Corinna Moesle

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Mr. Starkey
Gifted English 8
26 February 2016

GCP Assignment #4: Interview

Palermo, Lisa. Personal Interview. 19 February 2016.

Lisa Palermo, DDS, Periodontist

The point of this interview was to procure information about some experiences and thoughts of the interviewee. This
is a word for word interview of me and Dr. Palermo that was done personally at her office in Reynoldsburg on
February 19, 2016. The interview took a total of twenty minutes to conduct.

Q: How do you treat mouth diseases, such as periodontitis and gingivitis?

A: Every patient is individual, so your treatment depends on a lot of different things. Your patient's history, what
your clinical findings are, what your gradi graphic findings are, and then deciding what treatment is best for that
patient. So theres not just one specific thing, you know one regionate like 1 2 3 4, its different for every single
person. We have a typical way we treat periodontal disease, remove any etiologic factors, which is plaque, that starts
with the initial cleanings and things like that. Then you have to reassess, you have to decide have there been damage
to the foundation, does the foundation need fixed, possible surgery. You can be doing bone grafting. You have to
look at the patient evaluate their medical history, its very important. The mouth is a window into the body. You
could have a patient who is diabetic, and if you dont identify that, the treatment is not going to work. Every day is
investigative. You are an investigator and an artist.

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Q: Do you have any favorite tools?

A: I call them my little, microscopic tools. Dr. Miller is famous from his grafting techniques, and he has little, tiny
micro tools I use when I graft. They are very fine delicate tools. My favorite thing other than that tool is the threedimensional scanning. Thats amazing. Its made me smarter. Its like youre snorkeling and all the sudden you are
scuba diving.

Q: Are there any tools you wish to have?

A: I am thinking more futuristic here; if I had a little microscope that could go down a longer bone, or be able to
see what kind of bacteria is in the tissue to make sure you get all the bacteria out and the bone. You dont know if
you get it all, and thats why some things will occur.

Q: Do you use any lasers for your work? What are your thoughts on them?
A: No lasers. There are a lot of camps on lasers. There are some groups who are big advocates for lasers, and there
are some that are not. Our organization, the academy of perio, does not advocate lasers. However, I think its up to
the practitioner to decide whether they want to use it or not. There is some good literature that shows that the laser
basically sterilizes the pocket, when we talked about bacteria getting into the tissue, the laser can sterilize the
bacteria in the tissue and the bone. The problem is that we dont know what the laser does to the tooth to support
underneath. We dont know; does it damage it long term, does it crack the problem short term and we see recurrence.
So the literature is still sort of sketchy, kind of a grey area. We do things that we know will work and we tell the
patient it will last term. We know our traditional surgical therapy will work, because weve done it. Yet we dont
know if lasers will work. There are a lot of questions.

Q: Have you experienced any big issues in the past you have learned from?
A: I would say that I have learned that you control over yourself and how good you are; you educate, you do the
best that you can so you can practice up to success. But some things you dont have control over, the people around
you and you can not let that affect how you work. You have to stay very focused and not let other things, business
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wise or staff wise, affect what you know how to do and what you are great at. You can get yourself very tense and
upset and it can affect your mental health. Also learn to take time for yourself, and what the most important thing is
your family. If you do that youll be better when youre here. It has nothing to do with what I do, I like to learn and I

learn more everyday. We learn from people and procedures we do and that we might think about it and do it
differently because we might want a different result. You kind of have investigate and work that out. Id say to look
at the bigger picture.

Q: Are there any areas of the mouth you are cautious of, such as nerves?
A: Sure, everywhere. Thats why you need to know your head-neck anatomy, inside and out. You need the three
dimensional scan, it tells us everything, where it shows the nerves. I know where to put in my implant from my three
dimensional scan. The nerves are everywhere. And you have to know your stuff. Most the time it is just textbook,
you know where it is supposed to be. But the floor of the mouth is probably the scariest. That is where a lot of things
that sit, that is the danger zone. So you have to be very respectful of that and know your limitations. Like the
pathology biopsies I send out to be evaluated, and its at the floor of mouth and back, off it goes.

Q: What suturing techniques do you use?

A: It depends, I actually call it my Palermo stitching because I dont really go off of the pictures in a book. I suture
depending on what Im trying to achieve and I think suturing is one of the most important things you can do. But
interrupted sutures. continued sutures, I do all kinds of stuff. The interrupted is the main one.

Q: What kind of implants do you use, like screws? Cylinders??

A: Sometimes I use different ones because they look better, especially in the front. I have my reasons why I use
them. One of them being doctor preference. Two would be the type of bone they have. Dense bone I could probably
use nobalmore and softer bone I would probably use asterism. So then again, each patient is individual. But those
two, I use those two.

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Q: Do you have to follow any laws, something to do with numbing?
A: No, there are precautions for numbing. Again it goes back to knowing the patient's medical history. Like some
patients can have some kind of arrhythmia, so we would have to find out what kind of arrhythmia it is. Maybe
theyve had a stroke. But we know that you can use between nine to eleven carpules on a patient. After that it is too
much. So you have to plan the treat the patient according to that.

Q: How long was the schooling for this job?

A: Okay, not including high school, it is eleven years. You have college, which is four, dental school, four, and
theres residency which is three.

Q: What tools do you prefer when you are doing bone reshaping?
A: Some sort of rotary instrument, so that you can get it done fast.

Q: Have you ever taken a piece of gum tissue from another part of the mouth other than the palate for a graft?
A: Yeah. I have. Way back behind the last second molars, theres really thick tissue. You can section it out and thin
it down its so thick and you can lean it back, its harder to do. If youre already dealing with surgery back there, and
you have tissue, you can take it and finish it so you can stick it where ever you need to stick it.

Q: What was the most difficult case you have ever had?
A: I would say one of my hygienist's dad. Because of his medical history, he had very atrophic mandible, means no
bone, we were doing hybrid on him. Brad was here and it took like six hours and I had very limited space to go.

Q: What kind of string do you use when you suture?

A: An absorbable gut suture, its actually from a pigs stomach, or a silk suture.

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Q: How can you tell when gums are inflamed?
A: Inflammation is red. But back to every patient is individual. Some pieces look like you have a mouth bleed. You
might have someone who naturally have red gums. You might have someone who is allergic to something that
causes a redness in the gums. I would say redness is not the full indication of inflammation. I would say that
soreness is a sign of inflammation, fluffiness, the size of it, what it looks like. All those things.