Periodontal Disease and Rheumatoid Arthritis – Controlling Two Birds with One Stone?

  Challenge: Our case study represents an example of the emerging evidence from interventional and, more recently, animal studies showing how seemingly unrelated diseases such as periodontal disease and rheumatoid arthritis can be related through similar genetic, biological, and clinically consistent mechanisms.1,2,3,4 Background: The initial medical assessment for a 57-year-old female diagnosed with palindromic rheumatoid arthritis was conducted at our functional medicine clinic....
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How to Share a Case Study

 An article written by Crowe, Cresswell et al. states a case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context.1 Periodontal disease fits this definition because it is a complex issue with real-life context. Personally, case study presentations have been a huge benefit in establishing my approach to periodontal therapy. What I learned in school is that the one size fits all approach should work, however I’...
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Classic Periodontal Disease

Challenge: A new patient with poor home care and lack of dental attention presented wanting whiter teeth along with a cleaning. Background: A male 40-year-old new patient whose last dental appointment was 3/8/2017 presents with adult chronic periodontal disease, severe wear on anterior teeth and decay on #19. The patient appears generally healthy (BP 118/79) with no medical conditions or medications. There is a suspicion of sleep disordered breathing along with an anterior tongue tie. Solu...
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The Co-management of an Esophageal Cancer Survivor

Background: The patient is a 75-year-old female with a history of esophageal cancer in 2013. The origin of the cancer was determined to be lichen planus. Surgical removal of the lesion occurred, and no reconstructive surgery was needed. However, post-surgery to present date, the patient experiences severe acid reflux and sleeps with her head elevated. She has great home dental care and follows a 3-month periodontal maintenance. During the head and neck exam, no significant findings were disc...
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A Common-Sense Approach to Diagnosis and Treatment Planning: Weekly Case Reviews with Dr. Lee Sheldon

Most webinars explore new, innovative, fabulous procedures. What about the day-to-day procedures such as the new patient, the periodontal case, or the restorative case? What about the basics? • How to communicate to the patient? • How to prioritize to make dentistry within reach of the average person? • How to gain greater case acceptance? • How to remove the insurance obstacle? Dr. Sheldon brings his whole team approach to patient management and communication to his new webinar series....
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Chronic Anterior Inflammation Finally Resolved

Challenge: The patient's main concern was to reduce chronic inflammation around tooth #8 and #9. The patient previously had received treatment at a general dentist and a periodontist without significant improvement. Background: A new female patient, age 28, was last seen by another dentist on 12/5/2018. Her home care consists of brushing twice daily with Tom's of Maine® toothpaste and a Sonicare™ power toothbrush, and Crest® Pro-Health™ rinse with occasional flossing. Her family history i...
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Case Study: Class II Periodontitis

  Background: The patient is a 54-year-old female who presented with the chief complaint “My gums bleed when I brush, there are possible cavities and I don’t like the tooth crowding.” Her last dental visit was about 6 years ago. There is a family history of diabetes, cardiovascular disease, stroke and cancer. The home care consisted of manual tooth brushing 1-2 times per day with occasional antibacterial mouth rinse. During the clinical assessment, it was discovered that several amal...
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Case Study: Periodontal Disease and Cardiovascular Disease

Challenge: A new patient who has neglected dental care for 20 years with a chief complaint of broken teeth and bleeding gums appoints to address his dental concerns. Background:  A 70-year-old male patient with broken teeth and bleeding gums appoints to our office. His last dental visit was estimated to be 20 years ago. Surprisingly the patient was not experiencing dental pain. The periodontal assessment revealed generalized 4-6 mm pockets with localized 7-9 mm pockets, inflamed and bulbo...
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Class II Generalized Periodontitis and Rheumatoid Arthritis Requesting Implant Placement

Challenge: To establish periodontal remission by addressing the clinical manifestations of periodontal disease and altering the oral flora in order to lower the incidence of periodontal disease relapse. Bacterial management will eliminate a source of total body inflammation and increase success of implant placement. Background: The patient is a 66 year-old-male with rheumatoid arthritis, taking Lisinopril and is a potential candidate for implant to restore #19. Patient’s daily home care r...
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Periodontal Therapy Without Pharmaceuticals

Challenge: A patient of record with a history of prostate cancer is exhibiting active signs of periodontal disease. Background:  A 69 year old male with a history of prostate cancer including surgical removal of the prostate. Patient also has a history of atrial fibrillation and cardiac ablation. He presents with active periodontal disease symptoms. The patient states, “I want to be proactive and per my functional medicine doctor, there could be bacteria complicating my overall health.” ...
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