Patient Background: A 41-year-old female patient is seen for a new patient exam. Her last dental appointment was 10 months ago. Today her primary concern is occasional bleeding gums with brushing. Currently, there are no medical conditions reported and no medications or supplements reported. The patient indicated she may be experiencing peri-menopausal symptoms, but this is not confirmed by a medical doctor. Upon dental examination, generalized 4mm to 6mm pockets were revealed with generalized bleeding on probing, and red, puffy gingival tissues. A family history of tooth loss and type 2 diabetes was divulged. The patient’s home care currently consists of 2-3 times daily brushing, and occasional flossing.
Introduce testing to the above patient.
Janice Kaeley DDS MSD: Patient, bleeding gums are not normal with brushing and is worrisome. Based on your family history of type 2 diabetes, the amount of bleeding I have seen during your exam, and the deep periodontal pockets, we need to see what is going on. This OralDNA® test is a simple oral rinse test that will give me insight into which bacteria are causing your problems. Based on your bacterial profile, we will decide whether or not to use an antibiotic and the report will provide a recommendation for the best choice. Now this antibiotic, or antibiotics, will be used with full mouth deep cleaning, or scaling and root planing. We will do one side of your mouth at a time with no more than 7 days between halves. Once the deep cleaning has been completed, we will do a re-evaluation in 4-6 weeks to see how your pockets have responded. A second oral rinse test will let us see the new bacterial profile. Based on those results, we may or may not recommend periodontal surgery. Don’t worry about the surgery yet – let’s focus on the deep cleaning first and if surgery is needed, we can cross that bridge together. Does that sound reasonable? In the meantime, I would highly urge you to see your PCP (primary care provider) for a physical and get some blood work done as well. Let’s be proactive about your health, especially because you have a known family history.
MyPerioPath® Test Results:
Interpret MyPerioPath® results for the patient.
Janice Kaeley DDS MSD: We have received your results. You are above the threshold levels for 7 of the 11 bacteria that were tested for and you are approaching the threshold for another 2. Based on the results, a recommendation of Amoxicillin and Metronidazole has been given. You will start your antibiotics the day of your first appointment and will continue for 8 days. Do you have any questions?
Janice Kaeley DDS MDS: We have received your test results and there is a 64% reduction in your bacterial load! I am so very proud of the gains you have made. Great job! I would like for you to keep up with your home care as you have been. We will still see you every 3 months for your periodontal maintenance, but we are definitely headed in the right direction.
I would like you to follow up with your PCP for your annual physical as I had mentioned to you in your consultation appointment. It’s very important for us to stay on top of your overall health. Diabetes and gum disease are very intimately linked, and at times we are the first to notice changes in your gums that may point to diabetes. With your family history, we need to be more vigilant. I would also like to do another salivary test in 12 months just to make sure we are still headed in the right direction. Does that sound like a fair game plan?
MyPerioProgress® is a comparison feature of the MyPerioPath® report. Starting June 1, 2021 properly linked previous and current MyPerioPath® results will be eligible for $20 off when ordered within 1 year (365 days). View the instructional video below for more information.
- How Do You Speak Testing? With Janice Kaeley DDS, MSD - June 4, 2021