CBD: is a blood panel for a laboratory analysis that measures the presence and concentration of cannabidiol (CBD) in the blood.
CBC: A complete blood count (CBC) is a common blood test that measures various components of the blood, including:
Red Blood Cells (RBCs): Count (number of cells), Hemoglobin (protein that carries oxygen), and Hematocrit (percentage of blood volume occupied by RBCs).
Chemistry Screen:
A chemistry screen is a blood test that measures the levels of various substances in the blood, such as electrolytes, fats, proteins, and glucose, to provide information about your general health and organ function. It can help a doctor diagnose conditions, monitor the effectiveness of treatment, and evaluate overall health. Different types of screens exist, like the basic metabolic panel (BMP) and comprehensive metabolic panel (CMP), which measure different numbers of substances.
A chemistry screen can measure a wide range of substances, including:
Electrolytes: Sodium (Na), potassium (K), chloride (Cl), and carbon dioxide (bicarbonate) especially in smokers. This also helps you determine the level of hydration and what’s needed to manage for tissue and wound closure.
Kidney function: Blood urea nitrogen (BUN) and creatinine. For elimination of toxins and medications post operatively.
Liver function: Albumin, alkaline phosphatase, alanine transaminase (ALT), aspartate transaminase (AST), and bilirubin. This will give insight as to metabolism of medications, anesthetics, sedatives and go further on bone marrow qualities for recuperation.
Blood sugar: Glucose. Cross contamination, delayed healing and wound opening on elevated levels.
Proteins: Albumin and total protein. Will aid in proper healing and osteocyte activity.
Other substances: Calcium, lipids (fats), and others depending on the specific panel
Lipid Profile: A specific liver function blood test that measures different types of fats (lipids) in your blood, including total cholesterol, HDL, LDL, and triglycerides. It is used to assess your risk for heart disease and cardiovascular disease by providing a detailed breakdown of your blood’s fat levels.
Fibrinogen: A fibrinogen blood panel, also known as a Factor, I assay, is a test that measures the amount of fibrinogen in your blood. Fibrinogen is a protein produced by the liver that is essential for blood clotting. The test helps diagnose bleeding or clotting disorders by determining if your fibrinogen level is too low, which can cause excessive bleeding, or too high, which can increase the risk of harmful blood clots.
TIBC: (not used very often).
This test (Total Iron-Binding Capacity) bloodwork measures how well a protein called transferrin in your blood can attach to and carry iron. This test, usually ordered with other iron tests, helps diagnose a range of conditions by determining if there is too much or too little iron in the blood, which can indicate issues like iron deficiency anemia or hemochromatosis. Symptoms of low or high iron can include fatigue, weakness, and pain.
Doctors may order the test when looking into liver problems, blood disorders, or other conditions that affect iron levels.
25 Hydroxy Test: Also called the Vitamin D deficiency test.
Implant dentistry as we know today is quite different than when it began in the late 1980’s. The evolution of the actual fixtures has been over-developed to improve the attraction towards the host bone cells. However, the host bone cell still needs a boost and must be viable for all of this to be effective. These bone cells suffer from a range of situations all contrary to our final objective. The mere preparation of the osteotomy will increase the heat generated and lead to some of those cell’s death. Add to that, the average implant patient is of an older age group and their own inherent decreased ability to regenerate bone and other cells. This is a recipe for failure. More reasons for looking at your osteotomy burs and replacing them often.
The aging person has a debilitating cellular structure, and we as Implantologists must be aware of the implications this weakened system poses to our success ratios.
One of the main and silent opponents to success with grafts and ultimately implant dental procedures is the strength or weakness of the bone cell. Whether it is a Type I or a Type III bone, the results are the same with a weak bone cell.
Failure of varying degrees.
Testing patients for simple blood tests will reveal many factors un-beknown to the average implantologist.
As a general rule…
Women over the age of 45 are more prone to these factors than men or younger women. This does not mean it will not affect the latter, but rather a starting guideline for success and testing. The most relevant test for the validity of bone cells is the Vitamin D deficiency test. This test, called the 25- Hydroxy Test and can be accomplished by the patient’s physician or the office can draw blood and send the sample to the appropriate lab for testing and results.
Vit D Guidelines:
Average person ranges from 30-100 ng/ml. Within this test are 2 versions.
Therapy is based on a measurement of the total values.
<20ng/ml Vit D Deficiency
20-30 ng/ml suggest insufficiency but NOT deficiency
>30 ng/ml OPTIMUM LEVELS
The astute clinician will forcibly extrapolate this information based on the intended use or sacrifice at the cell layer. For instance, if simple implant dentistry in a healthy adult, then a lower level may be fine. However, add an older patient, receiving bone grafting, followed with implants and this patient should be addressed with a slightly higher curve of need.
The recommended Vit D levels as required for Implant Dentistry
<30 ng/ml Deficiency. Refer for supplementation
30-50 ng/ml Insufficient level to accept risk/rewards. Refer for supplementation
>50 ng/ml Sufficient levels to sustain treatment and healing with no additional supplementation.
