TRENDS IN SALIVARY TESTING
Patient Background: 65-year-old female, patient of record, diagnosed with rheumatoid arthritis, experiencing recent flare up, and feeling increased stress as she is preparing to retire from her high school English teaching position. Patient has been on 3-month recare since active periodontal therapy 10 years ago, her home care is adequate, consisting of electric toothbrush 2 times per day, flossing 4 times per week and hydro-flossing 3 times per week.
Introduce testing to the above patient: Mrs. Smith, I know you and I have been working together diligently for many years to control your periodontal disease. However, I am seeing a trend that may indicate your gum disease is being negatively influenced by your chronic health conditions such as your arthritis. Your immune and inflammatory systems appear to be on overdrive and can no longer handle the bacterial load from your periodontal infection the way they used to. To see exactly what we are dealing with, I want to test your saliva to see what kinds of bugs are living in your mouth. Some of these bacteria are very resistant to all the hard work you and I have been doing to control them. Just as your primary care provider evaluates your bloodwork to determine the effectiveness of your prescribed medications, I will test your oral bacterial load to measure the effectiveness of our treatments. The bugs do not just stay in your mouth, they may be spreading to other parts of your body and can make your other conditions worse.
MyPerioPath Test Results:
Interpret MyPerioPath® results for the patient: Mrs. Smith, we have your lab results and you do indeed have several high risk and moderate risk periodontal bacteria at high levels in your mouth. So, here is what we are going to do. In addition to the mechanical periodontally therapy, I am going to send you home with a gum recovery kit for you to use over the next three months until your next appointment. This will promote wound healing. I also want you to begin taking anti-inflammatory supplements such as turmeric, omega-3, high dose vitamin C, and collagen. These will work from the inside out to help your immune and inflammatory system aid in controlling the bacteria and inflammation. We may need to do a round of antibiotics if some of these measures are not producing a shift to fewer bacteria. However, if we do need to use a systemic antibiotic, I know from the lab results specifically which antibiotics will work the best to reduce a good portion of your periodontal bacteria. Also, we will be testing your saliva in 6 months to compare results to this test and using it as a benchmark. Finally, I want to send correspondence to your physician to alert him/her to what I am treating you for and to make him/her aware of your periodontal status. Periodontal disease is a multidisciplinary disease and I want to include your physician in your overall care. I will also give you a copy of your results. Your lab report shows the individual species of bacteria in your mouth and the chronic diseases they are associated with. This could explain why your autoimmune disease has been flaring up for the last year.
Additional Insight: When placing an order for MyPerioPath®, the option to remove the Therapeutic Thresholds is something our team prefers. In previous cases where the thresholds appeared, some below threshold patients would confuse being below threshold as healthy. By eliminating the thresholds, this assumption rarely happens.
The gum recovery kit consists of StellaLife® Rinse & Gel and Hyperbiotics® probiotics. The flavors are good so patient compliance is high and we have had great success with improved periodontal conditions.
Leslie I. Bautista RDH
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