Case Study: Widow Maker

September 17, 2015 Dr. Wade Case Study 0 Comments
Background
  • White Male, Age: 67
  • Medical History:
  • Heart Attack (Widow Maker in August of year Feb 2012)

Patient has had no obvious symptoms or headaches and no chief complaints of oral cavity. Has been taking his meds consistently after heart attack and gets regular check ups from his cardiologist and general physician. He has retired recently and keeps busy training and breeding labs. He stays on frequent hygiene recall with our office.
The hygienist recently took new FMX for our CRE (Comprehensive Recall Evaluation) and noticed something strange in the #13 area. The x-ray today was compared to a previous x-ray.  (See Photo A dated 5/5/2015 with photo B dated 7//2011)

Photo A
Photo A 5/5/2015
Image B 2015FMX
Photo B 7//2015

Upon evaluation a 3D cone beam scan and pathogen report was ordered to evaluate the area. Only complaint the patient has is that he tends to want to take a toothpick in that area. He states “it feels good”.

See the photos of the obvious bone loss in the area that show up in 3D cone beam. (See photo C, D, E dated 5/20/2015)
See results of his pathogen test. (See photo F dated 5/13/2105)
Above Threshold for En, Pm, Ec and present for ( high risk )Tf, Pi, Cn.

3D Cone Beam Images

Photo C 5/20/2015
Photo C 5/20/2015

Photo D 5/20/2015
Photo D 5/20/2015
Photo E 5/20/2015 Photo E 5/20/2015

See results of his pathogen test: Photo F dated 5/13/2015

Photo F 5/13/2105
Photo F 5/13/2105

Above Threshold for En, Pm, Ec and present for ( high risk )Tf, Pi, Cn

Before getting him to the oral surgeon for extraction and bone grafting, we suggested advanced inflammatory testing prior to extraction to be sure his health was able to sustain his surgery. We requested previous testing from cardiologist and physician, non of which had tested for LpPlac2, hsCRP, or MPO. We wanted to know how HOT this patient was before proceeding in case we wanted his healthcare providers to up his dosage of meds to protect him during and after the surgery.

Current meds were:

  • Atorvastatin 20mg 1xday
  • Metoprolol25mg 2xday
  • Aspirin .81 mg 1xday

Relevance Total Health ran his blood work. Surprisingly he was completely cool! He did not need any medication changes prior to surgery. He had extraction performed and bone grafts placed.
Upon re-evaluation at Stonebrair Smile Design, dental office, he stated he was feeling much better. Actually felt better than he had in years right after the surgery with the pain medication he had taken after surgery. It helped him not feel so achy with his knees (old football injuries).  I suggested that since he was so cool and that his laboratory workup looked so good that he should discuss with his physician about reducing his statin medication level from 40 mg a day. These drugs can leave a person feeling very very achy and stiff and over-all not a great daily activity motivator. He stated he would be going later that day and would discuss. He did and the doctor did make a change to Crestor 10mg 1xday and as reported by patient he is feeling better than ever before.

Provoking Questions?

Could his dental infection contributed to his heart attack? It was not obvious in 2011 x-rays but was present in 2014and 2015 x-rays. His heart attack was in 2012.

He has a high level of PM as of 2015. Could a dental infection with a pathogen test picked up the infection earlier?

Would be interesting to know what his inflammatory markers and pathogen test showed right before or after his heart attack. But there is no record of either.

The time frame in between his FMX of x-rays was within a normal standard of care frame of time? How often is too soon or too long for a full series?

As all of us become more aware and learn more, we begin to visualize all data with new eyes. Something we may have overlooked once could with new knowledge be so obvious now. Never feel bad for missing something because you simply did not know it at the time. Now is the right time! If you know something take action!!

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