Periodontics · patient case question
What is the MOST appropriate first-line treatment?
Patient case: 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.
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.