Classic Periodontal Disease

Challenge: A new patient with poor home care and lack of dental attention presented wanting whiter teeth along with a cleaning.

Background: A male 40-year-old new patient whose last dental appointment was 3/8/2017 presents with adult chronic periodontal disease, severe wear on anterior teeth and decay on #19. The patient appears generally healthy (BP 118/79) with no medical conditions or medications. There is a suspicion of sleep disordered breathing along with an anterior tongue tie.

Solution: At the diagnostic appointment on 7/22/2020, a specimen was secured for MyPerioPath® analysis. Periodontal therapy consisted of 4 quadrants of scaling and root planing under Oraqix® with ultrasonics, hand instruments and irrigation with diluted betadine. The systemic antibiotic consideration on the MyPerioPath® lab report of Amoxicillin 500 mg tid for 10 days and Metronidazole 500 mg bid for 10 days was administered immediately following scaling and root planing. Patient was instructed to use OraCare medicated mouth rinse 2 times/day and oral probiotics, in addition to gumline brushing and Waterpik™ use daily. A follow-up appointment was scheduled on 10/5/2020 to evaluate healing and perform the post treatment MyPerioPath® test.

Results: The patient responded to the periodontal therapy favorably, resulting in no bleeding on probing. We will continue to monitor some isolated periodontal pockets on #14DB and #15MB and test again when needed. The post MyPerioPath® had a 70% reduction in periodontal pathogen (burden) load which is a significant shift. Patient was very happy with the look and feel of his teeth. In subsequent visits, we will address our suspicion of sleep disordered breathing.

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Brenda Sullivan RDH
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