How Do You Speak Testing? With Bianca Velayo DMD – Part 1

Hypothetical Patient Bio:

Patient A (Husband): A 35-year-old male, non-smoker, generally healthy with no systemic conditions. The patient reported that his symptoms began approximately three years ago and progressively worsened despite regular brushing.

Patient B (Wife): A 32-year-old female, non-smoker, generally healthy with no systemic conditions. She is currently 18 weeks pregnant with her first child.

Periodontal Assessment:

Patient A: Probing depths: 5-8 mm in several sites, indicating moderate to severe periodontitis. Radiographic analysis showed significant bone loss around the molars. Presence of subgingival calculus and heavy plaque buildup.

Patient B: Probing depths: 4-6 mm, indicating moderate periodontitis. Radiographic analysis showed mild to moderate bone loss. Presence of subgingival calculus.

Introduce testing to the above patients:

Hi, I’m Dr. Bianca Velayo. I’m a multi-practice owner and I primarily see patients at my flagship office, Green Valley Smiles Dentistry in Henderson, NV.

If this couple were to schedule new patient appointments with me at my office, it would look something like this:

I greet the couple in the waiting room and bring them back to my consult room. I start every new patient exam with an informal interview process so I can get to know that patient better prior to any x-rays.

I review their medical history, chief complaint, and ask questions about those dental goals and any related concerns.

Patient A (Husband): I already know he’s a 35-year-old male, non-smoker, describes himself as generally healthy with no systemic conditions. He tells me that his symptoms began approximately three years ago and progressively worsened despite regular brushing.

Patient B (Wife): This person is a 32-year-old female, non-smoker, generally healthy with no systemic conditions. She is currently 18 weeks pregnant with her first child.

For Patient B who is pregnant, I tell her that I am so excited that she is here because research shows that getting regular dental care during pregnancy improves pregnancy outcomes!

For patient A, I applaud him for also taking care of his oral health because partners share bacteria and pass it down to their babies so it’s perfect timing for a check-up so the whole family can be set up on a healthy routine.

At this time, I also practitioner; meaning that I don’t just look at your teeth, I look at how your oral health is related to your overall health and my goal is to provide a comprehensive treatment plan to help you become healthier and happier.

Patients always love this experience to chat with me prior to x-rays and are excited to learn about the ways that I plan on taking care of them!

My dental assistant then proceeds to take patient radiographs, and I view the x-rays in the consult room while she’s taking them. I’m thankful to have AI built into our software that also points out their bone loss and radiographic calculus. My brain automatically starts thinking about clinical attachment loss and periodontal disease and I’m looking forward to corroborating the diagnosis with the clinical exam.

I meet my patients in the exam room and seat the husband and wife in two adjacent rooms and ask them if it’s ok for me to open the sliding door so that they can watch and listen as I work on their partner. I jokingly tell them this is the Honeymoon Suite. They love it!

I ask who wants their exam first. The wife volunteers so I get started with her visual exam and periodontal charting. Not to my surprise, she has probing depths of 4-6 mm, indicating moderate periodontitis. Radiographic analysis shows mild to moderate bone loss, presence of subgingival calculus. Her gums are bleeding, and she is generally uncomfortable during the exam. I apologize and let her know that pregnancy creates a lot of hormonal changes in a woman’s body, and it causes our gums to be hypersensitive to bacterial plaques in the mouth, resulting in more sensitive and swollen gums.

My clinical culture surrounding periodontal disease is that for every patient that is diagnosed with periodontal disease, I automatically treatment plan for an Alert 2® panel in addition to scaling and root planing with bacterial decontamination laser therapy. Having a solid protocol makes it really easy to approach cases like this.

I sit her up and review my findings with her. Her husband is sitting in the next room, and I ask him if he wants to listen as well.

I have this awesome periodontal disease poster hanging on the wall that shows the stages of periodontal disease, and I ask her to follow along with me.

I explain to her that I used a probe to measure how tightly attached her gums are to her teeth. In healthy gums, the gums are tightly attached to the teeth. Then I draw her attention to the

advanced periodontal disease stage— I continue to educate her that there are many factors that affect a patient’s gum condition such as genetics, bacteria, lifestyle, and underlying health history, such as being pregnant. I let her know that she has stage 2 periodontal disease and reassure her that more than half of American adults have some form of periodontal disease so it’s very common. However, it is so important for us to get her periodontal health under control because if left untreated, the destruction can progress and lead to bone loss. I let her know that I’m extra concerned because she’s pregnant and I know that there are bad bacteria that live in the mouth that are associated with adverse pregnancy outcomes.

I let her know that our game plan is to order some labs – I will take a saliva test and send it to OralDNA® Labs. We will receive a 7-page report that tells us what types of bacteria live in her mouth, at what levels, and if she has any genetic predisposition to periodontal disease and other chronic inflammatory diseases. I will give her a printout of the report and we will work with her OB/GYN to make sure that she and the baby are safe and healthy.

Then I reassure her again and let her know that she is coming in at the right time.

She is at ease and ready to get started with the treatment! I walk over to the next room and I ask Patient A if he’s ready for his turn now. I sit him back and start with his clinical exam. Again, I am not surprised when I measure probing depths of 4-6 mm, indicating moderate periodontitis based on the mild to moderate bone loss plus presence of subgingival calculus I saw on the x-rays. I sit him back up and then I review the findings with him.

He says to me, “So I have periodontal disease too?” I nod.

Patient B is listening along.

I share with them how common it is for couples to have similar oral health conditions because they share bacteria. I reiterate the treatment plan to patient A and let him know that we will be ordering an Alert 2® panel, we will do scaling and root planing with bacterial decontamination laser therapy and get them on a 3-month periodontal maintenance routine.

The couple is 100% on board and are curious to know their test results. We collect their oral rinse samples that same day and we begin scaling and root planing that same day as well!

Patient A and Patient B’s periodontal conditions highlight how interconnected oral health is within families, influenced by factors like shared bacteria and systemic conditions such as pregnancy. With their initial exams and OralDNA® tests completed, we now have detailed insights into their periodontal health. In Part 2, we’ll dive into how these test results guided their personalized treatment plans and set them on the path to better health.

 

Bianca Velayo DMD
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