Page 30 - GP Fall Final 2017

micra at much higher levels. She was then ished, but each time she did come in, her necessary in any practice enhances the lev-
prescribed the antibiotic therapy with the medical history increased in complexity el of care we extend to our patients.
caution that the antibiotic therapy is not a with symptoms including hyperalgesia and
stand-alone treatment but should be done in vague joint aches. I came to suspect that an I believe that, with the advent of precision
conjunction with scaling and root planning. underlying medical component was com- medicine, the concept of targeted treat-
She was advised to share the testing results promising the patient’s immune system. ment will become a greater consideration
with symptoms including hyperalgesia and vague joint aches. I came to suspect that an
with her dentist. I encouraged her to continue her medical in health care. In maintaining the standard
underlying medical component was compromising the patient’s immune system. I encouraged
her to continue her medical inquiries despite her frustrations. I also advised her to share her
inquiries despite her frustrations. I also of using current evidence to guide deci-
oral microbiology lab results with her physician. The patient returned to the practice
advised her to share her oral microbiolo-
Case C before requesting another sampling at age 32. The lab analysis revealed the sion-making, all modalities should be con-
sporadically,
Leading the way to discovery gy lab results with her physician. The pa- sidered. Our role, as clinicians, is to incor-
presence of F. nucleatum and P. micra at subthreshold levels. It also revealed a high level of S.
intermedius and the re-emergence of C.
This patient, a Caucasian female, came to tient returned to the practice sporadically, porate technology, research and diagnostic
the practice at age 23 for restorative care before requesting another sampling at age skill in order to offer our patients treatment
albicans; both of which are opportunistic pathogens. Shortly after this analysis, the patient was
tentatively diagnosed with an autoimmune disease.
(Figure 7). She reported a long history of 32. The lab analysis revealed the presence options designed to secure the most satis-

of F. nucleatum and P. micra factory outcomes. In my experience, oral
at subthreshold levels. It also microbiology testing, although not an exact
revealed a high level of S. genomic modality, reduces the risk of bac-
intermedius and the re-emer- terial resistance from empirical prescribing
gence of C. albicans; both and delivers targeted, clinically useful re-
of which are opportunistic sults. It is an important tool worthy of con-
pathogens. Shortly after this sideration in the successful management of
analysis, the patient was ten- a chronic, systemically impactful condition
tatively diagnosed with an such as periodontal disease.

Figure 7. Presenting full mouth series. autoimmune disease. References: Please see the online version at
Figure 7. Presenting full mouth series.
dental fillings as a child and adolescent. OMT has been used in dentistry for de- www.nysagd.org.
OMT has been used in dentistry for decades: for post-surgical evaluation; typically, by
Her DMFT index was 20 (out of 28). Her cades: for post-surgical evaluation; typi-
medical history included an allergy to Sulfa cally, by periodontists for refractory cases; Dr. Lorna Flam-
periodontists for refractory cases; and following empirical antibiotic prescribing that yielded
drugs but was otherwise unremarkable. Her and following empirical antibiotic pre- er-Caldera received
poor results. As described here, it is also used very effectively at recall for detection of a
homecare was very good, with a Silness- scribing that yielded poor results. As de- her B.S. degree from
suspected pathogenic presence. I have utilized OMT for appropriate patients in my practice since New York University
Loe index of 1. Mild generalized bleeding scribed here, it is also used very effectively
was noted during assessments. Prophylaxis at recall for detection of a suspected patho- and her dental de-
2002 with excellent results. The three case studies presented here are from among the hundreds
was completed and a recare frequency set genic presence. I have utilized OMT for ap- gree from the Uni-
of my patients who have benefitted from the accuracy of OMT. The data resulting from
versity of Maryland
up. The next several years were focused on propriate patients in my practice since 2002 School of Dentistry.
facilitate diagnosis and treatment that otherwise would not be possible in my office. This
restorative care, which included resin res- with excellent results. The three case stud- She is an Assistant
torations, endodontic therapy, crowns, por-
contributes greatly to patient satisfaction and retention. ies presented here are from among the hun- Professor in the Dental Hygiene depart-
celain veneers and onlays. Gingival bleed- dreds of my patients who have benefitted ment of New York City College of Tech-
ing and Inflammation noted during recare from the accuracy of OMT. The data result- nology and maintains a private practice
13 | P a ge

visits during this period was attributed to ing from facilitate diagnosis and treatment in Manhattan, NY. Dr. Flamer-Caldera
the constant state of temporization of mul- that otherwise would not be possible in my has achieved Fellowship in the Academy
tiple teeth at any one time. The patient’s office. This contributes greatly to patient of General Dentistry, the American Col-
home care became less consistent, with the satisfaction and retention. lege of Dentists, and the International
plaque index averaging around 1.5. Once Academy for Dental Facial Aesthetics.
the restorative work was completed, mild, Currently, this type of microbiological test-
generalized bleeding persisted. The patient ing is not covered by most insurance plans. From the President-Elect
also reported “itchy gums”. The patient was When determining a fee, take into account continued from page 4
now 28 years old and oral microbiology the time involved in collecting the sample,
testing was advised. Lab analysis revealed overnight shipping charges, laboratory fee, topics for upstate and downstate. Before
the presence of A. actinomycetemcomitans, and time for reviewing the analysis with the I knew it, eight and a half years have
F. nucleatum, P. micros (renamed P. micra), patient. Sampling and packaging supplies flown by. The NYSAGD then decided to
C. rectus, and C. albicans. Findings com- need not be factored in as they are provided move me to vice president, then presi-
dent-elect. This is where I stand now. I
pletely supported the clinical evaluation by the laboratories at no cost. I consider a am waiting for my term as president to
of persistent bleeding and inflammation. reasonable fee range to be $275 to $400. begin in 2018.
Presence of the aggressive pathogen, A. Recommendation for testing should be pre-
actinomycetemcomitans, was particular- sented to the patient as the most detailed My goals for my term as president are
ly alarming. An antibiotic regimen based scientific analysis available to aid in diag- to increase membership as well as at-
on drug sensitivity results was prescribed. nosis and direct their treatment. I’ve found tendance at our lectures. This is not an
The patient completed the regimen and the vast majority of patients are willing to easy task. I have a bit of a head start
was retested four months later at age 29. pursue this course of action because of its as we have developed our social media
A. actinomycetemcomitans and C. albicans high likelihood of success. presence on Facebook and Twitter. I am
were no longer present, but the other noted also proud of our new student chapter at
pathogens were still present in varying de- Apart from providing me with an accurate NYU. I believe that these two initiatives
grees, along with the addition of S. constel- and effective way to retain most of the will increase our exposure to the dental
latus – a puzzling result in a young, healthy more challenging periodontal cases in my community. We have also expanded our
patient. A stronger combination dose of practice by resolving them, OMT reinforc- journal with high quality dental articles
antibiotics was then prescribed. The patient es treatment strategies that, for me, have and our circulation is up.
became less regular in recare visits once evolved through decades of seeking ef-
the cosmetic component of care was fin- fective solutions. Undertaking OMT when I am very honored that the Board of the
NYSAGD has shown confidence in me. I
look forward to serving all of our members.
www.nysagd.org l Fall 2017 l GP 26