The IRx Protocol is an Initial (I) prescription (Rx) periodontal protocol, using periodontal trays before debridement, scaling, or surgery that is helpful in our COVID-19 world. In essence, we prescribe periodontal trays1 to be used by the patient to administer antimicrobials deep into periodontal pockets in 10-15-minute daily increments as the initial phase of periodontal therapy. The tray therapy is then used as home care throughout the treatment phase and into maintenance.
The purpose of the IRx protocol is to address gingival infection, bleeding, and inflammation before in-office treatment. These outcomes have significant clinical implications including
1. reducing risks of bacteremia for patients with co-morbidities.
2. making in-office treatment more comfortable for the patient (due to less inflammation).
3. improving the visibility for the clinician (less bleeding and swelling) and requiring less time to complete, for example, debridement or scaling.
With the pandemic limitations to emergency treatment, delayed patient care is mounting. The IRx Protocol that we first implemented in 2013 helps these patients while they wait for care. You improve their health and decrease a chronic burden on the immune system. During this pandemic, oral health has taken on a new priority. If patients can’t avoid the virus, the best defense against it is a healthy immune system.
Case Presentation
The patient presented with moderate periodontal disease, isolated areas of significant destruction, generalized and severe bleeding on probing, calculus buildup, worn dentition, undiagnosed sleep apnea. He expressed fear of the dentist, and his oral health had not been a high priority. He returned to the practice in 2019 after not being seen for 15 years.
The patient’s concern for finances led him to decline scaling. He accepted Rx trays, debridement, and diode laser therapy. The dental team continues to advocate for scaling.
Treatment Method
The patient presented on April 23, 2019. Customized trays with 1.7% hydrogen peroxide and doxycycline calcium2 were prescribed for home usage in 15-minute increments. Trays were delivered on May 23, 2019. Debridement was completed on June 17, 2019.3
The patient returned every three months until the pandemic forced the office to limit care. On June 11, 2020, he returned to the dental office after 6 months. He had run out of the medication for his tray therapy.
Results
On July 29, 2019, six weeks after debridement and 9 weeks after the tray therapy started, the patient returned to the practice at which time a full periodontal chart and images were taken. Bleeding on probing dropped from 100% to 30%. Deep (>4mm) and bleeding pockets dropped from 77% to 29%.
These results were maintained throughout 2019 and the first half of 2020. When the patient returned to the office on June 11, 2020, Bleeding on probing measured 32% and deep and bleeding pockets 30%.
Clinical Implications
Rx Tray therapy used before mechanical care can significantly reduce bleeding, infection, and inflammation. For patients in delayed periodontal care during COVID outbreaks, Rx Tray therapy is an adjunctive treatment option to help fight the inflammatory response before the next office visit.
REFERENCES
1-Perio Trays®, Perio Protect LLC, St. Louis, MO.
2-Perio Trays® from Perio Protect, LLC in St. Louis, MO; Perio Gel® from QNT Anderson, LLC in Bismarck ND; Vibramycin® from Pfizer in New York, NY.
3-Debridement included diode laser therapy with American Dental Technologies Diolase ST using a 320 fiber at 0.7 watts.
