lead to eventual tooth loss. In the past, a periodontist would be limited to a small section at a time because of the need to harvest tissue from another site and a limit as to how much tissue could be taken without creating too large a wound. This would mean two surgical sites with sutures to remove at a subsequent appointment as well as multiple surgeries.

PST is best comparable to arthroscopic surgery. A pinhole size opening below the gum allows me, with special instruments, to move tissue to cover the exposed roots, and maintain it in position without the need for sutures. This brilliant approach was invented by Dr. John Chao who trained me to perform this procedure.

This has been one of my most gratifying times as a practicing periodontist because of how I have been able to offer something to my patients that was previously too difficult or unachievable. If you or someone you know has receding gums, please visit my website: or call my office, (310) 274-1428 for more information.

Keep Flossing…

In case you didn’t hear the latest mind boggling news, the following is an excellent example of how common sense is over ruled by bureaucrats who are scientifically illiterate and incapable of thinking:

The British Dental Society concluded that flossing your teeth wasn’t necessary because there were “insufficient studies demonstrating its benefits.” That’s like saying we need more studies to prove that the sun sets in the west. (Have you noticed the prevalence of missing teeth in people living in England?) This flies in the face of overwhelming evidence seen in my practice and those of my colleagues that patients who don’t floss have gum disease while those who floss CORRECTLY have healthy gums. The studies that the British Dental Society alluded to didn’t take into account the way people were flossing which was probably being done incorrectly and therefore ineffective. (Many patients coming in to my practice do not floss correctly and must be shown the proper technique.) What’s worse, is that our own National Health Service (NIH) has come out questioning the value of flossing. This is your government at work! Remember, you know your symptoms better then anyone else. If your gums bleed and are puffy, chances are you need to floss and need to floss correctly.

In addition, the American Academy of Periodontology “recommends daily flossing as one part of a regular oral hygiene routine, which also includes brushing your teeth twice a day and ensuring you receive a comprehensive periodontal evaluation every year. The accumulation of plaque bacteria beneath the gum line may cause an inflammatory response which ultimately leads to gingivitis, a mild form of periodontal disease. If left untreated, periodontal disease can worsen, leading to tooth loss and increased risk for other systemic disease such as diabetes and heart disease. Flossing allows for the removal of plaque bacteria and debris from areas in the mouth that brushing alone cannot reach….Because the development of periodontal disease is slow in nature and because a variety of factors can impact its progression, studies that examine the efficacy of daily flossing are best conducted over a number of years and among a large population. Much of the current evidence does not utilize a large sample size or examine gum health over a significant amount of time. Additionally, many of the existing studies do not measure true markers of periodontal health such as inflammation or clinical attachment loss. In the absence of quality research, patients should continue to include flossing as a part of their daily oral hygiene habit.

June Blog

Proactive Patients Do Better in the Long Run

Study after study shows the connections between the health of the oral environment and the rest of the body. Yet, as a whole, dentistry referred more patients to the periodontist in the last 15 years of the last century than we have in the first 15 years of this century.

When patients are finally referred, there is greater disease severity and more tooth loss, which means greater systemic risk. Why? It appears that there is an economic motivation because of the way many dental insurance plans work. Dental insurance benefits have not increased to keep up with costs and many plans make it costly for the general dentist to refer to a specialist. This trend is also being seen with many other medical and dental specialties. The insurance industry is being shortsighted in its policies because this will ultimately increase their costs because of more severe problems down the road. It therefore is incumbent upon the patient to be more proactive about their care and request a referral to a specialist when they suspect it would be beneficial to them.

Sadly, a substantial portion of my new patients would have required less treatment had their referral occurred earlier. Bleeding of the gums when flossing, worsening gum recession, bad breath and loose teeth are usually signs of active gum disease that is not being effectively managed. Patients need not be timid to ask their doctor for a referral if they sense there is a problem.

I work closely with referring general dentists. We both appreciate our patient’s needs and our individual practice’s expertise. I am an expert in periodontal disease, implant placement, and pinhole surgical technique. I personally would refer my family only to an expert in all other dental fields.

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