Adam Lang

Perio Lab 8
Chapter 14
Case 1
The pregnancy may exacerbate the patients localized severe plaque-induced
gingivitis if sound daily home care habits are not adopted, as well as frequent visits
to an RDH, to suppress her current gingival condition which may be modified by a
factor in this case: Pregnancy-associated gingivitis, and her immunological
exaggerated inflammatory response to dental plaque biofilm.
Not all patients who are pregnant develop pregnancy associated gingivitis.
Those who adhere to daily home care regimen before pregnancy, (and frequent
visits to the RDH,) may not display signs of pregnancy associated gingivitis such as
edematous, dark red, with bulbous interdental papillae.
In this case the patient presents with a localized, severe plaque induced
region of the periodontium. Changes in the levels of sex/endocrine hormones due
to pregnancy will most likely play into an exaggerated inflammatory response of the
gingiva to small amounts of plaque. An assessment of local contributing factors
must be weighed by the RDH to effectively treat and stabilize the patient
throughout pregnancy.
Case 2
Soreness and abstinence of ulcers can be controlled by gathering information
such as what kind of toothpaste, (as well as other adjuncts used like tarter control
mouth rinses) the frequency/duration of each product and symptoms expressed by
the patient. A daily journal may help the clinician/patient narrow the search of the
culprit product.
The gathering of a sound medical history should be obtained and referenced.
This is needed because most allergic reactions occur most commonly in patients
who have a history of hay fever, allergic skin rashes, or asthma. Extra effort can
also be pooled into an investigation of medications that may also be playing a part
in the allergic reaction to tarter control toothpaste.
Once the culprit product is weeded out, abstinence from said product is often
suggested. Once the inflammation has subsided, the patient is most likely not to
encounter abstinence from daily home plaque control practices.
Case 3
I would explain that, due to clinical findings such as marginal redness, and
bleeding upon probing, coupled with the patients age and daily oral hygiene
practices is most likely due to a result of circulating sex hormones. Puberty

associated gingivitis is an exaggerated inflammatory response to a small amount of

plaque biofilm.
Even though positive home care methods are practiced, small amounts of
plaque biofilms can provoke gingiva which exhibit bright red, soft, friable, smooth
tissues. I would recommend to mom and the patient to continue daily home care
habits such as brushing three times a day, flossing correctly, and adhering to
suggested recall intervals. The patient can bring a toothbrush to school and brush
after lunch as well. Until sex hormones diminish, continue the info stated above to
help reduce plaque, thusly reducing the bodys exaggerated response to even the
tiniest amounts of dental plaque.
Chapter 15
Case 1
I would illustrate that the disease progression of chronic periodontitis is slow
to moderate. Changes in gingival clinical appearance of periodontitis may be
lacking such as bleeding, gingival redness, and pain, especially if the patient is a
smoker. The clinical appearance of tissues isnt a reliable indication that
periodontitis is present. Even if the patient received periodontal therapy in the
past, his periodontium may have been stable at the time: Periodontitis exhibits
active and inactive periods. He may not have had periodontitis in the past, or was
not properly educated by a clinician of the progression of periodontal disease.
Chapter 20
Case 1
I would first explain that the radiographs only serve as a snapshot of disease
prevalence at that current time. Radiographs are an important diagnostic tool, but
only offer a piece of the pie for the clinician to accurately diagnose. Periodontitis
also has periods of activity, and inactivity. The radiographs may suggest there is no
alveolar bone loss. However the radiograph is a 2D picture of a 3D object. A
periodontal class diagnosis cannot be relied solely upon the crestal contour and
height of alveolar bone because a standard radiograph would only show the
mesial/distal aspects of bone contour and height. The diagnostic quality of the
radiographs would also limit diagnosis.
Case 3
The prevalence of localized vertical bone loss on many sites radiographically
will offer additional clues for the clinician to formulate a more accurate periodontal
diagnosis. It will infer the clinician to adapt a multifaceted approach. Radiographs
only offer a piece of the pie such as the prevalence of radiographic calculus. The
patients occlusion must be verified, and an intraoral inspection of tooth intra/inter
arch relationships will offer clues to determine secondary contributing factors. The
use of an 11/12 explorer will offer the clinician great clues as well.
A sound medical/dental history will also offer insight: Family history in relation
to periodontal disease, for example. Questioning the patient on oral habits such as

using toothpicks aggressively over time, dental prosthetics used, coupled with
occlusal disharmony may be a great diagnostic tool.