Periodontics · patient case question
What is the most appropriate initial therapy for the natural dentition?
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: A. Scaling and root planing with oral hygiene instruction and risk factor control
- A. Correct. Non-surgical therapy is always step one. Scaling and root planing with oral hygiene instruction, smoking cessation support and liaison with her physician about glycaemic control comes first, and the tissues are then re-evaluated at four to six weeks to see what residual disease actually needs surgery.
- B. Surgery before non-surgical therapy operates on inflamed, infected tissue with unknown response potential. Re-evaluation after initial therapy typically shrinks the surgical need considerably.
- C. Antibiotics cannot penetrate a mature biofilm. Without mechanical disruption they achieve very little, and adjunctive systemic antibiotics are reserved for specific situations rather than used routinely.
- D. Pockets of 5 to 6 mm without mobility are treatable. Extraction at this stage is indefensible.