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

Kristi Case-Williamson RDH

Kristi Williamson, graduated from OIT in 2007 and has obtained an expanded functions and laser certification as a Registered Dental Hygienist. She has worked for Dr Mayes since 2013. Kristi is happily married with two kids and was born and raised in the Grande Ronde Valley.
Kristi Case-Williamson RDH

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11 thoughts on “Classic Periodontal Disease Reaches Remission

  1. Dr Tom Nabors says:

    Congrats on this very successful case. It was successful also because of your personalized treatment using appropriate meds for her unique disease. Please consider checking her family to help protect from relapse as we potentially discovery of others infected.
    Kind regards

    1. Kristi Case-Williamson says:

      Great point, I will ask more questions at maintenance appointments thank you

  2. Patti Cozby says:

    Love the results. How many antibiotics were prescribed and did the patient only take the antibiotic after the first visit of therapy?

    1. Kristi Case-Williamson says:

      2 antibiotics were taken for 10 days as recommended stated on first day of srp and was still taking at and after second half mouth completed

  3. Alan Orsborn says:

    How many weeks post systemic antibiotics was the second MyPerioPath test? You get nice results immediately following antibiotics, but a truer picture of whether or not remission has occurred would be seen one or two periodontal recall visits down the road.

    1. Kristi Case-Williamson says:

      4 weeks

      1. Alan Orsborn says:

        You’re still well within the window of antibiotic coverage. OralDNA says not to administer the MyPerioPath test within 6 weeks of any systemic antibiotic therapy because you will not obtain an accurate picture of pathogen levels. You cannot on the basis of these test results say that the patient is in remission for periodontal disease.

        1. Alan Orsborn says:

          Furthermore, the test was developed to assess the risk for systemic disease caused by oral pathogens, not as a measure of periodontal disease. The true microbiological picture of periodontal disease biofilm, of which the MyPerioPath test is a crude snapshot, consists of many, many more species than the 11 known to cause systemic diseases, and even includes yeasts and viruses. There are over 1200 different bacteria known to inhabit the oral cavity. 45% of these are known only by their DNA signature, we have know idea what they look like, what they do or if they are virulent. Our understanding of the complex microbiology of the mouth is in its infancy. I think the MyPerioPath test has a place, but we always need to be mindful of its limitations, and of ours.

  4. Kristi Case-Williamson says:

    Sorry, I need to make a correction. It was almost 8 weeks post antibiotic when the MyPerioProgress test was taken, not 4 weeks.

    1. Robert Wheeler says:

      The first perio path test was 10/4/18.
      The second perio path test was 1/15/19
      8 weeks between 2nd perio path test and last antibiotic dose.
      Could you give the dates of the 2 sessions of the root planing and scaling? Thanks
      Just looking at the timing of everything.

      1. Diane Larson RDH, BSDH says:

        An amendment was added to the blog to include the exact dates of therapy applied. Please review the amendment, now posted in the original blog.

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