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Periodontics · patient case with 3 questions

Rapid attachment loss in a young adult

Patient: 26-year-old patient.

Chief complaint: Gums bleed and some teeth feel loose.

History: Non-smoker, no systemic disease. A sibling lost teeth young.

Findings: Radiographs show bone loss disproportionate to the visible plaque, with only light calculus on posterior teeth. Perio charting shows 4 to 5 mm pockets on almost all teeth with bleeding on probing. Clinically, heavy calculus is present on the anterior teeth. Working diagnosis: aggressive (Grade C) periodontitis.

Question 1

What is the MOST appropriate first-line treatment?

  1. Scaling and root planing with adjunctive systemic amoxicillin and metronidazole
  2. Scaling and root planing alone
  3. Immediate periodontal flap surgery
  4. Prophylaxis and systemic antibiotics
Show answer and explanation

Correct answer: A. Scaling and root planing with adjunctive systemic amoxicillin and metronidazole

  • A. CORRECT. Grade C periodontitis is associated with tissue-INVASIVE organisms that mechanical debridement alone cannot eliminate. The evidence supports SRP combined with adjunctive systemic amoxicillin plus metronidazole — the van Winkelhoff combination — given at the time debridement is completed.
  • B. SRP alone is the standard for chronic periodontitis but is often insufficient here, which is exactly the distinction this item tests.
  • C. Surgery is not the first step. Non-surgical therapy comes first, with re-evaluation at six to eight weeks, and surgery reserved for residual deep sites.
  • D. Coronal polishing does not remove subgingival biofilm and calculus. Antibiotics without thorough mechanical disruption of the biofilm are inadequate and drive resistance.

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Question 2

How is the microbiological picture in this condition best characterized?

  1. Two strictly aerobic species
  2. Three or more strictly anaerobic species
  3. A single facultative species acting alone
  4. A single strictly anaerobic species
Show answer and explanation

Correct answer: B. Three or more strictly anaerobic species

  • A. Deep pockets are anaerobic environments. Strict aerobes cannot survive there.
  • B. CORRECT. The subgingival flora in aggressive periodontitis is POLYMICROBIAL and dominated by strict anaerobes — Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia and Treponema denticola — alongside Aggregatibacter actinomycetemcomitans. No single organism accounts for the disease.
  • C. A. actinomycetemcomitans is strongly associated with localized aggressive periodontitis, but it acts within a polymicrobial community rather than alone.
  • D. Periodontal disease is not a monomicrobial infection. Isolating one species does not explain the destruction.

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Question 3

At the end of the appointment she stands up and feels dizzy and lightheaded. What should you do?

  1. Administer supplemental epinephrine
  2. Sit her fully upright and give her water
  3. Place her supine with the legs slightly elevated
  4. Send her home to rest
Show answer and explanation

Correct answer: C. Place her supine with the legs slightly elevated

  • A. Epinephrine is for anaphylaxis or cardiac arrest. Giving it in vasovagal presyncope is dangerous and inappropriate.
  • B. Sitting upright worsens cerebral hypoperfusion and is what precipitated the symptom.
  • C. CORRECT. Postural lightheadedness after a dental appointment is presyncope. Lay her SUPINE with the legs slightly elevated to restore cerebral perfusion, loosen tight clothing, give oxygen, and monitor. Recovery is usually rapid.
  • D. Discharging a symptomatic patient without observing recovery risks a syncopal collapse and injury on the way out.

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Practice patient cases Periodontics study notes