Page 29 - GP Fall Final 2017

Reviewing the laboratory analysis (Figure view revealed moderate bone loss around Case B
3) with the patient can become a seminal the premolar teeth. Upon six month recare All in the family: avoiding re-infection
moment in the patient’s understanding of (age 23), full periodontal charting was This patient, a Caucasian male, was age 55
completed, which showed sulcus depths at the time of oral microbiology testing. His
Case A initial visit was several years prior to test-
ranging from 2 to 5 mm. The patient de-
Uncovering the cause of bone loss in a male youth ing. His medical history was unremarkable
nied any family history of periodontal dis-
This was the initial visit for a 22 year-old male, ethnic Indian, graduate student. He was dentally
ease. Radiographs to complete a full mouth and did not include any medications. His
educated, has an unremarkable medical history, no food allergies, and did not take any
series (Figure 4) were exposed and more homecare was fair to good with a Silness–
medications. His homecare was impeccable with a Silness–Loe plaque index of 0. He had a
areas of bone loss were noted. The results Loe plaque index of 1.5. He presented with
perfect Class I occlusion (no orthodontic treatment history), no restorations, no abfractions or
other signs of parafunction. Bitewing radiographs were exposed. Prophylaxis was completed
were presented to the patient who became moderate generalized marginal gingival
and mild bleeding upon probing was noted in several posterior areas. Radiographic review
quite panicked about the possibility of inflammation and intact, well- contoured
revealed moderate bone loss around the premolar teeth. Upon six month recare (age 23), full
periodontal charting was completed, which showed sulcus depths ranging from 2 to 5 mm. The
losing any teeth at a young age. Oral mi-
restorations. Periodontal probings ranged
patient denied any family history of periodontal disease. Radiographs to complete a full mouth
crobiology testing was recommended and from 3 to 5 mm. Prophylaxis was complet-
series (Figure 4) were exposed and more areas of bone loss were noted. The results were
performed. Laboratory analysis (Figure 5) ed. Hygiene recommendations emphasized
presented to the patient who became quite panicked about the possibility of losing any teeth at
a young age. Oral microbiology testing was recommended and performed. Laboratory analysis
revealed the presence of P. micra and C. home care and included an oral antimicro-
(Figure 5) revealed the presence of P. micra and C. rectus above threshold levels, an unusual
rectus above threshold levels, an unusual bial rinse in the regimen. The patient main-
finding in one so young. An antibiotic regimen was prescribed and followed through by the
patient. He declined a retest that year and was tested again at age 25. Laboratory analysis
finding in one so young. An antibiotic reg-
tained a six month recare schedule.
(Figure 6) revealed an absence of any periodontal pathogens. The patient continues to maintain
imen was prescribed and followed through
his recare schedule and excellent home care.
by the patient. He declined a retest that year Marginal inflammation improved slight-
and was tested again at age 25. Laborato- ly with each recare, as did home care, but
never cleared up completely.
The patient expressed little
Figure 3. Laboratory analysis. Reviewing the laboratory analysis (Figure 3) with the
interest in clinical findings,
periodontitis as a severe chronic infection stating his mouth feels good
patient can become a seminal moment in the patient’s understanding of periodontitis as a severe
needing medical treatment, as with any
to him and he has followed
serious condition. The analysis should all of our instructions. Re-
be reviewed as one would a CBC blood
care was then reclassified for
chronic infection needing medical treatment, as with any serious condition. The analysis should
a three month interval and
profile produced as part of an annual
physical exam. It presents an evidence- oral microbiology testing
Figure 4. Full mouth series on 22-year-old male.
be reviewed as one would a CBC blood profile produced as part of an annual physical exam. It
based foundation for a focused discussion
Figure 4. Full mouth series on 22-year-old male.
was advised as a means to
on the next phase of care as well as offering Figure 5. OMT results- the center portion of the analysis has been enlarged. (***please remove this reveal any microbial
line***)
a quantifiable tool for tracking disease
pathogenic status. The
presents an evidence-based foundation for a focused discussion on the next phase of care as well

lab analysis revealed
progression and resolution. The review
18
can be a time for the patient to accept the above threshold num-
9 | P a ge
as offering a quantifiable tool for tracking disease progression and resolution. The review can bers of P. intermedia
18
disease process and embrace the treatment

strategy prepared by the doctor. The most group, P. micra, and S.
important aspect of the discussion is the
be a time for the patient to accept the disease process and embrace the treatment strategy intermedius, as well as
the presence of F. nu-
reality of a remediable condition. This can
act as a great motivator for the reluctant cleatum. The patient
prepared by the doctor. The most important aspect of the discussion is the reality of a remediable
was duly alarmed and
patient and the involved patient alike.
immediately wanted
Retesting is available and it allows post-an-
condition. This can act as a great motivator for the reluctant patient and the involved patient to start the antibiotic
regimen. Discussion
tibiotic tracking of the pathogenic presence.
It most often confirms success of the anti- ensued about part-
alike. Figure 5. Preliminary OMT results. ner transmission and
biotic treatment through restoration of the
normal oral flora; sometimes it indicates Figure 5. Preliminary OMT results. OMT for his spouse
the presence of resistant microbes that may was advised. The pa-
have emerged opportunistically. tient was determined
Retesting is available and it allows post-antibiotic tracking of the pathogenic presence. It most to wait until his wife

Case A had been tested so
Uncovering the cause of bone loss in a
often confirms success of the antibiotic treatment through restoration of the normal oral flora; that, if need be, they
male youth could undergo anti-
This was the initial visit for a 22 year-old biotic treatment at
sometimes it indicates the presence of resistant microbes that may have emerged the same time. The
male, ethnic Indian, graduate student. He
was dentally educated, has an unremark- spouse was the same
able medical history, no food allergies, and
opportunistically. age and under the
did not take any medications. His homecare care of another DDS.
was impeccable with a Silness–Loe plaque Her medical history
index of 0. He had a perfect Class I occlu- included psoriasis for
sion (no orthodontic treatment history), no
CASES Figure 6. Follow-up OMT results. which a medication
restorations, no abfractions or other signs had been prescribed.
of parafunction. Bitewing radiographs ry analysis (Figure 6) revealed an absence Her lab analysis revealed above threshold
were exposed. Prophylaxis was completed of any periodontal pathogens. The patient levels of P. intermedia group, F. nuclea-
8 | P a ge
10 | P a ge
and mild bleeding upon probing was noted continues to maintain his recare schedule tum, and P. micra – the exact ones present
in several posterior areas. Radiographic re- and excellent home care. in her husband, with F. nucleatum and P.
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