Uncontrolled Diabetic – Referred by Physician


Background: The patient is a 41-year-old female who has not been seen by a dental professional since 2008 (10 years). The patient stated her chief concern as “My doctor said my uncontrolled diabetes could be caused by my mouth.” Other medical concerns are high blood pressure and acid reflux. The home care routine consisted of manual tooth brushing only. Following the periodontal assessment, the patient was diagnosed with active, localized, chronic periodontitis due to the present sub-gingival calculus, supra-gingival calculus, and inflamed, bulbous tissue.

Challenge: To find the source of her inflammation and infection. If the source is of a bacterial nature, then the goal is to reduce the bacteria. By reducing the bacterial load, the hope is to reduce or eliminate medications for diabetes and blood pressure. Please note: The patient accepts her responsibility for the decline in her overall health.

Solution: We recommended OralDNA®’s MyPerioPath® to identify the bacterial cause of the periodontitis and to help individualize the treatment plan. The specimen was secured on the initial exam date and results were analyzed 7/27/2017. The periodontal therapy consisted of Level 5 full mouth therapy. The “5 tip” cavitron method was incorporated with irrigation of water and chlorhexidine. Arestin® was placed in pockets 5mm or greater and the recommended systemic antibiotic was prescribed. Additional home care instruction included incorporating a Sonicare®, Waterpik™, Pro-Dental probiotics and PerioSciences® AO ProVantage dental gel. An additional MyPerioPath® test was recommended post therapy and was secured 10/19/2017.

Results: All parties were excited by the post therapy results. A major biofilm shift was noted with the reduction of the bacteria responsible for her inflammation. Reduction of pocket depth, bleeding and inflammation were noted. The patient was able to discontinue use of three diabetic medications, preventing the need for diabetic injections! The patient also stated losing 20 lbs., which has stabilized her blood pressure, and reported a pleasant reduction of acid reflux. My patient was thrilled with the overall results and has noticed a huge difference with the way her mouth looks and feels.

Reflecting on this case, it is imperative to have all the information on which bacteria are causing the problem. Having the evidence, allows the clinician to tailor the treatment for each patient in order to target the cause and measure the effectiveness following treatment.

We hope you enjoyed the throwback blog. This interview originally posted 7/20/2018.

Mary Kay Carroll RDH
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