Patient Bio: Your patient is 34 years old, and she is new to your practice. She recently moved back to the area to be closer to her father who was recently diagnosed with dementia. Her partner and two children will also be joining your practice soon. She is not taking any medications and her last dental visit was before she moved about 9 months ago. She presents with these clinical signs.
How would you introduce therapy including MyPerioPath® to this patient?
In our practice, the doctor completes the examination on the patient and provides information on the diagnosis while stating the treatment recommendations. As the hygienist, I will reiterate and review the doctor’s treatment plan with the patient along with repeating the Mouth Body Connection™ linking her oral health and her risk for dementia originally educated by the dentist.
Visual aid tools are important. I use a sample report of the OralDNA® lab test called MyPerioPath® and a periodontal board depicting the stages of periodontal disease. The board is handed to the patient to help them visualize what we see and provide clarity of their situation. The treatment plan for the patient is broken down into five steps.
Here is an example of my hypothetical conversation.
Patient, we have evaluated the depth of your gums with the probe, the x-rays reveal a risk for losing teeth due to the amount of bone loss, the plaque and calculus build up around your teeth could be contributing to your bleeding, inflamed gums, and these are all clinical signs of infection. Harmful bacteria and inflammation originating in the mouth can increase your risk of 120 different systemic diseases. You shared that you have a family history of dementia. Research has linked enzymes and bacteria residing in the mouth to patients who have suffered from dementia; therefore, knowing what specific bacteria are present in your mouth is important. You may also want to have your family members evaluated as certain oral bacteria can be transmitted between family members.
The test called MyPerioPath® will give us insight into what bacteria may be causing the current active infection and reveals what we can’t see. The lab test screens for 11 different species of bacteria associated with periodontal disease and some systemic diseases. The bacteria are divided into three sections including high risk, moderate risk, and low risk. The results will also inform us whether the bacterial load is above what is considered the normal reference level. If bacteria are above the reference level, the doctor may consider prescribing an antibiotic to augment periodontal treatment.
Your patient says yes to testing, you collect the specimen and provide same day therapy.
Therapy is broken down into five steps.
- The first step is the collection of a sample of saliva. The sample is sent to OralDNA® Labs for processing.
- The second step is the mechanical procedure of removing as much bacteria as possible. Full mouth scaling and root planning (SRP) treatment will smooth the root surfaces of the teeth, eliminate calculus buildup, and disrupt plaque formations above and below the gums.
- The third step is to irrigate with Chlorhexidine gluconate, an antimicrobial agent, to help flush away bacteria from the gums and disinfect the areas treated.
- The fourth step is completed by the doctor who will use the laser to help further decontaminate the gums by killing as many remaining bacteria as possible. The laser will also promote faster healing.
- The fifth step and last step for the day, is to schedule an appointment for the patient to be seen by the periodontist in 4-6 weeks following SRP treatment. The periodontist will evaluate the health of the gums, compare findings from the initial visit, and diagnose whether further treatment is needed.
Once the patient has completed the gum therapy treatment, I would explain the importance of monitoring the health of her teeth and gums every 3 months and continuing the periodontal maintenance treatments to maintain everything we did today. Trusting us to be her providers is not taken lightly and we want to continue doing the best we can to keep her and her family healthy.
The test results are posted 7 days following the therapy.
How would you discuss these results to your patient?
In most cases the periodontist will be discussing the results in greater detail with the patient, specifically, the Mouth Body Connection™ between Pg and Alzheimer’s disease. My quick conversation is: “Due to having nine out of the eleven bacteria, and eight that are present above the normal reference level, a systemic antibiotic will be prescribed to take orally. It will also be combined with a prescription for an antimicrobial rinse and a daily probiotic.”
This is a hypothetical case and should be used for educational purposes only.
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