How do You Speak Testing? With Dr. Michael Perpich

Patient Bio: A 24-year-old male new patient, who recently graduated is seeking treatment. His chief complaint is crowding and a bothersome #14 which had endodontic treatment 7 years prior. His periodontal clinical signs are listed below. The patient hasn’t seen a medical doctor in two years as his studies were very demanding. His blood pressure today is 108/73.

How would you introduce therapy including Alert 2™ to this patient?
In reviewing your exam, it looks like you have several areas where the pocket depths are 5 or more millimeters deep, with bleeding. Bleeding is a sign of infection, if left untreated this infection can cause teeth to become loose or be lost. This infection is important to resolve to have your best outcomes of anything such as tooth alignment or potential implant depending on what is going on with that upper molar. Treatment of the gum infection is a simple three-step process. The first step is scaling & root planing. This removes the bacteria from the pocket. The second step is irrigating the pocket with an antibiotic rinse. This removes any bacteria left behind after the scaling. The third step is treating the lining of the pocket with a laser to make sure there are no bacteria in the gum tissue. However, the best treatment includes an evidence-based plan, and a salivary analysis is where we should start to determine specifically what bacteria are present and how they could relate to common medical conditions. This is no different than a medical doctor doing blood work for you. The identified bacteria could be putting you at risk for certain cancers, cardiovascular disease, joint and muscle ailments, and dementia. Also, it would be my recommendation for you to see a medical doctor as it has been several years since your last medical exam.

You receive the results 1-week post-therapy and review them.

How would you discuss these results with your patient?
I have reviewed your Alert 2™ report. There are numerous varieties of bacteria in your mouth. Many are more resistant to mechanical removal only, so the treatment applied last week with scaling & root planing, irrigation and laser should be adequate for you to heal. However, you have a genetic susceptibility. Your Interleukin 6 is high which indicates, you are at a high risk for periodontal inflammation. A shorter recall is crucial for the best management of your disease. I am so glad we were able to complete the treatment for you. You will heal over the next weeks. When you return, I will recheck your bacteria levels with another collection. If everything goes as planned, we will then see you regularly and if something is unresolved, you will be referred to our periodontist.

This is a hypothetical case and should be used for educational purposes only.

Michael Perpich DDS
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