‘Practicing in the Real World when Patients Refuse Scaling’

Award Winner: Dr. Jim McCreight and Jamie Rotunno, RDH.

Dr. Jim McCreight and Jamie Rotunno, RDH

The backbone of comprehensive periodontal therapy is scaling, the removal of bacterial communities, sometimes calcified, that are causing the infections in the gum tissue and the inflammatory response. When patients refuse scaling, there are not many alternatives. More brushing and flossing will not help singificantly. You can dismiss the patient, wait until the disease progresses and requires surgery or extractions or, like Dr. Jim McCreight and hygienist Jamie Rotunno, you can intervene with adjunctive Perio Tray® homecare, schedule debridment and prophies every three months, and continue to advocate for scaling.


The patient in this case study presented with moderate periodontal disease, isolated areas of significant destruction, generalized and severe bleeding on probing, calculus build up, worn dentition, undiagnosed sleep apnea. He expressed fear of the dentist and his oral health had not been a high priority. He returned to the practice in 2019 after not being seen for 15 years.

Pre-treatment radiographs and images taken on April 23, 2019

The patient’s concern for finances led him to decline scaling. He accepted Rx Perio Tray® therapy, debridement, and diode laser therapy. Perio Trays with 1.7% hydrogen peroxide (Perio Gel®, QNT Anderson, Bismarck, NC) and doxycycline calcium (Vibramycin®, Pfizer, New York, NY) were prescribed for home usage in 15-minute increments. Trays were delivered on May 23, 2019. Debridement and diode laser therapy (American Dental Technologies Diolase ST) were completed on June 17, 2019. The patient returned on July 29 when images and charting were taken.

Images taken on July 29, 2019 after Perio Trays, diode laser and debridement.

Research shows that when the Perio Tray® delivery of peroxide is incorporated into patient homecare, pocket depths and bleeding are substantially reduced. Vibramycin® syrup (a doxycycline) delivered in a Perio Tray® has been shown to stabilize bone support. Dr. Blattner recommended using the trays several times a day in 15-minute increments.


For patients with chronic periodontitis, the Perio Tray® is as important as a toothbrush. It delivers antimicrobial and oxygenating agents deep below the gums where toothbrush, rinse, and floss can’t reach. When used regularly, Perio Tray® delivery can improve and maintain gum health for years. At this patient’s most recent periodontal maintenance visit in September 2017, there was no bleeding on probing.


For additional information on the dental practice of Dr. Jim McCreight in Steamboat Springs CO, visit https://www.steamboatdentistry.com/about-us/meet-our-team/dr-jim-mccreight/. Details on prescription Perio Tray® therapy is posted at www.PerioProtect.com

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