Type II Diabetic and Periodontal Disease
By: Debbie Bickford, RDH
October 19, 2018
The Challenge:
A Type II Diabetic patient, who has been a long term client, has uncontrolled periodontal disease and a history of not responding to previous periodontal treatment.
The Background:
- Age: 73
- Sex: F
- Medical History: Type 2 Diabetes, gout, high blood pressure, kidney issues
- Last Dental Exam: Sept 2017
- Home Care: Patient has been on periodontal maintenance regimen
- Chief Complaint: Bleeding gums, high blood glucose, overall in poor health and not feeling well
- Other Notes: Nutritional - Patient states she is trying to control blood sugars, but they have been out of control
- Clinical Assessment: Bleeding gums, advanced periodontal disease around #2, unopposed 7-8mm pocketing
- Periodontal Assessment: Advanced periodontal disease
- Medical Assessment: Uncontrolled diabetes
The Solution:
- Date of Pre-MyPerioPath® (pre-therapy test): 1/11/2018
- Periodontal Therapy: Extraction #2, 4 quads of scaling and root planing, air flow polisher with glycine powder for biofilm reduction
- Medical Therapy: Ongoing with primary physician
- Systemic Antibiotic Use: Amoxicillin 500mg tid for 8-10 days AND Metronidazole 500mg bid for 8-10 days, depending on the severity of infection.
- Home Care: ProBiora® Pro-oral probiotics, Immune tabs from Hyperbiotics®, Sonicare toothbrush
- Other Notes: Patient declined Perioscience® product.
- Date of MyPerioProgress® (post-therapy test): 4/17/2018 and 9/8/2018
Additional comments: Patient declined 3rd script of Metronidazole and Amoxicillin. Patient to continue with ProBiora Pro oral probiotics, Immune tabs and Sonicare usage as well as an improved diet and exercise routine. Patient has an appointment with her nephrologist soon and will consult on antibiotic usage. Patient will probably wait for 6 months for her next saliva test. Pt is very pleased with her results and how her general health has improved.
The Result:
At the 3 month evaluation including a MyPerioProgress the patient had improved but periodontal concerns still remained. A second round of systemic antibiotic was administered based on the second MyPerioPath results and a follow-up was scheduled. Following the second MyPerioProgress - total of three MyPerioPath tests performed 9 months after therapy, a 61% reduction of the total bacterial load was achieved. The patient is very pleased with her periodontal results and feels the zinc supplements have helped the blood sugar control. We have helped her achieve good periodontal health while helping her decrease health risks. Medically, the patient has seen great improvements. Her blood sugar is now 100-120 and she is working with her medical team to lower or eliminate some of her diabetic medicines. “The saliva testing has given us a great way to add science to the equations and give us quantitative results.”
About the Author:
