Periodontics · patient case question
All of the following organisms are associated with early gingivitis EXCEPT:
Patient case: Deep pockets and a rising HbA1c
demo: 49-year-old female
chief: Bleeding gums and bad taste; she has noticed her front teeth are drifting.
history: Type 2 diabetes for eight years, most recent HbA1c 8.9 percent. Smokes half a pack a day. An implant placed at site 30 two years ago has recently begun to feel tender.
meds: Metformin, estradiol.
findings: Generalised probing depths of 5 to 6 mm with bleeding on probing at 62 percent of sites and no acute symptoms. Radiographs show generalised horizontal bone loss and saucer-shaped bone loss around the implant at 30 with bleeding and suppuration on probing.
Show answer and explanation
Correct answer: B. Enterococcus faecalis
- A. Fusobacterium nucleatum is a key bridging organism in plaque maturation, linking early gram-positive colonisers to late gram-negative pathogens.
- B. Correct, and this is the exception. Enterococcus faecalis is a gut commensal whose oral significance is in persistent endodontic infection and failed root canal treatment, not in the developing gingival biofilm.
- C. Prevotella intermedia appears in gingivitis and increases markedly in pregnancy and puberty gingivitis, where steroid hormones substitute for its vitamin K requirement.
- D. Actinomyces species are among the earliest colonisers and dominate in the shift from health to gingivitis.
Note: Tannerella forsythia, which the recall listed, is a red complex organism of established periodontitis rather than early gingivitis, so it would also be defensible as an exception. The unambiguous outlier is Enterococcus faecalis.