The first case study is a 61 year old male patient of record in Walter Below DDS’ Westlake, Ohio practice had nine 4 mm periodontal pockets with 10 bleeding sites.  The standard of care diagnoses class 2 periodontitis, treats the patient with scaling and root planning with  three month periodontal maintenance follow ups.  But Dr. Below looks deeper and discovers a chance to reduce health risks before serious symptoms erupt.

The patient’s updated health history reveals Mitral Valve Prolapse, high blood pressure and prescribed statins with daily baby aspirin. The patient did not have a next appointment scheduled with his physician. The family history shows Mom suffered from stroke, diabetes, cancer and hypertension, then died from heart disease at 70 years old.  Father had heart disease, diabetes and hypertension before dying from a heart attack at 68 years old.  Father had periodontal disease and both parents had tooth loss.  The patient tested positive for pathogenic red bacteria: Porphyromonas Gingivalis (PG),Tannerella Forsythia (TF) and Treponema Denticola (TD). A blood sample sent for analysis later shows C-reactive protein at 6.3 mg/liter, indicating 6 times more inflammation than normal.  A1c measures 6.3% (elevated glycated hemoglobin).  The patient’s physician was directly contacted and requested the patient appoint with him before leaving the dentist’s consult appointment.  Both dentist and physician are co-managing this patient’s care for six months.  The physician will monitor medications and heart function with a diabetic workup. Periodontal therapy includes laser bacterial decontamination before deep scaling and root planing to remove plaque and calculus without bacteremia.   Laser assisted periodontal therapy (LAPT) will remove necrotic gum tissue to promote healing and kill pathogenic bacteria.  To keep the bacteria in remission post therapy, home care is replaced with the Clean Kiss Oral Care System.

Next, a 50 year old woman patient of record in Bradley Parker DDS’ San Bruno, CA practice has 14 probe scores over 3.4mm with 17 bleeding sites.  The updated patient health history reveals the patient had a heart attack 5 years prior—at 45 years old.  She is diagnosed as pre-diabetic and prescribed Metformin® and has high blood pressure with no prescribed medication. She did not have a next scheduled appointment with her physician. Her father had a heart attack with bypass surgery and died from heart disease in his 60’s.  Mom had diabetes and died in her 70’s.  Mom had gum disease and tooth loss resulting in dentures.  Both parents were hypertensive.  The patient tested positive for pathogenic red bacteria (PG,TF,TD).  A C-reactive protein score of 3.7 mg/liter is 300% higher inflammation than normal.  A1c of 7% shows elevated glycated hemoglobin at diabetic level despite current medication.

The physician was not available to discuss this case before the patient’s scheduled treatment consult and the patient declined periodontal therapy.  But after being presented a co-management plan with her physician, began her six month perio therapy including SRP, LAPT and the Clean Kiss Oral Care System.  She also returned to her physician for a diabetic work up and medication management.