When utilizing salivary diagnostic testing, most cases we encounter will “fit the mold”. We will also encounter many unique cases where we must expand our horizons and consider other possibilities for our patients’ responses to treatment. In my career, I have found these types of cases to be the most rewarding. In my recent blog, MyPerioProgress®-Your Road Map, we reviewed a scenario where a patient’s periodontal therapy outcome and the bacterial profiles were not aligned after treatment – clinical improvement was observed but the post MyPerioPath® aka MyPerioProgress® revealed persistent high levels of bacteria.
Let’s look at a second possible outcome after periodontal treatment. The patient appoints for re-evaluation, and the post-therapy MyPerioPath®, MyPerioProgress®, reveals bacteria levels have improved but the patient is still having clinically evident inflammation. Some clinicians might ask, “What went wrong with the test? How can the bacterial levels be lower but the patient still has inflammation?” The objective clinical laboratory test is indicating what is happening at this point in time and there is good news to consider. This post-therapy report shows the success of lowering the bacteria levels. So we can potentially rule out bacteria as the initiator of the inflammation. Now the focus of what is next for therapy would be to concentrate on other influencing factors of inflammation. For example, does this patient have an IL-1 or IL-6 genotype that predicts an accentuated inflammatory response? Is this a patient that will continue to exhibit inflammation even at lower bacteria levels? Do we need to strive for even further bacterial reduction? Consider the MMP3 genotype: 5A/5A could produce an increased local expression of MMP3 and predisposes the patient to chronic periodontitis. Would you want to consider more frequent re-care appointments for a patient with the 5A/5A MMP3 genotype? Additionally, consider that IL-1 (TT/CT), IL-6 (C/C) and IL-17A (G/G) genotypes predict a slightly enhanced immune response to specific pathogens. Is this patient genetically wired to have an immune response to lower levels of bacteria than a person with a “normal” genotype? Will it take them longer to respond to the lowered bacteria levels?
Other known modifiable contributing factors should be considered such as stress, nutrition, oral care, oral products, probiotics, etc. Is this a patient that may need to be co-managed with a periodontist? Would you want to start a conversation with these patients’ primary care doctors? Are there medications that could be contributing to chronic inflammation levels? Would you consider referring these types of patients to other health care providers such as a health & wellness coach, nutritionist or functional medicine practitioner? Are there other factors that you are unaware of?
I will share the stories of two patients I encountered in my clinical career where both post-therapy MyPerioPath®, MyPerioProgress®, reports showed dramatic reduction of bacteria but both patients still had significant clinical inflammation. One patient eventually revealed to me that during and after periodontal therapy, she had been under tremendous stress due to a very traumatic situation that involved domestic abuse. In talking with the patient, I encouraged her to seek out professional help. With the help of counseling, she began healing from her emotional and physical trauma and her oral tissues also gradually responded.
The other patient I treated, had excellent oral hygiene but his tissues never looked as healthy as I had aimed for. The MyPerioPath® report showed low levels of only a few pathogens. He was seemingly healthy except for a persistent skin rash that had been diagnosed as eczema by his primary care physician. The rash was being treated with topical steroid creams; however, his skin condition worsened and so did his oral inflammation. Eventually he was diagnosed and treated for psoriatic arthritis. After a more accurate diagnosis and appropriate treatment his skin improved and so did the oral inflammation.
While these cases may be anecdotal in nature, I believe they clearly illustrate that we as healthcare providers must utilize all resources at our disposal to help our patients attain their best health possible. The benefits of salivary diagnostic testing in cases like these are evident. Lab reports generated from MyPerioPath® and Celsus One™ tests help us to navigate our treatment decisions.
So rather than looking at unexpected test results and questioning what went wrong, let the lab reports help you make informed clinical decisions and in some cases direct you to look beyond the mouth. As providers, we never give up on our patients, so let’s not be quick to give up on laboratory testing when we don’t see the report result we expected.