case 38.pdf - Case 38 Advanced Periodontitis M AN DE EP G...

This preview shows page 1 - 2 out of 11 pages.

Case 38 Advanced Periodontitis MANDEEP GHUMAN Summary A 49-year-old woman has periodontitis. Diagnose and plan management of her condition. History Complaint e patient complains of two loose upper back teeth, and the teeth feel 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. e 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 in 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. Medical History e patient reports being t and well, takes no medica- tions, and has no allergies, as revealed by her medical history questionnaire. 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 uses oss on her anterior teeth every day and only occasionally on her molars and premolars, where access is more di cult. Current or Past Smoking. Smoking increases the risk of periodontitis ve-fold. 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 diabetes. Family History of Premature Tooth Loss. A positive family history can be associated with development of peri- odontitis at a younger age. Stressful Life. Patients who cope poorly with stress are more likely to develop periodontitis. Examination Extraoral Examination No cervical lymphadenopathy is present. e temporoman- dibular joint and mandibular movements appear normal. Intraoral Examination e other mucosa and soft tissues of the mouth are normal except for a buccal sinus just anterior to the upper right rst 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.

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture