Periodontal Disease with a Patient Experiencing Vision Impairment

The Challenge:

Patient is experiencing recent vision impairment presented as Stage III Grade B, active generalized periodontal disease with localized severe periodontal disease in the maxillary anterior area.

The Background:

• Age: 36
• Sex: M
• Medical History: Patient reports recent vision impairment with the right eye. Under the care of the ophthalmologist, a diagnosis has not been found. No other systemic diseases or conditions reported.
• Last Dental Exam: Within 3 years
• Chief Complaint: Loose anterior tooth with mild discomfort.
• Clinical Assessment: Class III Mobility on teeth 8 and 10, no clinical findings of decay. Patient reports no history of trauma to the head or neck.
• Periodontal Assessment: Generalized 3-5mm probing depth with localized 9+ probing depths on teeth 7 and 8. Generalized bleeding in all 4 quadrants. Suppuration from teeth 8 and 10.

Additional Comments: Patient states he noticed loosening of teeth around same time as vision impairment. This occurred approximately 3 months prior to the dental exam.

The Solution:

• Date of MyPerioPath^® (Pre-Therapy) test: 12/21/2020
• Periodontal Therapy: Full mouth scaling and root planing, irrigation, and bacterial decontamination.
• Systemic Antibiotic used: Metronidazole 500mg 10 days.
• 6 weeks post SRP: Consult with Periodontist and extract teeth 8 and 10.
• Date of MyPerioProgress^® (Post-Therapy)Test: 02/18/2021
• 3 months post extract; cone beam computed tomography (CBCT) and evaluation for implants by periodontist. Areas of teeth 8 and 10 showed not enough bone for implant placement. Permanent bridge was recommended and completed for this patient.

Additional comments: During the full course of therapy, the patient discontinued the use of medication for his ophthalmic problems and reported a stabilization on vision loss. The patient’s ophthalmologist requested copies of our salivary diagnostics results to investigate further.

The Result:

There was generalized improvement in all 4 quadrants resulting in 1-3mm probing depths with no bleeding. The microbiological reduction of 67% resulted in his periodontal health. The patient has been able to maintain this periodontal health for one year and counting. The patient has been consistent with our recommendation of a 3-month hygiene care where a periodontal maintenance, irrigation and bacterial decontamination is performed each time.

Although the patient was unable to have implants to replace missing teeth 8 and 10, the fixed bridge #6-#11, along with stabilization of his vision has restored his self-confidence. This case has taught me to be confident with our treatment protocols. Even though this case had a twist–the vision impairment and the recognition of the loose anterior teeth—our treatment protocol had a positive correlation. This case supports the information we currently know about the Mouth Body Connection^™ is just the tip of the iceberg.

About the Author: