Neglected Active Periodontal Disease

Challenge: A new patient, 59-year-old male, presents to our office with no specific concerns. However, a previous provider recommended a “deep cleaning.” This “deep cleaning” treatment was never completed. Patient has 4 fully erupted wisdom teeth that are difficult to access for daily cleaning.


  • Age 59
  • Sex: Male
  • Medical History: High Blood Pressure but is taking medication
  • Last Dental Exam: 2019
  • Home Care: Manual toothbrush 2x daily, baking soda with peroxide, floss occasionally
  • Chief Complaint: None
  • Clinical assessment: Severe gingival inflammation, moderate plaque with heavy calculus sub/supragingival. Moderate to severe bone loss is evident on radiographs
  • Periodontal Assessment: 2-9mm pocketing, Class I furcations noted, localized bone loss 15-33%


  • Initial MyPerioPath® test taken 6/3/21
  • 6/4/21: Right side upper & lower scaling & root planing performed with left side irrigation
  • 6/8/21: Left side upper & lower scaling & root planning performed with right side irrigation
  • 6/15/22: Full mouth irrigation, review of results and prescription for Metronidazole and Amoxicillin
  • 10/7/22: Patient cancelled 3-month re-evaluation
  • 12/16/22: Patient appointed for overdue 3-month re-evaluation – periodontal maintenance, periodontal charting, follow up MyPerioPath® test
  • 5/2022: Patient presents for periodontal maintenance, exam, and radiographs

Additional Comments: Patient did finish the prescribed antibiotics however he has not been compliant with flossing or his re-care visits. He stated he thought the Waterpik™ could replace flossing.

Results: At 6 months after completion of the initial scaling & root planing appointments the patient showed improvement in pocket depths and tissue appearance. MyPerioPath® comparison also showed a dramatic reduction in the bacterial load. At his visit a year later, the tissue continues to show health except for around the wisdom teeth. It has been recommended to extract tooth #1 due to decay. We will continue to encourage consistent hygiene appointments, improved home care and bacterial monitoring to help ensure long term remission of the periodontal disease.

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Chelsea Gonzales DDS
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