The Three-Tier Approach (Why 2/3 of Periodontal Healing Doesn’t Happen in Our Chair)
Inspired by Dr. Carrie Labritz
Once we’ve diagnosed a periodontal infection, and shown the patient the evidence through microscopy, photography, or salivary diagnostics, the next question patients ask (out loud or silently) is:
“Okay… now what?”
This is where the Three-Tier Approach becomes one of the most powerful teaching tools we have.
It frames periodontal therapy in a way that finally makes sense to patients and supports calibrated, confident conversations from every member of the dental team.
And the model that does this so elegantly comes from biological dentist Dr. Carrie Labritz, who laid out the framework in a way that is simple, memorable, and incredibly effective for patient understanding.
Let’s break down why each tier matters, not the how-to steps, so your team has a framework that sticks.
Tier One: What We Do in the Office
The part they expect. The part they value more when we explain it well.
Tier One is the clinical intervention, the work that happens once we’ve shown them the infection.
And here’s the key message they need to understand:
Tier One is where healing starts, not where it ends.
This is also where you get to highlight the investments you’ve made as a practice:
• Microscope
• Laser
• Ozone
• Antimicrobials
• Guided biofilm therapy
• Specialized periodontal workflows
These aren’t “extra gadgets.”
They’re tools we use because you invested in delivering a higher level of care — not to sell products or procedures, but to give patients the best chance at controlling an infection that affects their whole body.
Tier One shifts the microbiology.
But it cannot maintain that shift on its own.
Which leads us to the human part.
Tier Two: What They Do at Home
The hardest part — but also the most powerful.
Two big truths your patients need to hear:
Healing requires daily disruption of the infection.
Human behavior is messy. And that’s normal.
Even after a heart attack, only 4–5% of patients sustain the three biggest lifestyle changes (diet, smoking, exercise).
So expecting perfect daily oral habits? Not realistic.
But consistency?
Small steps done regularly?
Understanding why their home care matters?
That’s doable.
Tier Two is where we remind patients:
“You’re not a passive recipient of care. You’re an active partner in your healing.”
When they feel ownership, not shame, the entire process changes.
Tier Three: The Immune System/Medical History
The piece most patients have never connected to their gums.
Patients always think the problem lives in their mouth.
We know better.
Their immune system, influenced by diabetes, hormones, stress, sleep, nutrient status, autoimmune conditions, and more, determines how aggressively they react to the same exact bacteria as someone else.
Same bugs.
Different body.
Different response.
When patients understand this, they stop thinking:
“I must not be brushing well enough.”
And they finally see:
“My body is struggling with an infection, and my medical history affects how well I can heal.”
This is where the big lightbulbs flash.
What This Model Works
The Three-Tier Approach changes everything because it:
✔️ Removes shame
✔️ Adds clarity
✔️ Creates realistic expectations
✔️ Centers the patient as a partner
✔️ Makes the treatment plan make sense
✔️ Aligns the whole team’s language and reasoning
And the biggest takeaway:
👉 We start the healing — but two-thirds of the outcome depends on the patient’s daily habits and their biology.
Stay Awesome!
Tosha, RDH
