A 49-year-old woman has periodontitis. Diagnose and plan
management of her condition.
e patient complains of two loose upper back teeth, and the
eetingly sensitive to hot and cold.
History of Complaint
She is an irregular dental attender at your practice and had
last seen your colleague 3 years ago prior to his retirement.
clinical notes show that he had diagnosed generalized severe
chronic periodontitis and carried out a course of nonsurgical
periodontal treatment, but the patient did not attend for review
because of her busy work schedule. Despite the past treatment,
on presentation, several teeth are loose, and the patient reports
dental sensitivity as well as occasional soreness when gums are
amed. She also recalls having gum abscesses on at least two
occasions in the past and being prescribed antibiotics.
Besides having all her third molars extracted 20 years
ago, she cannot recall having any other extractions.
e patient reports being
t and well, takes no medica-
tions, and has no allergies, as revealed by her medical history
What Additional Speci
c Questions Will You Ask
the Patient? Explain Why
Oral Hygiene Regimen.
e patient tells you that she
cleans her teeth twice daily with an electric toothbrush. She
oss on her anterior teeth every day and only occasionally
on her molars and premolars, where access is more di
Current or Past Smoking.
Smoking increases the risk of
is patient has never smoked.
Presence of Diabetes or Any Other Condition Causing
Susceptibility To Infection.
Poorly controlled diabetes has a
strong association with periodontitis.
is is relatively severe
periodontitis, and there is a history of multiple abscesses.
ese features do not necessarily indicate an underlying
condition, but it would be worthwhile to exclude diabetes
and ask the patient to see her doctor to be tested. Another
feature that might suggest diabetes is rapid attachment
loss within a short period in middle age, suggesting type 2
Family History of Premature Tooth Loss.
family history can be associated with development of peri-
odontitis at a younger age.
Patients who cope poorly with stress are
more likely to develop periodontitis.
No cervical lymphadenopathy is present.
dibular joint and mandibular movements appear normal.
e other mucosa and soft tissues of the mouth are normal
except for a buccal sinus just anterior to the upper right
premolar. All teeth, with the exception of the third molars,
are present. All remaining molars and two premolars con-
tain small- to medium-sized amalgam restorations. No car-
ies is detected.