Franke R Berres, Zeerak Samuel, Amin ur Rahman, Saqib Rasheed, Bilal Sheikh, Khurram Ataullah.
Chronic Periodontitis.
J Pak Dent Assoc Jan ;11(1):27-32.

Chronic Periodontitis leads to degeneration of periodontal supporting structures and eventual tooth loss. Its onset may be at any age but is most commonly detected in adults with continual increase with age. In most cases the presence of local factors especially bacterial plaque play an important role in the initiation of chronic periodontitis: This case report describes a patient with chronic periodontitis and its surgical and non-surgical management.

Case Report: The Patient was a 46-year-old Swiss Female. She was married and worked as a post-officer. When she came for periodontal examination she complained about sensitive teeth, bleeding gums and a change of position of her teeth in the lower anterior region. Medical history was obtained by questionnaire and interview. It revealed good general health. The Patient suffered from hay fever seasonally. She was a light smoker (approximately 5 cigarettes per day). The family history was unremarkable. She had her dental checkups done once a year on a regular basis but her general dentist failed to diagnose gum disease until it had progressed to a level when the patient realised that routine cleanings were ineffective to check the bleeding from her gums. Full mouth radigraphs were taken and full mouth examination was made. The extraoral exams showed no abnormalities and the patient had no pain or problems with either TMJ. The jaw joints did not exhibit any popping, clicking, crepitus or tenderness upon palpation. The associated muscles were normal. Excluding the periodontal tissues the intraoral examination revealed no abnormalities. Five years ago third molars 18, 38 and 48 were extracted. Clinically several teeth showed hypoplasia of the enamel. Amalgam and composite restorations have been done previously. The periodontal clinical exam showed adequate amounts of keratinized tissue. In general the periodontal tissues were swollen, reddened, inflamed and edematous. Increased amounts of supragingival and subgingival plaque and calculus were noted. The plaque index (PI) was 76.1% and bleeding on probing (BoP) score was 87.7%. Clinical probing dephts and the clinical attachment level ranged from 2 to 8 mm. Molars showed class I and class 11 furcation involvement. Some teeth revealed grade I mobility. Radiographically generalized horizontal bone loss in the maxilla and mandible was noted and localised vertical bony defects on 13, 17, 24, 31, 32 and 44 were visible. The trabecular pattern was well developed indicating moderately dense bone in the maxilla and mandible. Radiographic evidence of calculus was notable on teeth 22, 24, 26, 31, 32,.41, 42, 43, 44 and 45. All roots were well developed and of normal size, shape and form. Furthermore caries could be detected on teeth 24 and 25 and overhanging margins on teeth 14, 24, 25 and 45. Tooth 28 was impacted.

The diagnosis was generalized severe chronic periodontitis. Primary causes of the disease were bacterial infection, calculus and inadequate fillings were contributing factors. All teeth had a fair prognosis, no tooth was hopeless.

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