At OralDNA® Labs, we understand that identifying and addressing oral bacteria is critical to improving patient outcomes. A recent case shared by Dr. Lee Sheldon, a distinguished periodontist, highlights the synergy between advanced diagnostics and methodical care. In his video, Dr. Sheldon detailed how he saved a severely compromised tooth (#24) for a 47-year-old patient. His approach reinforces the importance of leveraging tools like OralDNA testing to guide treatment plans.
Dr. Sheldon began with the story of his patient, a woman who drove 45 minutes to his office after her general dentist recommended extracting tooth #24. She sought a second opinion, determined to save her tooth. Upon examination, Dr. Sheldon observed Class III mobility, severe swelling, and periodontal pockets too deep to probe without causing pain. “The patient was already anxious in the dental chair,” he explained, “so causing unnecessary discomfort wasn’t an option.” He explained his treatment philosophy: “If a patient has a full dentition or a full arch, I want, if possible, to avoid prosthetic appliances. As soon as we go to bridges or partials or anything else, we’re introducing a new variable into the system, and that variable means that it’s more difficult to clean.”
Dr. Sheldon started by performing a bite adjustment. “She was banging on that tooth very hard,” he said. Using a diamond bur, he ground down tooth #24 so the patient no longer put pressure on it, which helped relieve her discomfort. “She breathed a sigh of relief,” he recalled, because now her other teeth could touch, and she wasn’t putting pressure on this one anymore.
Next, Dr. Sheldon ran an OralDNA MyPerioPath® test to assess the bacterial profile in the patient’s mouth. While waiting for the test results, he prescribed cephalexin and metronidazole to address the infection. He also prescribed Diflucan for yeast infections since the patient had a sensitivity to amoxicillin. “I wouldn’t ordinarily prescribe Diflucan, but the response was so unusual,” Dr. Sheldon explained.
After receiving the MyPerioPath test results, Dr. Sheldon confirmed that the antibiotics chosen were effective, as the test showed the presence of red complex bacteria, indicative of aggressive periodontitis. To stabilize tooth #24, Dr. Sheldon splinted it to adjacent teeth (#23 and #25) using a composite splint. “It’s like putting a cast on a broken bone,” he explained.
The final step in the treatment plan involved performing periodontal endoscopy, or perioscopy, to thoroughly clean the root surface. “We used an endoscope to remove calculus and applied EDTA to eliminate micro-islands of bacteria,” Dr. Sheldon noted.
Dr. Sheldon followed up with the patient in three months and six months, seeing significant improvement in both the patient’s condition and in the X-rays, which showed bone regeneration around tooth #24. “The body wants to heal,” Dr. Sheldon said. They took away the etiologic factors, splinted the tooth, cleaned the root, and observed. The body healed itself.
Dr. Sheldon’s case underscores critical principles in periodontal care: preserve natural teeth whenever possible, leverage diagnostics like OralDNA to personalize care, and address causative factors methodically. As Dr. Sheldon put it, “Periodontal disease is actually quite predictable to treat,” and “The body wants to heal.” This case highlights how combining clinical expertise with advanced diagnostics can lead to exceptional outcomes for patients. To see Dr. Lee Sheldon’s full explanation, watch his video here. You won’t want to miss his detailed insights and practical wisdom!
For more from Dr. Lee Sheldon, visit the IDS page of our Protocol Directory.
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