Our New York City dental practice has considered the systemic (whole body) relationship of dental disease for over two decades.  We have been obtaining periodontal cultures of patients with advanced gum disease, based upon the early work of Dr. Max Listgarten, since 1988.  The recent discovery of diabetes in a patient based initially on periodontal (gum) diagnosis is a case in point.  The Center for Special Dentistry is proud to work with Dr. Keith Berkowitz at the Center for Balanced Health in mid-town NYC.  The fasting glucose tolerance test they performed to diagnose the patient’s diabetes will contribute to the overall health of this 42 year young woman.

42 year old female presented for an implant placement in the space of tooth #18. Previously it was noted that the patient was having periodontal problems, had undergone several rounds of scaling and root planning and had been placed on amoxicillin with metronidozole to resolve the condition. A periodontal culture was taken to determine the type of pathogens and if any resistant strains were present. The lab results showed gram negative rods resistant to both of the antibiotics. The patient was placed on 500 mg Cipro BID 7 days. A follow up visit revealed the gums were in a better condition. The patient was also referred to Dr. Keith Berkowitz (www.centerforbalancedhealth.com) to test for fasting blood sugar levels due to the suspicion of a systemic cause of the periodontal condition, prior to implant placement. The blood test revealed a fasting blood sugar level of 139 and the patient was diagnosed with diabetes.  Dr. Berkowitz recommended controlling the diabetes with diet modification for this health-oriented, compliant patient.

Today, the patient was anesthetized and given proper surgical dressing. A flap was made from teeth 20 to18. A 6 x 9 mm implant was placed, as well as a 5.7 x 3mm healing abutment was placed out of occlusion. Slight enamelplasty was done on tooth 18 to allow room for the healing abutment, due to the severe mesial angulation of tooth 18. A panoramic film was taken to verify proper placement of the implant as well as proper seating of the healing implant. The tooth was left without a temporary for the time being to allow integration of the implant and bone.

N.D., New York University College of Dentistry

Today, I observed the periodontist in the evening. The Arestin treatment that was done in that visit was a new learning experience for me because in perio classes in NYUCD we have been taught the various treatment regiments but I have never seen anything outside of scaling and root planning. It was interesting to watch antibiotics being administered directly into the area of the infection. In school many times I have been told by faculty to use hydrogen peroxide while doing an SRP to inhibit the growth of anaerobic bacteria in the area of PDL; that is because while doing an SRP gets rid of plaque and calculus, many of the bacterial populations remain unaffected. By administering antibiotics directly at the site of aggravation we are addressing the problem where it starts as oppose to just eliminating the result of the problem.

H.A., New York University College of Dentistry, Patient 4