Periodontal Patient with Poor Diabetic Control Combined with Poor Home Care

The Challenge:

A periodontal patient of record is diagnosed with active periodontal disease. Therapy is needed to achieve a healthier oral state; however, the patient has uncontrolled diabetes and poor home care that may be contributing to the patient’s oral health status.

The Background:

• Age: 48
• Sex: Female
• Medical History: Diabetes, high blood pressure, high cholesterol, thyroid disease
• Last Dental Exam: 3/6/19
• Home Care: Not very diligent with homecare. Has PerioProtect^™ trays but does not use them regularly. Uses Peridex^™ daily. Patient does not floss regularly.
• Chief Complaint: Bleeding gums
• Other Notes: Blood sugars very high
• Clinical Assessment: Inflammation with bleeding, moderate calculus build up.
• Periodontal Assessment: Generalized 4-6mm pockets with bleeding on probing.
• Medical Assessment: Uncontrolled diabetes

The Solution:

• Date of Pre MyPerioPath^® (pre-therapy test): 11/19/2018
• Periodontal Therapy: Scaling and root planing
• Medical Therapy: Patient has nutritionist and diabetes counselor.
• Systemic Antibiotic Use: Doxycycline 100 mg bid for 8 days
• Home Care Instruction: PerioProtect trays, Peridex, CoQ10 and Vitamin D
• Date of MyPerioProgress^® (post-therapy test): 1/24/2019

Additional comments: The Systemic Effects of Oral Pathogens, page two of the MyPerioPath report helped in educating the patient that there were several bacteria that could be complicating her diabetic control.

The Result:

After therapy and a period of time for healing, the MyPerioProgress post-therapy specimen was collected on 1/24/2019. Upon periodontal evaluation after therapy, the tissue appeared to be healthier. There was a dramatic reduction of calculus and decrease in bleeding on probing. The patient’s overall skin appearance was improved and she indicated better control of her blood sugars.

I learned that we need to use OralDNA tests more often, so we can have an objective measurement of what the therapy achieved. The patient appreciated seeing the more dramatic changes in the biofilm. She realizes her periodontal status is delicate and it can impact her overall health. We will continue to monitor her compliance and administer another MyPerioPath when her disease state relapses.

About the Author:

Carter joined the Dycus Dental team in 2018. She graduated from Tennessee State University in 2015 and served as the class secretary. She moved to Cookeville in 2018 from Macon, Georgia.

Carter loves her coworkers and the family atmosphere at our office. She enjoys giving specific care to each of our patients and has a positive attitude and a smile on her face every day!

Carter married her husband Tre in 2015. When she is not at the office she enjoys traveling, exercising, reading and watching Tennessee Tech football games.