Periodontal Disease and Cardiovascular Disease

The Challenge:

A new patient who has neglected dental care for 20 years with a chief complaint of broken teeth and bleeding gums appoints to address his dental concerns.

The Background:

• Age: 70
• Sex: Male
• Last Dental Exam: 20 years ago
• Home Care: Manual brushing twice a day with occasional flossing.
• Chief Complaint: Patient is experiencing broken teeth and gingival bleeding without pain. However, the patient exhibits signs of dental anxiety.
• Clinical Assessment: Several teeth were planned for extraction along with restorative needs.
• Periodontal Assessment: Generalized 4-6 mm pockets with localized 7-9 mm pockets, inflamed and bulbous gingiva with generalized moderate plaque, as well as heavy subgingival and supragingival calculus.

Additional Comments: Due to a high blood pressure reading of 175/101 following the periodontal diagnosis, all treatment was halted, and he was referred for medical consultation

The Solution:

• Date of MyPerioPath^® (pre-therapy test): 1/24/2019
• Other Notes: Patient education focused on improved daily home care and the importance of the mouth body connection, specifically the connection between periodontal disease and cardiovascular disease.
• Periodontal therapy: The same day therapy consisted of four quadrants of scaling and root planing, irrigation with chlorhexidine and use of a SIRO diode laser.
• Systemic Antibiotic used: Metronidazole 500 mg for 8-10 days
• Home Care: Instruction included brushing twice daily, flossing nightly, and incorporating interdental brushes and a Waterpik^™
• Date of MyPerioProgress^® (Post-Therapy) Test: 5/1/2019

Additional Comments: Approximately 1 week following the initial diagnosis and after medical clearance, the patient began periodontal therapy. The blood pressure reading taken prior to the same day full mouth therapy was 142/92.

The Result:

The patient was very compliant with his home care routine and used the systemic antibiotic as prescribed. The second salivary test revealed a 71% reduction in pathogens overall with Aa, Pg and Tf all lowering to undetectable levels. The patient’s tissue health improved, now stippled and there is almost a 100% reduction in bleeding. The periodontal probe measurements all decreased to 2-3 mm with just one localized 5 mm on tooth #31 mesial remaining.  The patient’s high blood pressure is now medication controlled. His medical doctor attributed the initial elevated reading to dental anxiety. He has remained consistent with follow up periodontal cleanings and his oral health appears to be stable. It was amazing to see a patient who stayed away from dental care for two decades, because of fear, start to become a routine patient who understood the significance of periodontal disease.

About the Author:

Shawn graduated from San Joaquin Valley College; Rancho Cucamonga, CA and has been practicing dental hygiene since 2008. He is laser certified and emphasizes the importance of the mouth body connection through patient education. He is quoted “As my patient, you can feel confident that your oral health is my primary concern. Through high-quality treatment, we will establish and maintain great oral health. My goal is to make the dental office a fun and friendly place my patients look forward to visiting.” In his spare time, he enjoys photography, reading, nature, and most of all, spending time with his wife and kids.