Periodontal+Case+5+-+Aggressive+Periodontitis

=Case #5 - Aggressive Periodontitis = //*There is no photo to accompany this case*//
 * Please view page #508 (Figure 33-1) in Carranza to see a picture of our case*


 * I. Overview of Localized aggressive periodontitis **: 

Aggressive periodontitis differs from chronic periodontitis. Characteristics include:
 * · The rapid rate of disease progression seen in an otherwise healthy individual
 * · An absence of large accumulations of plaque and calculus
 * · A family history of aggressive disease which is suggestive of a genetic trait
 * · Microorganisms include: A. actinomycetemcomitans (found in high numbers)
 * · Bone loss: vertical or angular pattern of bone destruction is found around the first molars/incisor regions
 * Must include 2 permanent teeth, one of which is a first molar and involving no more than two teeth other than the first molars and incisors.
 * · Cause is unknown
 * · Generally affects individuals under age 30
 * · More often found at times of puberty


 * II. Medical history/Dental History: **
 * · Chief complaint: “When I chew my food I have a dull pain that bothers me”
 * · Patient is an 14 year old African American female
 * · Last dental exam was 1 year ago
 * · Last dental x-rays: 4 BWX from 1 year ago
 * · Last cleaning: 1 year ago
 * · Patient is healthy, with no systemic problems
 * · Patient has recently began menstruating


 * III. Provide a gingival description utilizing the picture (refer to photo above): **
 * · Free: generalized bright pink, scalloped, resilient, and smooth
 * · Attached: Generalized bright pink, firmly attached to underlying bone, and stippled


 * IV. Assessments **
 * · MBI: 7%
 * · BOP: 11%
 * · Probing depths: Generalized 2-4 mm with localized 6-9 mm
 * · Recession: None noted
 * · Furcation involvement: #30BL and #19 BL Class III
 * · Mucogingival Defects: None noted
 * · Fremitus: +6-11
 * · Mobility: + 22, 27, Class I: 23, 26, Class III: 24, 25
 * · RCC Calculus code: Light/Medium
 * · ADA: Generalized case type II, Localized case type IV
 * · AAP: Localized aggressive periodontitis


 * V. OHI ****: **

· Patient education is huge. It is important to educate the patient on the cause of the disease and it progression. Because this patient is diagnosed at a “later” stage, the teeth that are affected with severe bone loss have a poor prognosis. Bone grafting is a possibility for this patient for areas that have vertical or angular defects. However, this patient would only be a candidate if they had proper OH. Plaque removal is imperative. Therefore, we would reinforce the Bass technique and “C” shape floss method. This patient’s gingival tissue appears to be healthy,which is why we would just re-evaluate their technique to make sure that she was being as effective as possible. “C “ shape flossing technique was recommended because she does not have access to furcations (there was no recession) or to deep periodontal pockets. We would also educate the patient on the benefits of a full mouth disinfection as well as the systemic administration of antibiotics. Microbial testing should be sought to determine which antibiotic would be more effective against the microorganisms present.

**Treatment Planning;**
 * __Appt. 1__ **
 * · Periodontal Assessments
 * · FMX
 * · DDS exam (possible antibiotic prescription)
 * · 2nd check
 * · PI/OHI- Patient education on localized aggressive periodontitis


 * <span style="font-family: 'Comic Sans MS',cursive;">Refer patient to periodontist to review options for surgery (may be purely resective to eliminate the pocket depth, regenerative for bone grafts, barrier membranes and wound healing agents or a combination of both) **<span style="font-family: 'Comic Sans MS',cursive;">

__**<span style="font-family: 'Comic Sans MS',cursive;">Appt. 2 **__<span style="font-family: 'Comic Sans MS',cursive;">
 * <span style="font-family: 'Comic Sans MS',cursive;">Review OHI-bass technique
 * <span style="font-family: 'Comic Sans MS',cursive;">Scale half mouth

__**<span style="font-family: 'Comic Sans MS',cursive;">Appt. 3 (within 24 hours of 2nd appointment) **__<span style="font-family: 'Comic Sans MS',cursive;"> <span style="font-family: 'Comic Sans MS',cursive;"> <span style="color: #800080; font-family: 'Comic Sans MS',cursive;"> **VII. Additional treatment:** <span style="font-family: 'Comic Sans MS',cursive;">
 * <span style="font-family: 'Comic Sans MS',cursive; font-size: 9pt;"> <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;">Review OHI-“C” shape flossing
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;"> Scale half mouth
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;"> Fluoride treatment
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;"> Full mouth disinfection
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;"> Tongue is brushed with CHX gel (1%) for 1 minute
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;"> The mouth is rinsed with CHX solution (0.2%) for 2 minutes
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;"> CHX irrigation into periodontal pockets (1%)
 * · <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;">Full mouth disinfection
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;">· Systemic antibiotics/microbial testing
 * <span style="font-family: 'Comic Sans MS',cursive; font-weight: normal;">· Referral to periodontist

<span style="color: #800080; font-family: 'Comic Sans MS',cursive;"> VIII. Questions: **

<span style="color: #000000; font-family: 'Comic Sans MS',cursive;"> 1. Aggressive periodontitis usually occurs in individuals of what age range: a. 10-30 years b. 15-40 years c. 1-10 years d. 40 years and older

2. In what regions of the mouth is localized aggressive periodontitis commonly found? a. lower anteriors and 1st molars b. upper anteriors and 2nd molars c. lower anteriors and premolars d. upper anteriors and premolars

3. What bacteria is most commonly found in aggressive periodontitis? a. P. intermedia b. P. gingivalis c. A. actinomycetemcomitans d. spirochetes

4. What would provide the best prognosis for a patient with localized aggressive periodontitis? a. periodontal surgery b. early detection c. nutritional counseling d. antibiotic therapy

5. Which nationality is most often affected by aggressive periodontitis? a. caucasion b. asian c. african american d. hispanic

6. What is a distinguishing factor of aggressive periodontitis that makes it differ from chronic periodontitis? a. its onset of age b. its lack of correlation between inflamation and plaque and calculus present c. Both A and B d. Neither A or B

7. Patients with localized aggressive periodontitis are typically: a. healthy b. medically compromised c. smokers d. diabetics

8. Another factor belived to be associated wtih localized aggressive periodontitis is: a. defective neutrophil function b. defective bed blood cell function c. defective plasma cells d. defective mast cells

9. What assesments can help identify localized aggressive periodontitis? a. furcation involvement b. probing depths c. radiographs d. all of the above

10. Local aggressive periodontitis often stops progressing spontaneously. Generalized aggressive periodontitis often stops progressing spontaneously. a. both statements are true b. both statements are false c. first statement is true, second statement is false d. first statement is false, second statement is true

Answers to Multiple Choice Questions on Case #5