CTX Turnover Rate test: Used for Bisphosphonates
This is a blood test that measures C-terminal cross-linking telopeptide (CTX), a marker of bone resorption or the breakdown of old bone. It is used to evaluate the rate of bone turnover, which is crucial for monitoring conditions like osteoporosis and the effectiveness of its treatment. Elevated levels indicate faster bone breakdown, while certain treatments can cause CTX levels to fall.
- Bone breakdown: CTX is a fragment of type I collagen, the main protein in bone.
- Rate of bone turnover: By measuring the amount of CTX in the blood, doctors can gauge how quickly bone is being broken down.
- Monitoring treatment: The test helps determine if a medication is working by measuring a decrease in bone resorption over time. For instance, a drop in CTX levels can show that an osteoporosis drug like a bisphosphonate is effectively slowing bone breakdown.
Sed Rate: A sed rate (erythrocyte sedimentation rate) is not a full blood panel, but a single test that measures inflammation in the body. It works by measuring how quickly red blood cells settle in a test tube in one hour; higher inflammation causes the cells to clump and settle faster, resulting in a higher sed rate. A doctor may order this test to help diagnose conditions like infections, autoimmune diseases, and certain cancers.
What a sed rate can indicate
A faster-than-normal settling rate can be a sign of inflammation in the body, which can be caused by various conditions, including infections, autoimmune disorders (such as rheumatoid arthritis), and certain cancers.
A slower rate can occur in conditions like polycythemia or sickle cell anemia.
Coagulation Panel: (Stroke Risk Panel)
A coagulation blood panel is a set of tests that checks your blood’s ability to clot properly. It includes tests like Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and International Normalized Ratio (INR) to assess clotting factors and help diagnose bleeding disorders or monitor the effectiveness of anticoagulant medications. This panel is also used to assess the risk of excessive bleeding before surgery.
Normal prothrombin time (PT) is roughly 11 to 13.5 seconds, or an International Normalized Ratio (INR) of 0.8 to 1.1 in a healthy adult. Normal activated partial thromboplastin time (APTT) is approximately 25 to 40 seconds. These values can vary slightly depending on the laboratory, patient factors, and the specific testing method used.
SMAC 21: Better known now as CMP:
A Comprehensive Metabolic Panel (CMP) is a blood test that measures multiple substances in the body to assess overall health and metabolism.
What it Measures:
- Glucose (blood sugar)
- Electrolytes (sodium, potassium, chloride)
- Kidney function (blood urea nitrogen)
- Liver function (albumin, enzymes)
- Calcium
- Protein
Purpose: Screen for metabolic disorders, monitor kidney and liver function, check for electrolyte imbalances, detect diabetes, and evaluate the effects of certain medications.
Results:
Abnormal results may indicate underlying health conditions, such as: Kidney disease, Liver disease, Diabetes, Electrolyte disorders, and Nutritional deficiencies.
Basic Blood Sugar test: Chairside finger stick procedure.
Identifies free glucose in the bloodstream. Advisable to test on known Diabetics at time of treatment and post treatment. May give insight to expecting wound closure problems.
Preferred rate <200
Salivary pH strips: Also known as Litmus test strips
pH is a measure used to identify acidic vs alkaline conditions. All known diseased cells thrive under more acidic conditions. The lower the pH levels is, the more disease propagation.
Studies have shown that pH level at or below 6.0 will affect both enamel and bone deterioration rates.
Always strive for more alkaline levels above 7.0.
Recommendations:
Patients should test themselves and their regular drinking fluids whether water or something else. They may find that even bottled water is acidic most of the time.
High Alkaline water filters such as the Apex brand on Amazon can assist in having high quality H2O.
These results will guide us in pre procedure preparations for increased success rates and less wound closure complications.
Simply Perio Genetic Salivary Diagnostics
The test involves a saliva sample sent into lab via its own, self-addressed return box. But to understand what the test results mean, here is a simplified version of what you need to consider.
The upper part of the test is self-explanatory. Patient information, date of sample and prescribing doctor.
You will see the results separated by colored sections.
The worst of these bacterial complexes is the Purple box.
Aggregatibacter Actinomycetemcomitans: known as AA
AA bacteria can cause several different infections all over the body. In addition to periodontitis, it is associated with endocarditis (a cardiac infection), brain abscesses, sinus infections, pneumonia, septic arthritis, urinary tract infections, maternal septicemia, and other serious conditions.
The following-colored segments are in order of severity and infectious contributions associated with each.
The Red complex is worse than the Orange complex.
But understanding the colors and what the color scale means is more important. For instance, just because a marker is in the Yellow does not mean its good or OK. It means the relative infectious potential has not reached the critical mass yet. We all should strive for having all the markers in the green and as far away from the Yellow as possible.
Most of these bacteria are not as destructive when alone. They need to be in clusters with others to be destructive. When looking at a band of these in the Red, know and understand the destructive capabilities are huge and already very well seated in that oral site.
There are other markers being tested as well with the same test.
Caries Index as the name implies gives us insight into the propensity for this patient to develop decay/caries. The SM & SS are also found alongside failed implants as well.
Yeast or Candida Albicans: This is a very important marker, especially if considering snap in or overdenture dental implant dentures. A high Yeats marker will most likely lead to higher implant failure and peri implantitis.
