Periodontics · patient case question
What is the diagnosis?
Patient case: Generalised bleeding on probing with an isolated 8 mm CAL loss on #23
Scenario: Bleeding on probing in 80-90% of the mouth, probing depths 2-3 mm throughout, EXCEPT tooth #23 which has 8 mm of CAL loss on the LABIAL ONLY. Photograph shows a patient who has lost no teeth, with healthy pink gingiva except at #23, where the root is almost fully exposed on the labial surface only.
Show answer and explanation
Correct answer: D. Generalized gingivitis with localized gingival recession on tooth #23
- A. Necrotizing disease presents with punched-out, cratered interdental papillae, pain, a pseudomembrane and fetid halitosis.
- B. Periodontitis in the 2018 classification requires INTERDENTAL CAL at two or more non-adjacent teeth, or buccal/lingual CAL of 3 mm or more with pocketing over 3 mm at two or more teeth. Neither is met by a single labial defect with 2-3 mm pockets.
- C. Stage III would require interdental CAL of 5 mm or more with a generalised pattern and probable tooth loss — none of which is present.
- D. Correct. Probing depths of 2-3 mm everywhere means there is NO periodontitis — no pocketing, no interproximal attachment loss. Bleeding on probing at 80-90% of sites in the absence of attachment loss defines GENERALIZED GINGIVITIS (over 30% of sites). The isolated 8 mm CAL on the LABIAL of #23 is RECESSION, which is attachment loss of NON-PERIODONTITIS origin.
Note: KEY PRINCIPLE: attachment loss confined to the BUCCAL/LABIAL surface with normal interproximal attachment is RECESSION, not periodontitis. The 2018 classification is built on INTERDENTAL attachment loss.