Challenge: A new patient who has neglected dental care for 20 years with a chief complaint of broken teeth and bleeding gums appoints to address his dental concerns.
Background: A 70-year-old male patient with broken teeth and bleeding gums appoints to our office. His last dental visit was estimated to be 20 years ago. Surprisingly the patient was not experiencing dental pain. The periodontal assessment revealed generalized 4-6 mm pockets with localized 7-9 mm pockets, inflamed and bulbous gingiva with generalized moderate plaque, as well as heavy subgingival and supragingival calculus. Several teeth were planned for extraction along with restorative needs. His typical home care consists of manual brushing twice a day with occasional flossing. Patient education focused on improved daily home care and the importance of the mouth body connection, specifically the connection between periodontal disease and cardiovascular disease. A MyPerioPath® sample was collected on 1/24/2019 for oral bacteria evaluation. The patient exhibited signs of dental anxiety during the diagnosis and treatment planning; however, there was treatment acceptance due to the realization of how his oral health can impact his overall and cardiovascular health. Due to a high blood pressure reading of 175/101 following the diagnosis, all treatment was halted, and he was referred for medical consultation.
Solution: Approximately 1 week following the initial diagnosis and after medical clearance, the patient began periodontal therapy. The MyPerioPath® result report showed high levels of 9 perio-pathogenic bacteria. The blood pressure reading taken prior to the same day full mouth therapy was 142/92. The same day therapy consisted of four quadrants of scaling and root planing, irrigation with chlorohexidine and use of a SIRO diode laser. Home care instruction included brushing twice daily, flossing nightly, and incorporating interdental brushes and a Waterpik™. The MyPerioPath® lab report suggestion of a systemic antibiotic, Metronidazole 500 mg for 8-10 days, was prescribed. The patient was scheduled for a follow-up appointment where a second MyPerioPath® specimen was collected on 5/1/2019.
Resolution: The patient was very compliant with his home care routine and used the systemic antibiotic as prescribed. The second salivary test revealed a 71% reduction in pathogens overall with Aa, Pg and Tf all lowering to undetectable levels. The patient’s tissue health improved, now stippled and almost a 100% reduction in bleeding. The periodontal probe measurements all decreased to 2-3 mm with just one localized 5 mm on tooth #31 mesial remaining. The patient’s high blood pressure is now medication controlled. His medical doctor attributed the initial elevated reading to dental anxiety. He has remained consistent with follow up periodontal cleanings and his oral health appears to be stable. It was amazing to see a patient who stayed away from dental care for two decades, because of fear, start to become a routine patient who understood the significance of periodontal disease.
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- Case Study: Periodontal Disease and Cardiovascular Disease - February 21, 2020