Diagnosis: Generalised aggressive periodontitis modified by smoking
Justification for diagnosis - 34 year old – young patients, bone loss inconsistent with plaque levels,
severe bone loss, multiple angular defects, patient healthy other than periodontitis, previous plaque
score unknown however wouldn’t expect such significant bone loss for patient of this age even if the
plaque free score was significantly low, generalised due to effecting more than 3 teeth other than
first molars and incisors. Clinical appearance inconsistent with radiographic findings (radiographs
appear more severe than clinical photographs).
Only one round of ʀSD. 40% sites bleeding – active periodontal disease
Very lightly restored dentition
Managementː
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ɪnitial therapy – baseline records (indices, radiographs) early diagnosis essential, cultures for
definitive diagnosis, managing patients expectations (periodontal disease explanation,
making sure patient understands that there is no ‘treatment’ for perio disease, we can just
control it) ɴSPT, decrease microbial load and disrupt biofilm on root with ʀSD, non-surgical
periodontal therapy, Oʜɪ, continued smoking cessation advice (no extractions due to no
symptoms – symptomatic therapy/treatment, ensure patient aware of poor prognosis of
multiple teeth and extractions may be indicated in near future), ensure patients given all
treatment options from the start
corrective therapy – further ʀSD where pockets 4mm+ remain, systemic therapy may be
indicated - antibiotics (250mg metronidazole + 375mg (or250/500ʔʔ) amoxicillin TDS 7days),
surgical periodontal therapyʔ
Supportive therapy – 2-3 monthly recalls and monitoring, Oʜɪ, if pockets still present at
monitoring (8-12 weeks after corrective therapy completion), attempt ʀSD again, consider
referral to periodontal specialist (case already indicates this has taken place), consider
surgery if not already performed
Prognosisː
Short term – we would not extract any teeth, would discuss with patient poor prognosis of these teeth in the long term
Long term – generalised poor prognosis, in particular
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Furcation involvement radiographically – Uʟ6, Uʀ6, Uʀ7, none recorded on perio chart, consider
independent treatment of furcation lesion if can be measured clinically (e.g. scaling, surgery)