December 2011 Award Winners - Dr. Howard Schwadron & Kim Stevens RDH
Hygienist Kim Stevens and Dr. Howard Schwadron are recognized with the Orkos Award for excellence in a case study treating a patient with severe periodontal disease and a fear of subgingival debridement. The patient’s condition was first documented by Kim Stevens, RDH in 1995 and detrimentally progressed over the years. From 1995 to 2007 the patient insisted that Dr. Schwardron treat her exclusively and repeatedly refused scaling and root planing (SRP), only consenting to topical scalings and polishing. By 2007 when the doctor told her she had to have scaling and root planing or lose her teeth, she consented to a hygiene appointment with Stevens.
At the September appointment in 2007, Stevens completed a comprehensive periodontal exam. The lower arch contained the deepest pockets measuring 10mm. Tooth #31 was in the worse shape. It had drifted mesially in the absence of #30 and pitched forward. There was 100% bleeding on probing and the bleeding was heavy. Because Dr. Schwadron’s office uses Florida Probe® charting that digitally announces pocket depths, bleeding, and exudate, the patient had to acknowledge the situation. As Stevens recalls, “The patient was so afraid of scaling and root planing that I purposely avoided those terms and reiterated Dr. Schwadron’s message that a deep cleaning was needed, but she adamantly refused. I was frustrated.” Stevens then told her the only thing left to try was a relatively new, non-invasive delivery of medication with prescription Perio Trays®. “But,” Stevens confided recently “I didn’t think it would work. I thought she would lose her teeth. At the time, I thought, how can you get any good results without removing the tartar?” The patient agreed to this non-invasive approach and Dr. Schwadron prescribed Perio Trays®.
Just short of two weeks later, the patient returned to receive her prescription trays, medication and wearing instructions. They scheduled an appointment two weeks later to monitor conditions. The patient then cancelled that appointment along with two more. When she returned two months later, as Stevens recollects, “her entire countenance was different. She just kept smiling. I will never forget it,” Stevens said. “I looked in her mouth and I couldn’t believe what I saw. Her gums looked pink, not purplish red from disease, and the clinically visible calculus documented in September was no longer there. I backed away from the chair, said her name, and she said ‘I know!’ “
With this initial success, the patient readily consented to a perio maintenance visit with Stevens one month later, January 24, 2008. As Stevens explains, “I had to really hunt to find any calculus and her measurements were so much better. She had just a few fours, mostly 2’s and three’s and the tens now measured fives, with no bleeding all. Her tissue was coral pink and her gums were tight.”
The patient continued to use the Perio Tray delivery of medication as directed. Tooth 31 could not be saved but all of the remaining teeth were. By August 22, 2011, improved conditions were maintained. Deep and bleeding pockets that measured 49% of all sites at the start of treatment had all been resolved.
Importantly, recession did not increase. “Improvement in recession is rare when inflammation is reduced this dramatically,” Stevens notes. “The tissue generally shrinks when inflammation subsides but it often does not reattach and recession increases. In this case, recessed, rolled inflamed tissue not only resolved but also reattached in most places.”
Learn more information about the prescription Perio Tray® from Perio Protect.