Richard H. Nagelberg, DDS, PC

Disclosures

July 01, 2011

A Woman With Periodontal Disease

A 62-year-old white woman presented for a routine oral examination in 1991. The patient did not have a chief complaint (Figure 1).

Figure 1. Periodontal pocketing on the distal aspect of tooth # 14.

History and Dental Examination

History. In 2009, the patient had hip replacement surgery. Her physician has advised her to take 600 mg clindamycin 1 hour prior to any dental treatment. The patient reports allergy to penicillin, and her current medications are solifenacin and ibandronate.

From 1990 to 1994, the patient had optimal periodontal health with routine prophylaxis every 6 months and composite fillings and crown and bridge work. Periodontal disease was first diagnosed in 1995. At that time, the patient was referred to a periodontist for nonsurgical periodontal care. Beginning in 1995, periodontal maintenance was provided to the patient every 3 months, alternating between the specialist and general dental practitioner. Periodontal evaluation was performed for the entire mouth, and the pocket depths, recession, bone levels, and other clinical parameters were noted in the patient's chart.

Periodontal evaluation, following the same protocol, was performed twice a year in the general dental practice and periodontist's office. The patient's periodontal condition stabilized substantially. Site-specific treatment was provided when bleeding or increasing pocket depths (> 5 mm) occurred. This included provision of subgingival scaling, as necessary, when subgingival calculus was present.

Dental examination. A comprehensive periodontal evaluation and charting were conducted and full-mouth x-rays were obtained. Periodontal pocketing depths of 5 mm and bleeding were observed in the upper left, lower right, and lower left quadrants (Figure 2).

Figure 2a. Initial probing: a 5-mm periodontal pocket on the distobuccal aspect of tooth # 14. Note that probing (PerioWise® probe; Premier Dental Products; Plymouth Meeting, Pennsylvania) should be performed at the middle of the interproximal sulcus. Probing the line angle would provide a false-negative result because crevicular bone would be expected to be higher on the sides of the pocket. This photo indicates only the initial probe placement. Insertion of probe to the middle of the interproximal sulcus, not the line angle, is the correct technique. 2b. Drawing illustrating suboptimal and optimal probing. View #1 (left) -- Suboptimal probing shows angling of the probe that will miss the depth of pocket. View #2 (right) -- Optimal probe positioning reflects accurate pocket depth measurement obtained by probing at an angle to the middle of the interproximal sulcus. Drawing courtesy of Larry Sweeting, DDS, Atlanta Dental Specialists. Republished with permission. 2c. Pretreatment x-ray of sulcus tooth #14 and #15. Note level of bone on x-ray.

Gingival bleeding and pocket depths (> 5 mm) were noted for teeth #s 14, 15, 17, 18, 19, 30, 31, and 32. Mobility, abfractions, and furcation involvements were absent. Localized recession of 1-2 mm was present in the anterior and upper left dentition. With this information, a diagnosis of American Dental Association case type III periodontal disease was made.[1] Active therapy was indicated as a result of the number of sites affected.

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