Chronic Anterior Inflammation Finally Resolved

Challenge: The patient’s main concern was to reduce chronic inflammation around tooth #8 and #9. The patient previously had received treatment at a general dentist and a periodontist without significant improvement.

Background: A new female patient, age 28, was last seen by another dentist on 12/5/2018. Her home care consists of brushing twice daily with Tom’s of Maine® toothpaste and a Sonicare™ power toothbrush, and Crest® Pro-Health™ rinse with occasional flossing. Her family history includes breast and renal cancer, cardiovascular disease, high blood pressure and heart attack, type 2 diabetes, and Alzheimer’s disease. The patient expressed her immediate concern was the swelling and bleeding of the maxillary anterior. She indicated with frustration “This area has been addressed by various providers with no improvement.”

After clinical assessment which included radiographs, preparation and viewing a plaque sample slide, and full mouth periodontal assessment, these concerns were noted: generalized inflammation and bleeding with 3-6mm periodontal pockets, moderate subgingival calculus, and light generalized plaque. Radiographs revealed horizontal and vertical bone loss while the bacterial slide showed various organisms prompting the need to identify and quantify the bacteria present. An oral rinse specimen was collected and shipped to OralDNA® Labs for analysis for MyPerioPath® and Celsus One™.

Solution: At the first visit after reviewing the MyPerioPath® results, the therapy applied consisted of full mouth debridement, periodontal charting, Triology® serum, and full mouth ozone. The next day, the second visit, consisted of full mouth scaling and root planing, Triology® serum, and full mouth ozone. Please note although the lab report showed bacteria present, a systemic antibiotic was not utilized. Several adjuncts were added to her existing home care routine including the Viajet oral irrigator, Perioscript twice a day on water irrigator, smart floss daily, copper tongue cleaner, Triology® rinse and Olive gold (ozonated olive oil). A follow-up appointment was conducted 6 weeks post therapy where a sample for a MyPerioProgress® lab test was collected to measure and compare the impact of therapy to the biofilm. Periodontal maintenance was performed along with periodontal charting, Triology® serum and full mouth ozone.

Resolution: Upon assessment at the follow-up appointment, the pocket depth reduction and bleeding were reduced significantly and the interdental papilla between tooth #8 and #9 showed great improvement. Overall, the patient expressed enormous satisfaction with this resolution. The therapy produced a 9% overall reduction of the pathogens which was measured by MyPerioProgress® results.

With the minimal reduction of bacteria, but significant resolution of clinical signs, the emphasis is placed on the home care regimen and regular maintenance visit. Celsus One™ shows a minimal risk of relapse due to her own inflammatory response. The goal is to be able to establish home care habits to assist the patient’s remission and reinforce the need for recall, not just for oral health, but overall wellbeing.

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Daniela Yanez RDH
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