Speaking of Dental Implants. This Simply Perio test now also includes a Pseudomonas Aeruginosa test marker. This marker is valuable in Pre Implant planning and Treatment Plan considerations. There is a reported nearly 48% increase in failures on these patients with this elevated marker.
Perio treatment and management can and should be highly stressed and implemented for best results.
The test has this portion listed as Peri-Implantitis Risk as this name will imply that the higher the level is, the higher the risk for peri implantitis, cervical bone loss, false bony integration or all out failure. Knowing this valuable information ahead of time will better prepare our conversation before we embark on offering life changing dentistry.
Treatment for Pseudomonas aeruginosa typically involves antibiotics, with combination therapy often necessary due to the bacteria’s high resistance to many drugs. The choice of antibiotic, such as aminoglycosides, carbapenems, fluoroquinolones, or specific cephalosporins, depends on the severity and location of the infection and the bacteria’s resistance profile. In severe cases, surgery to remove infected tissue may also be required.
Common treatment approaches for Pseudomonas Aeruginosa
- Antibiotics:
A healthcare provider will prescribe one or more antibiotics based on the specific infection.
- Commonly used antibiotics include aminoglycosides (like gentamicin or tobramycin), carbapenems (like imipenem or meropenem), and fluoroquinolones (like ciprofloxacin or levofloxacin).
- Cephalosporins (like ceftazidime or cefepime) and beta-lactamase inhibitors (like piperacillin-tazobactam) are also used.
- Treatment can be oral, topical, or intravenous (IV) depending on the infection’s severity.
- Combination therapy:
Using a combination of antibiotics is often recommended, especially for serious infections, to overcome resistance and prevent the bacteria from developing further resistance.
- Surgery:
In some cases, surgery may be necessary to remove infected tissue.
- Supportive care:
Critical patients may need intensive care unit (ICU) monitoring, and removal of any infected hardware like catheters is essential.
Treating Pseudomonas aeruginosa infections around dental implants typically requires a combination of surgical debridement, systemic and/or local antibiotics, and advanced techniques like photodynamic therapy or antimicrobial coatings. Mild cases may respond to rigorous cleaning and antiseptic mouth rinses, but more severe or recurrent infections often need surgical intervention, potentially including implant removal. Severe cases may require extended systemic antibiotics, such as intravenous (IV) and oral combinations, and specific antibiotics like ciprofloxacin or ceftazidime.
What tests to order & when?
Basic tests should include the following:
Simply Perio
pH Salivary strip
Chairside finger stick, Blood sugar test
CBC, Lipid Profile & 25 Hydroxy test
Additional tests & when are they needed?
CTX Turnover Test: Only if the patient has been on long term injectable Bisphosphonates and at times, long term oral Bisphosphonates.
CMP: (formerly SMAC 21): When suspicion of severe underlying, non recognized illness, auto immune disorders etc. are suspected.
Chemistry Screen: same as above but even more detail. Also includes additional proteins, Calcium and much more. His is very involved and obviously much higher cost. *make sure patient has insurance coverage for this test.
Fibrinogen: This test is used when the patient mentions “delayed blood clotting or some protein in the blood related issue”.
TIBC: This test is used when the patient mentions “iron deficiency or some blood related iron issue”.
Sedative Rate: Rarely used or ordered by dentists, but you may see it in a report received by another practitioner.
Coagulation Panel: VERY IMPORTANT test when there is evidence or knowledge of previous stroke, long standing hypertension that may be uncontrolled. Also, in these cases, if the patient is NOT being seen regularly by a cardiologist.
*Must refer to their cardiologist and get them to an MD ASAP.
What happens when these levels are high? How do we treat them or do we not?
First, one must understand that the so called “normal” levels indicated on the typical blood test results are based on a young and healthy adult.
Depending on the patient, their level of risk will also adjust what these normal levels are or what they should be.
Prudence and judgement should be taken into consideration when considering a specific patient and what is being deemed as a normal level on a blood chemistry sheet.
A “normal” screen is not a finite position or line. It is a range and that range reflects all test subjects in the group. So, a normal level on the low end could mean one thing in Vitamin D levels for example but still be within the identified “normal” range. If no treatment Is being done and the patient is otherwise healthy, then course of action may be continued as present. However, if complex treatment is being performed where major healing needs to occur, then a consideration for maintaining this patient on the higher side of the normal range or even higher would be recommended.
In the case for Simply Perio; the goal should always be to get all of the control groups as normal as possible with treatment, combination treatment and medications or other forms of detox like Ozone, rinses etc.
In the case for the blood chemistry, supplementation is usually the best answer. But, anti-fungal and antibiotics may also come into play depending on which screen and what levels are low or high. *Consult the patient’s MD/DO for further assistance.
This is a basic understanding of interpreting blood chemistry reports and incorporating the very valuable Simply Perio into your everyday dental implant practice.
The biggest value of all this data is upfront intel on the upcoming battle and how best to prepare to be successful. The Art of War within the body.
For more information or additional training, contact the author at: DrNilo@SiOSdental.com
Or call to: 1-239-293-3961