Background: The patient is a 54-year-old female who presented with the chief complaint “My gums bleed when I brush, there are possible cavities and I don’t like the tooth crowding.” Her last dental visit was about 6 years ago. There is a family history of diabetes, cardiovascular disease, stroke and cancer. The home care consisted of manual tooth brushing 1-2 times per day with occasional antibacterial mouth rinse. During the clinical assessment, it was discovered that several amalgam restorations had deteriorating margins; recurrent decay was diagnosed by exam and radiographs. During the periodontal assessment, patient was classified as Class II Periodontitis due to all 28 teeth measuring 4mm probe depths with 1 localized 5mm pocket, 110 out of 169 points of bleeding and with radiographic horizontal and vertical bone loss about 1-10% throughout.
Challenge: Our goal is to establish a remission of the disease and achieve a healthier bacterial load to reduce any oral/systemic complications. Our goal will be accomplished through periodontal therapy and education.
Solution: We recommended an OralDNA® MyPerioPath® to identify the bacterial cause of the periodontitis and individualize the treatment plan. The specimen was secured on the initial exam date and results were analyzed June 15, 2017. The periodontal therapy consisted of 4 quadrants of scaling and root planning, subgingival doxycycline was placed in all areas and the administration of a systemic antibiotic to target the specific bacterial levels. The patient was instructed to use a chlorhexidine rinse at home 2 times per day. An additional MyPerioPath® was recommended post therapy and secured October 5, 2017.
Results: On October 5, 2017, the patient was seen for a 6-week tissue check. The patient’s home care now consists of using an electric toothbrush 1-2 times per day, flossing a couple times per week, utilizing a tongue scraper, and using the chlorhexidine rinse. The chlorhexidine rinse was discontinued after 2 weeks due to increasing sensitivity. The post-therapy periodontal charting was completed with 1 localized 4mm residual pocketing remaining and 12 out of 168 bleeding on probing points. The patient’s post-therapy Oral DNA® MyPerioPath® saliva sample was collected. A prophy, polishing, flossing was also completed. On October 10, 2017 MyPerioPath® results showed reduced periodontal pathogens. The pre-test showed 7 pathogens above threshold and the post MyPerioPath® showed 0 pathogens above threshold. Patient was called and results were reviewed, the patient will be seen every 3 months for periodontal maintenance. She received a copy of the MyPerioPath® results to give to her medical doctor.
We hope you enjoyed this throwback case study, it originally posted 1/5/2018.
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