PerioEndoscopy and Integrative Care – Case Studies for discussion:
We have created this blog page to post pics and comprehensive information on actual PerioPeak case studies for the purpose of more in-depth clinical education and sharing of knowledge. Professionals and patients are welcome and encouraged to post here.
I will be seeing this patient soon traveling in from out of state. He has had blind root planing 4 times in past 18 months. Twice with the periodontist. He was told he has “rough roots”. While he was told to get a “physical”, he was not given a list of labs to check for causal risk factors such as D deficiency or other. I have requested comprehensive labs on him before treating him in April. I will also run a full genetic panel and pathogen test since no one has done this. This pt has hx of ortho, excellent diet, BMI wnl, no family hx of anything, has NG. He’s only 32. Pockets are gen 5-6mm with gen. BOP and severe infl as you can see, gen early to moderate horizontal bone loss on x-rays. We expect to find residual ortho cement sub-g in many areas. He does have seasonal allergies and there are mouth breathing and myofunctional issues as part of overall risk factors (bruxism as well). He is lactose intolerant and takes a high potency multivitamin daily. I have seen cases like this in the past (non-responsive, hyper-inflammatory), in my experience it always seems to be young males who are “type A” personality, there is also a genetic component. His mom has had hx of perio issues, father HBP but is overweight. Rarely do these individuals have pathogens. We will be looking closely into all systemic issues, including adrenals. Comments? I will post test results and findings next month once I have all the data.
Update – here is what we determined: As I suspected this patients bacteria profile is very clean, no pathogens. His genetic profile is positive for IL6, TNF alpha and IL17A polymorphism (he has hyper-inflammatory immune response). He was diagnosed with severe vitamin D deficiency and is now taking high doses. Upon clinical exam chronic mouth breathing was determined (along with tongue thrusting and clenching), with suspected sleep apnea. We referred him to the ENT right away for severe obstructive airway issues. We recommend he continue on Periostat and high doses of D3.