This patient had RPS done in 2009 and again in 2010 and was finally referred for a periodontal evaluation due to continued pocketing.
She was treated with Perioscopy.

The video can be viewed at: https://www.youtube.com/watch?v=ZBox05eS3TI

As you can see, gross amounts of harmful bacterial deposits were left behind after previous blind instrumentation appointments. These deposits were responsible for the patients continued disease state.

As we know, fractures are common in the world of dentistry and can occur with all ages, although they are more common in people above the age of 25.

The patient in this video had been seeing his general dentist for a number of years on a regular basis for treatment of his periodontal disease. The last several years he has complained of sensitivity to chewing, cold and touch on the lower right side, which seemed to be getting worse, so he began using a desensitizing tooth paste.

The tooth tested vital, x-ray showed no signs of endodontic involvement so he was refer for examination.

Perioscopy revealed what his dentist could not find; a root fracture that extended from under his gold crown and into the root structure. Prior to Perioscopy technology, this patient would have required exploratory surgery.

To see this video with x-rays and photos, go to:
https://www.youtube.com/watch?v=-DG8vNvvPFo

Kudos to Dr. John Kwan who posted the below information on his Facebook page;
“Perioscopy Incorporated started new development on the next generation Perioscopy System last month with the German company Schoelly FiberOptics.”

To access Dr. Kwan’s Facebook page, or to share it with others, go to:
https://www.facebook.com/#!/pages/Perioscopy-Inc/158776794171279

 

Initial Exam: June 2004
Rx for infection: Metro/Amox each 500mg x 14, both bid until gone
Perio Clinical Findings:
•The general level of periodontal inflammation is advanced
•Pocket formation summary: many advanced (>6mm) pockets present

Diagnosis:
•Generalized advanced chronic periodontitis. Advanced in extent with 4- 12mm pockets.
•Class l-lll mobility lower anterior teeth
•#’s 23-26 diagnosed as hopeless

Initial Tx Plan:
OHI for improved OH; Water Pik to be used as an adjunct to regular brushing and flossing
FM micro ultrasonic endoscopic debridement
3 month supportive periodontal maintenance appointments

Treatment; Nov 2004
FM micro ultrasonic endoscopic debridement using a Tony Riso magnetostrictive US scaler with local anesthetic
Teeth #’s 22-27 splinted for stability on the LA

UR Pre Tx; 6-2004
Pockets 4-12mm

LR Pre Tx; 6-200
Pockets 4-12mm

UL Pre Tx; 6-2004
Pockets 4-9mm

LL Pre Tx; 6-2004
Pockets 4-11mm

3 months Post TX:
OH only fair, or inadequate
Compliance w/ spt great for the next 8 years!

8 Years Post Tx
No teeth have been lost!
Pocket depths on the “hopeless” lower anterior teeth now probe 2mm. A reduction of up to 9mm.

To view this case go on the Hygienetown Perioscopy Users Forum, go to:
http://www.towniecentral.com/MessageBoard/thread.aspx?s=3&f=1850&t=190056&pg=1&r=2884767

Some of you may be unaware that in 2009 the AAOS published a statement calling for universal AP prior to oral procedures for those with a prosthetic joint. This statement was published on the AAOS website with no input from the ADA. It, essentially, dismantled the joint policy on the issue by the ADA/AAOS. The ADA on their website says there is no science to support this decision but at this time dentists are advised to communicate with the client's orthopedist for guidance. Most orthopedists will likely prescribe AP, although there is absolutely no evidence it is effective to prevent PJI. A rigorous case control study published by Mayo Clinic revealed that dental procedures were not a source for joint infection in their study and also that the drugs in the ADA/AAOS regimen had no evidence of efficiency for preventing PJI (Berberi et al 2010). The UK stopped all AP prior to oral procedures and report no increase in infective endocarditis. A recent study in USA reports same results, no increase in IE when AHA revised the guidelines in 2007. Someone should look at the prevalence of PJI comparing the prevalence between 1997 (when joint guidelines were published and called for AP only in high risk population for joint infection) up to 2008 and the prevalence from 2009 to 2012. That data would be interesting to see. Canada has a group that tracks PJI so their data could be used to look at the impact of the 2009 statement (positive or negative).

Saliva Diagnostics – Can It Help Prevent Caries?
http://www.checkdent.com/dental-blog/saliva-tests-and-caries-prevention.html?lang=en
Saliva Tests may improve patients’ monitoring and participation skills in caries-preventing measures.
With the help of saliva diagnostics development, attempts are being made to identify bacteria (streptococcus mutans and lactobacilli) and to take into account saliva flow rates and buffer capacity of saliva in order to identify patients with an increased risk of caries. Furthermore, these tests are supposed to improve patients’ monitoring and participation skills in caries-preventing measures.
Comparisons of caries frequency and bacterial concentrations showed only a small correlation between these two.
This discrepancy is more pronounced in children than adults. Only the absence of the streptococcus mutans correlates strongly to a lack of caries. This means that somebody who has no streptococcus mutans bacteria in the mouth does not have any caries either.
The increased incidence of lactobacilli is obviously an indicator of untreated carious defects. The concentration of lactobacilli in the oral cavity is influenced by the sugar content of food and the effectiveness of oral hygiene. However, lactobacilli are only of minor significance in the development of caries. By contrast, studies show that extremely low saliva flow rates and a simultaneously low buffer capacity correlate with caries frequency.
For this reason, neither an individual saliva test nor the totality of the saliva diagnostics commercially available today can precisely predict caries risk for an individual. This is proven by the often low correlation of the test results with the actual increase in caries. Above all, the border between the normal area and the risk area is unclear. Saliva tests performed only once are associated with a high chance risk.
A more precise prognosis of individual caries risk would necessitate repeated saliva tests, additional clinical examinations (such as the determination of the plaque index) and the ascertainment of individual dietary behavior as well as of fluoride intake.
Thus, saliva tests only serve (if at all) for the motivation, monitoring and education of patients. Lactobacilli correlate with the number of untreated carious defects and are a useful indicator for high sugar consumption. Careful oral hygiene is reflected in lower bacterial concentrations. Therefore, saliva tests can be helpful in motivating and monitoring patient participation in caries prevention.

I've searched for evidence comparing a group with positive saliva test to those with a negative test and measuring caries at end of a year. Cannot find even ONE. However, my mind is not closed, has anyone identified evidence to support the one time use for these costly tests?

Several colleagues and I recently had a discussion about the concept of why some dental offices were providing DNA testing for GENETIC PREDISPOSITION of periodontal disease.

For the life of me I couldn’t find ANY scientific evidence to support the rationale for this test! Then we began discussing providing risk analysis as a tool in patient management.

I offered to take this to the Users Forum to get some feedback on how other clinicians and offices are using, not using, or feel about providing these tools