Mia L. Geisinger, DDS, MS, is an internationally recognized periodontist, educator, and speaker known for combining clinical expertise with an engaging, interactive approach to dental education. She serves as Professor and Chair of the Department of Periodontology, as well as Director of Advanced Education in Periodontology at the University of Alabama at Birmingham. A Diplomate of the American Board of Periodontology, Dr. Geisinger lectures nationally and internationally on periodontal and peri-implant disease, the periodontal-systemic connection, and strategies for promoting oral and overall wellness. She has held leadership roles in the American Dental Association and the American Academy of Periodontology Foundation, and she currently serves as president-elect of the academy. Dr. Geisinger is celebrated for delivering evidence-based, entertaining continuing education while inspiring dental professionals to elevate patient care. She can be contacted via her website, miageisinger.com.
Q & A
Inside Dentistry (ID): What first drew you to periodontology—and what continues to excite you about the specialty today?
Mia L. Geisinger, DDS, MS: Before I went to dental school, I worked as a dental assistant. Both as a dental assistant and a dental student, I loved patient interactions in dentistry, and I was also drawn to the immediacy and healing capability of surgical procedures. Periodontology, in particular, offered the opportunity to regenerate oral tissues destroyed by disease as well as the chance to manage patients over a long-term period. The ability to address periodontal disease and inflammation, rebuild lost tissues, replace missing teeth, and improve patients’ oral and overall health are still things that I love about my practice and our profession.
ID: How has your understanding of the etiology and progression of peri-implant disease evolved, and how has that evolution shaped the way clinicians approach its prevention and management today?
Dr. Geisinger: One of the things that has changed in our understanding of periodontal and peri-implant disease progression and therapy is the emphasis on oral dysbiosis as an initiating factor for periodontal diseases and a focus on the importance of host modulation and pro-resolving factors in the treatment of these diseases. Previous disease therapies have focused on complete biofilm removal, including beneficial and pathogenic microbial species, and creation of a cleasible environment, but we know now that addressing the destruction of periodontal and peri-implant tissues that occur through the host immune-inflammatory response is also critically important.
ID: Given your work on peri-implant disease, what key clinical takeaways do you hope resonate most with clinicians as they translate this knowledge into everyday patient care?
Dr. Geisinger: Primordial prevention, which occurs before implant placement, and primary prevention, which happens before any signs of disease are detected, are key to managing peri-implant disease. We must treatment plan for success from the start and we must build regular, risk-based peri-implant maintenance procedures into our plans when patients are seeking dental implants.
ID: In your view, what are the most clinically meaningful updates in the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) classification system for periodontal and peri-implant diseases, and how well are they being implemented in general practice?
Dr. Geisinger: An advantage of the updated AAP/EFP periodontal and peri-implant disease classification system is the incorporation of risk assessment, through the grading portion, into periodontal diagnoses and the progressive nature of the classification system that reflects the progressive nature of periodontal disease that we see in clinical practice. Use of this system also allows for a precise and understandable communication tool with patients and colleagues and highlights the importance of early detection and treatment to reduce impactful and costly consequences of disease.
ID: How can dental hygienists and general dentists effectively bring their growing body of scientific knowledge—particularly around the oral-systemic connection—into meaningful, individualized patient care?
Dr. Geisinger: Often, our patients are not fully aware that oral inflammation and infection can impact their overall health and well-being. Dental healthcare professionals have a unique opportunity to educate patients and to provide care that improves the oral and overall health of patients. Incorporating a fulsome understanding of the connections between periodontal and systemic health and the potential impact that addressing periodontal disease can have on overall health can motivate patients to increase compliance with care recommendations, can improve our own job satisfaction, and can create opportunities for interprofessional engagement that result in benefits in the health of our patients and our communities.
ID: Which periodontal-systemic associations currently have the strongest evidence base, and where does the profession still need greater clarity?
Dr. Geisinger: Periodontitis has been credibly linked to over 57 systemic diseases and conditions. Some periodontal-systemic associations that have a robust body of evidence include the bidirectional evidence linking periodontitis and diabetes mellitus, cardiovascular disease and periodontal inflammation, and rhuematoid arthritis and periodontal disease and periodontal pathogens. Other systemic conditions that have been linked to periodontal disease include dementias, cancers, gastrointestinal diseases including inflammatory bowel disease, pregnancy outcomes and fertility, and overall mortality rates. It should be noted that causality is not well-defined for many of these associations and some of the mechanisms linking periodontal and systemic health are not fully elucidated. We also don’t understand how periodontal disease impacts the success of treatment outcomes for many systemic diseases. Widespread use of electronic health records that integrate dental and medical health data can help us better understand the impacts of periodontal health on all aspects of overall health.
