Board Certified Periodontist

60 – The Pareto Principle

Pareto principle

Hi there. You are listening to The Perio Patient Podcast, a podcast for my patients and anyone else who cares to listen. My name is Dr. Ben Young and I am a periodontist in private practice in San Antonio, Texas. This is podcast episode 60 and I have entitled it “The Pareto Principle.”

A tooth has four distinct parts: Enamel, dentin, a pulp chamber or canal and the one most involved with periodontal disease, which is also microscopic and least known about or understood by the general population, and that is cementum. And as the name implies, it holds or cements something — and these are what we call periodontal fibers. Is it coming back to you? I hope so. It is the beginning of a story I have shared thousands of times with people who have come to me with questions about why their gums bleed, or swell — or why a tooth or teeth are beginning to feel loose. Fortunately, there is a great deal we can do to treat this condition and depending how early it is identified and addressed, it is often possible to achieve close to a reversible situation — at least in the short term. What do I mean by this? I mean that most everything we have encountered in the past with regards to infections and inflammatory responses to infections can return.

There is no vaccine for periodontal disease and immunity would be nice but in this situation can set up inflammatory responses that result in further bone loss. Now, I said we can often reverse conditions through treatment in the short term, but what is necessary to maintain health, in the long run, requires a change in daily actions which are out of the direct control of dentists and dental hygienists. What you do on a daily basis to take care of yourself and your consistent return to seeing professionals at an interval established to be a reasonable interval in your particular case are critical components to your health. I think it is the dental 80:20 rule. We have all heard this likely applied in many areas of life — things like 20% of people do 80% of — fill in the blank. So today, let me give you a little more detail on the 80/20 rule as it has come to be known. It evidently all started with an Italian economist by the name of Vilfredo Pareto and is known as the Pareto Principle, the 80/20 rule, the law of the vital few, or the principle of factor sparsity. He made the observation back in 1896 that approximately 80% of the land in Italy was owned by 20% of the population. He then did surveys in other countries and found similar results.

The concept with Pareto’s name as actually developed by a management consultant by the name of Joseph M. Juran. This all get’s into the quality management side of businesses that have continually been attempting to improve their systems. In computing, Microsoft noted that by fixing the top 20% of the most reported bugs, 80% of the related errors and crashes in a given system would be eliminated. Another one in this area is that 20% of the code has 80% of the errors.” Another in computing is in general 80% of a certain piece of software can be written in 20% of the total allocated time. Conversely, the hardest 20% of the code takes 80% of the time. Let’s look at sports. In baseball, the Pareto principle is reflected in what is known as Wins Above Replacement which is an attempt to combine multiple statistics to determine a player’s overall importance to a team — 15% of all the players in a recent particular year produced 85% of the total wins with the other 85% creating 15% of the wins. Some sports trainers believe that 20% of exercises and habits have 80% of the impact, suggesting that trainees should reduce variety of exercises and focus on a few more effective ones. Occupational health and safety professionals use the Pareto principle when focusing on hazard prioritization — They believe that 20% of hazards account for 80% of injuries and so these are the hazards most important to be addressed first.

Let’s go-to health. In health care in the United States, in one study 20% of patients have been found to use 80% of health care resources. For crime analysis, the study known as the Dunedin Study found that 80% of crimes are committed by 20% of criminals. For example, some criminals were taken off the street when they bypassed subway tokens and when arrested, the background check revealed that they were wanted other crimes like murder. There is even a Pareto principle for disease transmission where approximately 20% of infected individuals are responsible for 80% of transmissions. They are known as super- spreaders. In the reverse, the majority of individuals do not transmit viruses to very many people. Taking this a little further — we are more likely to become sick by the 20% we are around compared with the 80% we pass by or have very brief contacts with. Now back to my 80/20 observations. 20 percent of your long-term success in maintaining a healthy mouth is based on the work of professionals. Let that sink in. It’s only 20%. This doesn’t mean they are unimportant – only that they can only help recreate a healthier environment in the short run. After this, there has to be a management plan in order for health to be sustained for the long haul. Let’s reverse and look at it from the 80% now.

In order to sustain health, you have 80 percent of the responsibility and it involves two simple tasks. The first one is daily homecare. Neglect flossing even for a day in some people has the potential of restarting problems that then begin to snowball. That’s why I continue to say that the question of flossing is yes or no. Yes, if it is consistently accomplished every day without fail and no, or not yet if it has not reached this level of consistency. Remember, flossing doesn’t cure anything, only maintains a level of health — and only for a period of time until bacteria have colonized in the harder-to-reach areas. This brings us to job number two. You are in charge of managing your appointments – when you need to see your dentist or dental hygienist clean those areas you are not able to directly reach. You need someone else to disrupt the organized bio-film or plaque, which then forces those pesky bacteria to have to reform and regrow. Well, that’s enough for today. Please leave comments and tell me if you have any 80/20 rules you think about or use in your life.

This has been the Perio Patient Podcast and I am Dr. Ben Young. Thanks for listening. Bye for now.