Active Periodontal Disease with Multiple Medical Complications

The Challenge:

A patient with Multiple Sclerosis (MS) and active periodontal disease, was recently diagnosed with type 2 diabetes, will receive periodontal therapy. Currently, proper home care is limited due to the physical difficulties of MS.

The Background:

• Age: 58
• Sex: Female
• Medical History: Several years of MS led to partial left-side paralysis and the inability to use her left hand. To manage type 2 diabetes, metformin was added to a long list of medications which contributed to xerostomia.
• Chief Complaint: Xerostomia, physical difficulties challenging proper home care regimen
• Periodontal Assessment: Generalized 4-5mm edematous pocketing with generalized hemorrhaging

The Solution:

• Date of MyPerioPath^® (Pre-Therapy) and OraRisk^® Candida Tests: 4/17/2018
• Periodontal Therapy: Biofilm disruption via ultrasonic and laser. Ozone oil therapy applied. Due to the lack of dexterity, PerioProtect^™ trays were fabricated and to be worn for 15 minutes 2 times daily.
• Systemic Antibiotic Used: Amoxicillin 500 mg tid for 10 days and Metronidazole 500 mg bid for 10 days
• Home Care: Sonicare with a peroxide and baking soda paste, ProBiora^® oral probiotic and CloSYS^® Silver mouthwash
• Date of MyPerioProgress^® (Post-Therapy) Test: 7/13/2018

The Result:

The patient reported using the PerioProtect trays daily along with the other home care changes of an electric toothbrush and localized probiotics. Upon periodontal assessment, complete pocket reduction to healthier levels was noted with no bleeding. The clinical endpoint of absolute clinical sign reduction was complemented by a MyPerioProgress revealing all pathogens below the reference lines, a microbiological endpoint. Patient was placed on a 3-month recall. After a total of 9 months of periodontal maintenance, the patient announced she was no longer on metformin and her A1C levels were completely normal. Periodontally, the patient remained stable. The patient is very satisfied with the results that we as a team were able to accomplish.

About the Author:

Brie graduated from Western Washington University with a bachelors focused on Political Science and Sociology. Having grown up with her dad being a dentist and working in his office she felt compelled to explore the dental field. She moved to New York and completed an AAS in Dental Hygiene at SUNY Binghamton. She has been practicing dental hygiene for over 15 years. She has spent most of her career specializing in the treatment and rehabilitation of periodontal disease.

Brie has attended many courses and received several certifications in the different modes of treatment of periodontal conditions to be able to provide the most effective top-notch care.

Brie has attended several Bale/Doneen preceptorship courses and is listed as a provider for the prevention of Heart Attack, Stroke and Diabetes prevention program. Brie is a member of the American Academy of Oral Systemic Health. She focuses treatment around patients’ oral systemic health. This approach allows her to evaluate oral/systemic health based on lifestyle, diet, medications, systemic conditions, oral periodontal pathogens present in mouth tested via saliva sampling, inflammatory bloodwork, sleep patterns, and airway evaluation.

The modes of treatment Brie is trained and extremely experienced in allow her to provide the most optimal care to her patients. She is certified in laser assisted periodontal therapy, the use of an endoscope, supportive bone regenerating biological proteins, and individualized home maintenance care.