ID: You’ve been closely involved in evaluating evidence. What advice do you have for clinicians working to navigate an increasingly rapid pace of emerging research?
Dr. Geisinger: It is a daunting task to keep up with the fast-emerging data on many areas in dentistry, including the periodontal-systemic connection. Continuing education courses, reviewing articles, and engaging in study clubs to improve and evolve the way that we assess and treat patients is a critical requirement for all oral healthcare providers.
ID: What role do you see precision medicine or personalized risk assessment playing in the future of periodontology? Are we close to integrating these meaningfully into clinical workflows?
Dr. Geisinger: I believe that as we have more integrated medical and dental data, our ability to predict disease outcomes and prescribe precision treatments will improve dramatically. In periodontal disease treatment, we are already evolving to incorporate adjunctive host modulation and microbiome modulation strategies like the use of specialized pro-resolving mediators, known as SPMs, and/or pre- and probiotic therapy to enhance treatment outcomes.
ID: Technology continues to reshape dentistry—from diagnostics to biofilm management tools. Which innovations do you believe are truly practice-changing in periodontics, and which may be overhyped?
Dr. Geisinger: Host modulation therapies and adjunctive biologics for regenerative therapy are true game-changers that allow practitioners to enhance outcomes, particularly in compromised patients. The enhanced imaging tools that we are able to currently employ also allow us a much greater ability to precisely treatment plan for periodontal and dental implant therapy in ways that can have long-term positive impacts on outcomes.
ID: You’ve emphasized the importance of the entire dental team in maintaining periodontal health. What are the most impactful ways hygienists can elevate their role in periodontal and peri-implant disease management today?
Dr. Geisinger: Periodontal health requires a combined effort between all members of the dental team and our patients. As dental healthcare professionals, we begin all care with the realization that the two most common oral diseases—dental caries and periodontal disease—are diseases of oral dysbiosis. If we then center the importance of patient-delivered oral hygiene, we can increase the success of all the dental treatments we provide. It is also critically important that we communicate this to our patients and engage them as co-practitioners to establish optimal oral health. Dental hygienists are on the front lines of establishing periodontal and peri-implant health, reinforcing home care practices, and identifying the earliest signs of disease. Patients also report that dental hygienists are the members of the dental team that they trust the most. Leveraging this trusted role to positively impact patients’ oral and overall health is an important role for all dental hygienists, whether they are in private practice, public health, or education. RDHs are true periodontal heroes for all of our patients.
ID: As an educator, how are you preparing the next generation of periodontists differently than you were even a decade ago?
Dr. Geisinger: All dental healthcare professionals, and periodontists in particular, are poised to see major changes in the ways that they practice driven by artificial intelligence, emerging technologies, advancements in scientific knowledge, and changing patient populations. Because of this, one of the most critical skills will be the ability to learn, unlearn, and relearn skills and knowledge over their practice lifetime. Creating dental healthcare professionals who are curious, engaged, patient-centered and motivated is more important now than ever before to allow them to continue to grow and thrive into the future of their careers.
ID: Looking ahead, what do you see as the most pressing unanswered questions—or “frontiers”—in periodontology over the next 5 to 10 years?
Dr. Geisinger: Enhanced understanding of the individual mechanisms of interactions between periodontal and systemic conditions and identification of specific therapeutic targets and endpoints will be critical to truly achieve precision periodontal care. Moving toward validated and reliable point-of-care diagnostics and true integration and medical and dental health data will enhance our ability to address disease at earlier stages and, hopefully, prevent some of the most dire consequences of delayed diagnosis and advanced disease.
ID: “Keep your heels, head, and standards high” is a great motto—how does that philosophy translate into your day-to-day approach to patient care and professional leadership?
Dr. Geisinger: The best teachers I have ever had were not easy on me. They had high standards and the firm belief I could reach them. I try to walk that standard every day for myself and those with whom I interact. That quote from Coco Chanel is a reminder that when you hold yourself, your team, and your profession to a high standard, we can all stand taller together and hold our heads high.
Figures and Images
Mia L. Geisinger, DDS, MS
