Active Periodontal Disease with Multiple Medical Complications

Challenge: A patient with Multiple Sclerosis (MS) and active periodontal disease, most recently was diagnosed with Type II diabetes, will receive periodontal therapy. Currently, proper home care is limited to the physical difficulties of MS.

Background: A 58-year-old female presented on 4/17/2018 with a chief complaint of xerostomia and physical difficulties challenging a proper home care regimen. Due to living with MS for several years, the patient has partial left-side paralysis resulting in no ability to use her left hand. She most recently was diagnosed with Type II diabetes and has added Metformin to her long list of medication contributing to the xerostomia. Upon comprehensive periodontal charting, the patient exhibited generalized 4-5mm pocketing with generalized hemorrhaging and edema.

Solution: Xerostomia being a chief complaint, we explained her dry mouth could be contributing to a potential growth of yeast and that a saliva test called OraRisk® Candida would be needed to rule in or rule out its presence. Additionally, a MyPerioPath® was recommended to further understand oral bacteria that may be contributing to the periodontal disease. From one specimen, the two tests were ordered on 4/17/2018. Her personalized periodontal therapy consisted of ultrasonic biofilm removal and laser treatment to remove inflammatory and granulation tissue, and ozone oil therapy. MyPerioPath® revealed significant levels of bacteria above threshold. These bacteria were targeted with Amoxicillin and Metronidazole. OraRisk® Candida revealed an overgrowth of C. Albicans so a prescription of Mycelx Troche was administered 5 times per day for 2 weeks. We opted for PerioProtect™ as a good home care regimen as these trays are not dependent on dexterity. Trays were fabricated and were worn for 15 minutes 2 times daily. In addition, instructions to incorporate a Sonicare electric toothbrush with a paste of peroxide and baking soda, localized probiotic Probiora™ and Closys Silver mouthwash. The post therapy appointment was scheduled 6 weeks out.

Results: At the post-therapy appointment on 7/23/2018, the patient reported using the PerioProtect™ trays daily along with the other home care changes of an electric toothbrush and localized probiotics. Upon periodontal assessment, complete pocket reduction to healthier levels was noted with no bleeding. A MyPerioProgress® (see photo below) was secured and later revealed all pathogens below threshold. Patient was placed on a 3-month recall. After a total of 9 months of periodontal maintenance, the patient announced she was no longer on Metformin and her A1C levels were completely normal. Periodontally, the patient has remained stable. The patient is very satisfied with the results that we as a team were able to accomplish.

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We hope you enjoyed the throwback blog. This case study blog originally posted 3/29/2019.

Brie Eickhoff RDH