Practicing in the Real World when Patients Refuse Scaling
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.
After three weeks of Perio Tray® delivery, hygienist Meghan Radcliff noted improvements in pocketing and considerably less bleeding. Gum tissue tone was noted as less red, more of a healthy pink, and less swollen. When the patient returned in early December, full periodontal charting shows additional improvements in pocket depths and only 1% bleeding on probing.
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.
“We are so excited about this case,” explains the hygienist Meghan Dunham, “because the patient was reluctant to accept treatment in the beginning. We were afraid that his case was irreversible. Once he started using tray therapy and changed his hygiene, we could see so much improvement. Now he is one of our best patients, always raving about his success with Perio Protect. For me,” she continues, “the additional benefit is to see him smile with confidence. He no longer shields his mouth when he smiles. The peroxide has also lightened his teeth and he has a wide, white, bright smile.”
“Perio Protect LLC is proud to work with dental teams doing such good work.” says Managing Director Tanya Dunlap. “It is our privilege to participate in their care for patients and to have the opportunity to see their success.” The Orkos Award for excellence in case study was founded by Perio Protect to recognize and honor the work of dental professionals to improve the gingival health of their patients.
This case stood out to the award committee,” explains Dunlap, “not only for the significant improvements in the patient’s health, but also for the approach the team took to address the patient’s fears and gain his trust.”
For additional information on the dental practice of Drs. Blattner and Heberer in Waterloo, IL, visit www.smilesrforever.com. Details on prescription Perio Tray® therapy is posted at www.PerioProtect.com