ORAL MEDICINE 2nd CASE

GROUP V 2013

SCENARIO OF THE CASE

65 year old female elderly complains her constant bleeding swelling in upper teeth. The swelling is recurrent and nowadays begins to smell not good. Her health has been downgrading after the lost of her husband. Over a year, she was diagnosed to Pneumonia. She consumed some medications like Bisoprolol, HCT, Aspirin, Athrifen, and Ranitidine. Vital signs showed abnormal values, variety up and down standard. Extraoral no significant certain issues. Intraoral caries servical, generalized gingivitis, and discoloration teeth Bad oral hygiene condition, using removable protheses, and calculus appeared almost in all regio.

What happened to her?

Lets take a look to the mind map!

CLINICAL DIAGNOSIS DIFFERENTIAL

Parulis Periodontal abscess Gingival cyst Peripheral giant cell granuloma Pyogenic granuloma

Apparently, she has PARULIS!

The parulis or "gum boil" appears as a soft solitary, reddish papule located facial and apical to a chronically abscessed tooth (Delaney and Keels, 2000). Parulis is a nodular lesion that develops on the alveolar mucosa at the oral terminal of a draining dental sinus tract. The abscess usually perforates spontaneously into the oral cavity (Leung and Fong, 2005).

DISCUSSION
The parulis, also known as the "gum boil," is an extremely common oral lesion. The parulis is a localized collection of pus in gingival soft tissue. The pus is produced as a result of necrosis of non-vital pulp tissue, or occlusion of a deep periodontal pocket. In this case study, parulis formation was caused by a non-vital tooth. Parulis formation as the result of a non-vital tooth can be described as follows: a.Pulp tissue becomes infected, dies, and undergoes necrosis. b. The necrotis tissue (pus) accumulates at the apex of the non-vital tooth. c. The pus drains peripherally and produces a "fistula," which is an abnormal channel in body tissue. d. A parulis forms at the end of the draining fistula.

Treatment of the abscessed tooth usually resolves the parulis. If the tooth is left untreated, the parulis may mature into a fibroma (Boyd, 2010). Treatment of Parulis (gum boil) consists of draining the underlying dental abscess and oral penicillin (Leung and Fong, 2005).

TREATMENT PLANNING
Medication of the pain KIE Release of the abcess Control in 1 week Maintenance

(Due to the ASA III and ORA III of her condition)

FAQ
Nama (NIM)