Challenge: A patient of record since 2014, single dad and full-time factory plant worker came in for a routine dental .
Background:
- Age: 33 years old
- Sex: Male
- Medical History: asthma, high blood pressure, patient reports smoking history, on and off up to a pack per day.
- Last Dental Exam: 2020
- Home Care: Brush, floss, rinse, shower flossing device
- Clinical Assessment: Dental history shows high caries risk, and adult periodontitis. The patient shows current clinical evidence of uncontrolled periodontal disease, not responsive to traditional therapy (cleaning and homecare).
- Medical Assessment: Current medications are Rosuvastatin, Lamictal®, Lisinopril and Oxybutynin.
In 2014, a recommendation for testing was declined because he did not feel he could afford it at that time. Today the timing was right. My presenting of Alert 2™ testing to this patient included “Over the years, we have seen times when your periodontal disease is stable and other times it does not appear to be controlled at all. By doing an OralDNA® Alert2™ test we will have a better idea what we are working against. The questions the results will answer are what bacteria and how much is present? Is there a high level of bacteria or is it a low level of bacteria? How is your body responding? For example, some people can have a large level of bacteria, but the body does not respond to it, so we do not see disease or disease is not present. On the other hand, others can have a small level of bacteria and the body over responds or gets really excited and then we see a lot of disease.
Alert2™ test is a swish & gargle collection. We will send it to OralDNA® Labs for processing. The lab will then provide a report that tells us the level and type of bacteria in your mouth. Additionally, the lab will do a genetic test that will tell us how you are programmed to respond to the bacteria. We will do the test prior to starting your initial phase therapy or scaling and root planing (SRP). After we get the results, I will call to review the report with you. After completing the recommended therapy, we will repeat the bacterial portion MyPerioPath in 6-8 weeks to see how effective we were at decreasing the bacteria load.”
Solution:
- Date of Pre MyPerioPath: 01/14/2021
- Dental/Periodontal Therapy: There were high risk pathogens identified and although his genetic risk category (based on the IL-6 gene marker) was not high, it was intermediate risk factor. For this reason, we chose to prescribe a combination treatment of systemic antibiotics to take while we completed the periodontal therapy of SRP with anesthetic, piezo removal of hard, soft and bacterial deposits, manual hand scaling and air polishing.
- Systemic Antibiotic Used: Amoxicillin and Metronidazole
- Home Care: Continue existing protocol.
- Other Notes: Recommendation is 3 month follow up care appointment.
- Date of MyPerioPath Progress (post-therapy test): 07/21/2021
Results: This patient had an excellent response to SRP and antibiotic therapy with a bacteria load decrease of 65%. Patient is more consistent with good oral care routine and cleaning his mouth more often.
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