Periodontics · patient case question
What is the periodontal diagnosis for this tooth?
Patient case: Spontaneous toothache on antihypertensive therapy
Patient: Female, 54 years old
Chief complaint: “This tooth throbs for twenty minutes after anything cold. It woke me up last night.”
History: Hypertension, controlled. Medications: hydrochlorothiazide, lisinopril. No known allergies.
Findings: Tooth #19 has a deep distal-occlusal carious lesion. Cold provokes a sharp pain that lingers about 20 minutes. Percussion is mildly tender. Probing depths 2–3 mm throughout with no bleeding on probing; the periapical shows an intact lamina dura and normal bone levels.
Show answer and explanation
Correct answer: B. Clinically healthy periodontium on an intact periodontium
- A. Necrotising gingivitis presents with papillary necrosis, pain, spontaneous bleeding and a pseudomembrane. Nothing of the sort is described.
- B. CORRECT. Probing depths of 2 to 3 mm, NO bleeding on probing, no attachment loss and no radiographic bone loss meet the 2017 World Workshop definition of periodontal HEALTH on an intact periodontium. The threshold is under 10 percent of sites bleeding, with depths of 3 mm or less. The tooth's problem is entirely PULPAL, and it is worth naming the periodontal status explicitly so the case is not over-treated.
- C. Gingivitis requires INFLAMMATION — the defining criterion is bleeding on probing at 10 percent or more of sites. There is none here.
- D. Periodontitis requires interdental CLINICAL ATTACHMENT LOSS at two or more non-adjacent teeth, with radiographic bone loss. Neither is present.