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Challenge:<\/u><\/strong> A 15-year-old patient with multiple years of periodontal concerns being co-managed with a periodontist without resolution.<\/p>\n Background: <\/u><\/strong>\u00a0A 15-year-old female has been presenting for care at our practice since age 4.\u00a0 From an early age the patient displayed behavioral concerns and chronic poor home care.\u00a0 The dental history is early eruption of #19, three month recall due to levels of supra and sub gingival calculus, and mild bone loss resulting in a referral to the periodontist who prescribed Biotene\u00ae and alternating care for a few months.\u00a0 Orthodontics were placed in 2015 and upon completion, the full mouth series of radiographs revealed even more bone loss, resulting in another referral to the periodontist who prescribed Biotene\u00ae and increased recall.\u00a0 On June 20th 2018, the periodontal assessment revealed gingival hyperplasia along with pliable gingival margins.\u00a0 Medically, the patient\u2019s mother noted nothing significant, however at age 15 she has not begun menstruation.\u00a0 Her appearance was pale and very thin.\u00a0 The mother reports for several years being unable to motivate the patient in areas of oral and personal hygiene.<\/p>\n Solution: <\/u><\/strong>A MyPerioPath\u00ae specimen was collected June 20th 2018, and a debridement was completed.\u00a0 Based on the results, a treatment plan was developed to include 4 quadrants of scaling & root planing, administration of systemic antibiotics to target bacteria identified by the MyPerioPath\u00ae and possible low dose doxycycline for 3-6 months, if needed.\u00a0 Post-therapy another MyPerioPath\u00ae will be performed.\u00a0 Further medical investigation was recommended such as checking of Vitamin D levels, estrogen & progesterone levels and thyroid.<\/p>\n Result:<\/u><\/strong> Therapy has been suspended. \u00a0In consult with the mother about the MyPerioPath\u00ae results and the recommended treatment plan, the mother reluctantly revealed the daughter was diagnosed with anorexia nervosa.\u00a0 I informed the mother I would be forwarding the test results to the daughter’s pediatrician and periodontist.\u00a0 She made me aware that the daughter’s Vitamin D level was very low and being tested every other day.\u00a0 In addition the daughter\u2019s thyroid and hormone levels were significantly low too.\u00a0 The mother stated the daughter is now in a 6-week eating disorder program followed by outpatient care.\u00a0 The mother agreed to therapy once the eating disorder is under control.\u00a0 Upon a visit by the mother for another sibling\u2019s care, the mother stated the daughter was improving but still has a long way to go.<\/p>\n I am appreciative of the level of care and concrete information I can now provide to my patients by utilizing OralDNA\u00ae salivary testing services.\u00a0 In conclusion, the underlying cause for this patient\u2019s gingival hyperplasia and low to moderate bone loss is anorexia nervosa.\u00a0 Early in this patient\u2019s care, I was suspicious there may be some depression concerns.\u00a0 This in addition to the clinical signs was a reason for referral to the specialist and a non-conclusive diagnosis.\u00a0 Now with testing I can rule in or rule out bacteria being a cause for the inflammation so we can explore other possible reasons for the inflammation and provide more timely care.<\/p>\n![\"\"](\"https:\/\/www.oraldna.com\/trends-in-salivary-testing\/wp-content\/uploads\/2018\/11\/Screen-Shot-2018-11-13-at-10.07.35-AM.png\")
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