PR Log - Sep 04, 2012 - Seattle-based dentist Dr. Jim Coleman and hygienists Karla Middendorf and Paula Kingsley received the Orkos Award, a recognition honoring dental practitioners who demonstrate excellence in a case study report for the treatment of gum disease. The patient in Dr. Coleman’s case study suffered from advanced periodontitis and had significant fears regarding pain management. Dr. Coleman’s team helped alleviate the patient’s fears by introducing him to a newer, non-invasive technology, which he was willing to accept.
Like many of us, the patient who was new to Dr. Coleman’s office had a fear of dental procedures. Over time he avoided necessary dental work and his disease progressed. Fear of treatment pain is a main reason people avoid seeing a dentist. This is especially true for patients with gum disease. The most common treatment for the disease is debridement and scaling, a thorough scraping of the tooth and root surfaces, which often require a local anesthetic. More severe cases require surgery. Patients who have experienced invasive periodontal procedures once are often hesitant to repeat the experience, which is often necessary. The problem is that, while such procedures effectively remove diseased tissue, they do not effectively address the bacteria that cause the disease, so in a few months or years, the patient returns to the dentist and needs similar procedures performed again.
To help alleviate his new patient’s fears and reduce any possible discomfort, Dr. Coleman prescribed Perio Trays® to deliver medication under the gum line, prior to administering in-office procedures. The Perio Tray is a customized tray in which patients place medication and then wear over their teeth and gums at home for minutes each day. It is a simple, non-invasive homecare option that is used with brushing and flossing.
Gum disease has, in the past, been hard to manage because the infection and the bacteria responsible for the infection are below the gum line, making it difficult to place medication in the area long enough to kill the bacteria. The Perio Tray addresses this problem, not only by effectively holding medication in place, but also by allowing patients to administer medication at home between dental appointments.
When Dr. Coleman’s patient returned for a follow up appointment after twenty days of applying medication with his Perio Trays, an examination revealed that bleeding had decreased significantly and the depth of the pockets between his teeth and gums had also decreased significantly. Microbiological testing showed a 90% reduction in red complex bacteria, a cause of gum disease. Inflammation had subsided enough to allow the hygienist, Karla Middendorf, to effectively perform a full mouth scaling above the gum line.
The initial treatment results were positive, but the patient’s conditions required root debridement too. The patient was very hesitant, so Dr. Coleman prescribed an anesthetic gel that was administered prior to the treatment using the patient’s Perio Trays. Administering anesthetic gel with Perio Trays made a huge difference for this patient, according to hygienist Paula Kingsley, who also worked with this patient. “With the delivery of the numbing agent deep into the [gum] pockets,” she explained, “perio maintenance visits were much more comfortable for the patient. Consequently he kept his appointments, we were able to complete the treatments, and the positive results have been maintained long-term.”
Following root debridement therapy, the patient was instructed to continue using Perio Trays with medication. Six weeks later, during his recall visit, hygienist Middendorf describes the results as outstanding, noting only 3% bleeding on probing and all pockets reduced to healthy depths of 3mm or less. The patient’s gum color had returned to a healthy pink, and microbiological testing revealed significant reductions in bacteria.
Long-term success like this is the ultimate goal. The difficulties patients face managing oral bacteria between dental appointments is a primary reason recurrent rates of gum disease are so high. The Perio Tray delivery of medication is a significant advancement in patient treatment options because patients use it at home between office visits for long-term maintenance. Furthermore, Perio Trays can be effectively used by patients with any stage of gum disease. Unlike other treatments, there are no pocket depth restrictions for Perio Tray usage, meaning that patients with milder forms can address the problems before they progress. Not only is the Perio Tray designed to deliver medication into every pocket depth, it is also designed for maximum patient comfort and convenience. Kingsley believes that when patients have access to the best tools, they have more options for proactive treatment and they can be more hopeful for a healthy outcome.
Dr. Coleman initially became interested in using Perio Trays as a way to help his patients with physical disabilities who were unable to brush or floss and were dependent on caregivers for their daily oral hygiene. What he and his team discovered, according to Kingsley, “was a tool that is so much more comprehensive, affordable, simple and effective for all of us and our patients.” After seeing patient successes with “off label” use of Perio Trays, Dr. Coleman decided to try prescribing the Trays for what they were designed for, treating patients with periodontal disease.
Middendorf, who has practiced hygiene with Dr. Coleman for sixteen years, uses Perio Trays herself for preventative care. “I use them so I don’t ever develop periodontal disease. I see what many of my patients deal with – bone loss, bad breath, local and systemic infections – and I want to avoid it for myself.: Laura Brecht, a dental assistant in Dr. Coleman’s office, explains that she uses the Perio Tray delivery of medication to reduce calculus buildup and eliminate the “itchy” gums she had around a crown. Dr. Coleman had trays made for his own personal use after seeing the benefits.
“The science behind Perio Tray delivery of medication wowed us,” said Kingsley. “It allows us to offer targeted treatments for the biofilm cause of the disease and it has changed the way we practice.” Dr. Coleman has been in practice for 20 years in Burien, WA since completing a successful dental career in the US Navy. He is a fellow and lifetime member of the World Congress of Minimally Invasive Dentistry (WCMID), a growing dental organization with a philosophy to lead the way in innovative dental patient care through prevention, intervention, and education.
The minimally invasive approach to patient care emphasized by Dr. Coleman and WCMID members corresponds to a trend throughout medicine that Perio Protect, LLC wishes to encourage. The Orkos Award was founded by Perio Protect to support and recognize the contributions of dental professionals using minimally invasive methods to treat gum disease. To receive the Orkos Award, doctors and hygienists submit documentation demonstrating significantly improved clinical outcomes for patients after treatment. “The qualifying evidence presented by Dr. Coleman was of particular interest,” explains Program Development Director Dr. Tanya Dunlap, “because the patient would have faced surgical intervention, which he was unlikely to accept.” Perio Protect congratulates Dr. Coleman and his team on this excellent case study.