Relapsed Periodontal Maintenance Patient with Breast Cancer

The Challenge:

A periodontal maintenance patient of record presented past due for re-care. The initial exam revealed signs of active periodontal disease indicating that the patient is no longer in periodontal remission. Medically, the patient is undergoing treatment for breast cancer.

The Background:

• Age: 54
• Sex: Female
• Medical History: Hysterectomy; Breast cancer diagnosed Spring 2019, Cancer treatment included surgery and chemotherapy; cold sores; heart murmur; psychiatric care; ex-smoker
• Last Dental Exam: 6/05/2019
• Home Care: Fair/poor
• Chief Complaint: "I have slipped with my home care since all of this medical stuff happened."
• Periodontal Assessment: 1-5mm generalized pink and brown pigmented (due to ethnicity) attached gingiva; rolled gingival margins; blunted papilla
• Medical Assessment: Patient presents as ASA 2; active, mobile, trying to improve health since cancer diagnosis

The Solution:

• Date of Pre MyPerioPath^® (pre-therapy test): 8/19/2019
• Periodontal Therapy: Localized scaling and root planing to 5mm, Atridox^® application to reduce inflammation
• Systemic Antibiotic Use: Not used due to insignificant levels of bacteria
• Home Care Instruction: Instructed to use Waterpik^®

The Result:

I submitted this case study before the patient returned for the re-care appointment because I wanted to highlight how the MyPerioPath results streamlined my therapy. Originally looking only at the clinical signs of disease, I would have assumed there was a significant bacterial cause and both myself and the patient were prepared to include systemic antibiotics in the therapy. However, when the MyPerioPath results showed minimal bacteria, I then understood most of the inflammation was due to what the patient was experiencing in her overall health. I was able to provide personalized therapy for this patient.

About the Author:

Maria is a 2013 graduate of dental hygiene from Community College of Baltimore County, Dundalk. She is a licensed registered dental hygienist in the state of Maryland and currently working for a private practice in Annapolis. In her free time, she enjoys rock climbing and riding dirt bikes with her fiancé Chris.