Classic Periodontal Disease Reaches Remission

Challenge: Several years of periodontal neglect revealed significant disease.

Background:  A 48-year-old female, new patient presented with the chief complaint of a broken mandibular molar with swelling that resolved temporarily when taking antibiotics for a sinus infection. The patient reported it has been several years since receiving dental care. The CT scan showed several teeth with periapical abscesses and furcation involvements. The periodontal assessment, including radiographs revealed generalized horizontal bone loss, localized vertical bone loss and generalized moderate to severe sub gingival calculus. The medical history noted an autoimmune form of arthritis and multiple sinus infections.

Solution: A pre-therapy MyPerioPath® was collected on 10/4/2018 and reviewed to determine a treatment plan. It was determined that scaling and root planing with an ultrasonic, iodine flush, ½ mouth at a time. Following the first ½, the patient began the systemic antibiotic regimen recommended in the MyPerioPath® results. Along with the systemic antibiotic, the patient was instructed to take a systemic probiotic 2 hours before and after the systemic antibiotic dose. The home care instructions consisted of electric toothbrush 2x/day, swishing with an antiseptic rinse 2x/day for 30 seconds, then no rinsing for 30 minutes after and proxy brush daily. Several extractions occurred after periodontal treatment. A post therapy sample, MyPerioPath®, aka MyPerioProgress®, was collected 1/15/2019.

Resolution: At the post-therapy appointment the tissue appeared pale pink and firm. There was no soft plaque present, as the patient was compliant with home care instructions. The success of this case is directly related to the patient’s compliance of completing all proposed treatment in a timely manner. Prior to treatment, the patient had failing teeth due to localized severe periodontal disease. By removing the teeth, starting the appropriate systemic antibiotics (recommended on the MyPerioPath® report) in conjunction with the scaling & root planning, we were able to stabilize her periodontal health. With the comprehensive treatment completed in a chronological order, there was not any time for cross contamination or re-growth of bacteria, therefore eradicating the periodontal infectious bacteria.

Amendment: There have been several comments regarding the timeline. Here are the exact dates extracted from the original case study submission by Kristi Case-Williamson RDH.
• Pre-therapy MyPerioPath® secured 10/4/2018
• 1st ½ of periodontal therapy applied 11/13/2018, started systemic antibiotic recommendation
• 2nd ½ of periodontal therapy applied 11/20/2018
• Post-therapy MyPerioPath®-MyPerioProgress®-secured 1/15/2019

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Kristi Case-Williamson RDH
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