Content Dam Diq Online Articles 2012 September Orkos100

Seattle dental team receives Orkos Award

Sept. 7, 2012
Dr. Jim Coleman’s team recognized for demonstrating excellence in a case study report for the treatment of gum disease.

ST. LOUIS, Missouri--The Seattle based dental team at Dr. Jim Coleman’s office has received the Orkos Award.

The award recognition honors dental practitioners who demonstrate excellence in a case study report for the treatment of gum disease.

The patient in this case study had advanced periodontitis and significant fears regarding pain management. Dr. Coleman’s team introduced the patient to newer, noninvasive technology, which helped him alleviate his fears and accept treatment. The documented success highlights positive trends toward effective, minimally invasive oral care.

Like many patients across the country, the 62 year-old, nonsmoking patient in this case study feared and avoided needed dental procedures until his gum disease was quite advanced. He found Dr. Coleman’s office after his previous dentist retired.

On his first visit, Dr. Coleman diagnosed him with Class III periodontal disease, including vertical and horizontal bone loss, 5-7 mm periodontal pockets, and 37% bleeding on probing. Microbiological analysis (Hain Diagnostics) further revealed high levels of periopathogens, especially Aa-complex and red complex bacteria.

The fear preventing the patient from accepting dental care is widespread in the general population. Research indicates that fear of pain is the main reason people avoid seeing the dentist. This is especially true for patients with gum disease.

The rigorous scraping of the teeth above and below the gum line often requires a local anesthetic, and surgical intervention when gum or bone tissue is removed is even more unpopular. Because it is so difficult to see the infections in the mouth, patients can often ignore the signs and symptoms of their disease until the condition is far advanced.

To help alleviate his new patient’s fears, Dr. Coleman prescribed Perio Trays to deliver medication under the gum line before root debridement therapy. The medication delivered with the special customized Perio Tray begins to address the biofilm infections causing the disease.

When the patient returned after 20 days of tray and medication usage, pocket probing depths decreased by 1-3 mm and bleeding decreased from 37% of probing sites to 14%. Microbiological testing indicated significant (90%) reductions in red complex bacteria.

Inflammation has subsided significantly enough to expose more of the calculus for hygienist Karla Middendorf to complete a full mouth supragingival debridement.

Despite the initial positive treatment response, the patient still feared the necessary root debridement therapy. When the patient returned a month later, Dr. Coleman prescribed an anesthetic gel delivered in the Perio Tray before the mechanical procedure.

With this additional pain management step, root debridement therapy was successfully completed in one procedure. The patient was instructed to continue to use Perio Trays with medication until the next appointment.

Middendorf described his results as outstanding at the recall visit six weeks later, with only 3% bleeding on probing and no pockets measuring more than 4 mm. Gum color returned to a healthy pink she noted, and microbiological testing revealed significant reductions in bacterial loads. Importantly, clinical attachment level measurements had also improved significantly.

The anesthetic gel in the Perio Trays has made a difference for this patient, according to Middendorf’s colleague, hygienist Paula Kingsley. Kingsley also worked with the patient.

“With the delivery of the numbing agent deep into the pockets,” Kingsley 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.”

Long-term success is the ultimate goal. The difficulties patients face managing oral bacteria between office visits is a primary reason recurrent rates of gum disease are high.

The Perio Tray delivery of medication is an advancement in patient treatment options because patients use it at home between office visits for long term maintenance. It also can be used by patients with all stages of disease.

Not only are there no pocket depth restrictions for Perio Tray usage--it is customized to deliver medication to every pocket depth--but also the delivery is 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 are more hopeful.

Dr. Coleman initially was interested in the Perio Tray delivery of medication for maintaining patients with physical disabilities, like Parkinson Disease or strokes, who are now dependent upon their caregiver for their daily oral hygiene.

What he and his team discovered, recounts Kingsley “was a tool that is so much more comprehensive, affordable, simple and effective for all of us and our patients.” Then, Dr. Coleman decided after seeing “off label” successes, why not use it for what it was design for, treating patients with periodontal disease.

Middendorf, who has practiced hygiene with Dr. Coleman for 16 years, uses Perio Trays for preventative care.

“I use it 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,” she said.

Laura Brecht, a dental assistant in Dr. Coleman’s office, explained 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 also had trays made for his own personal use after seeing the benefits.

The move Dr. Coleman’s team made toward minimally invasive dental care with the noninvasive Perio Tray is indicative of his emphasis on thinking “outside the box” and embracing evidence-based science through technology.

“The science behind the 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, Wash., after completing a dental career in the U.S. Navy. He is a fellow and lifetime member of the World Congress of Minimally Invasive Dentistry.

The minimally invasive approach to patient care emphasized by Dr. Coleman and WCMID members, corresponds to a trend throughout medicine that Perio Protect wants 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,” explained Program Development Director Dr. Tanya Dunlap, “because the patient would have faced surgical intervention which he was unlikely to accept.”

Contact Dr. Coleman’s office at (206) 242-4477 or at

For additional information about the Orkos Award, go to To learn more about the Perio Protect Method, visit

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