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Abstract: This is a case of a young male who came to the hospital with “bleeding from brushing his teeth for the past half month, bad breath, and over the past month, pus has been spilling out of his teeth in many places with loose teeth”. The patient had a history of bleeding from brushing for several years and a family history of the disease. After admission, he was diagnosed with acute periodontitis after completion of relevant tests. The patient’s symptoms improved significantly with the use of conventional treatment + medication + surgery.
Basic information】Male, 18 years old
Disease Type】Acute periodontitis
Hospital】The Second Affiliated Hospital of Nanchang University
Date of consultation】May, 2020
Treatment plan】Conventional treatment (supragingival scaling, scaling, root planing, removal of calculus) + medication (metronidazole, tinidazole, amoxicillin, compound chlorhexidine) + surgical treatment (flap scaling)
Treatment period】6 months of outpatient treatment, 1-2 months of follow-up
Treatment effect】The treatment effect is good, the symptoms gradually improved
I. Initial consultation
In May 2020, an 18-year-old male patient came to our department with “bleeding from brushing teeth in the past half month, bad breath, and pus overflowing from many teeth in the past month with loose teeth. Physical and specialist examinations showed that the patient had poor oral hygiene throughout the mouth, tartar (++++), irregular teeth, obvious gingival redness and swelling, soft texture, bleeding on light probing, whole mouth teeth, probing found BI: 3-5; PD: 4-9 mm ranging; pus inside, probing the root surface rough with tartar, detectable loss of attachment to varying degrees. Looseness examination: upper anterior teeth 12-22 were loose for one degree, lower anterior teeth 31-43 were loose for two degrees, 45-35 were loose for two degrees, 24-26 were loose for one degree, 34-37 were loose for two degrees, and 43-47 were loose for one degree. Oral cavity surface tomography suggested that the bone resorption of the whole mouth was one to two degrees.
II. Treatment history
The patient was diagnosed as having widespread acute periodontitis in adolescents based on the patient’s clinical manifestations and auxiliary examinations, and there were no special contraindications for the patient. The patient agreed to the treatment plan and intra-oral preoperative photographs were taken, a large periodontal examination form was established, and an informed consent form was signed. The basic treatment phase of acute periodontitis will first begin with conventional treatment modalities, including supragingival scaling, scraping, root planing, and removal of calculus; at the same time, medication such as metronidazole, tinidazole, and amoxicillin will be given for anti-inflammatory treatment, along with a mouth rinse with compound chlorhexidine. After the treatment of acute periodontitis was completed, periodontal surgery, i.e. flap scaling, was performed for localized deep periodontal pockets 31-33, 41-43, 25-26, 36-37. During the treatment period, the patients were followed up by telephone and oral hygiene education, and the patients had good follow-up and strictly followed the medical prescription and follow-up time.
III. Treatment effect
In this case, the treatment period was six months. After supragingival scaling, scraping, root surface leveling or taking flap and other cases for periodontal cleaning, together with the patient’s active maintenance of oral hygiene, change of living habits and brushing with the pasteurization method, the treatment effect of periodontitis was relatively good. After the surgery, the symptoms gradually improve, the lesions turn into the resting phase, the tooth looseness decreases, and the periodontal inflammation subsides, and then the interval of review is determined according to the control of the patient’s plaque and inflammation. At the beginning, it is once every 1-2 months, and the interval will be gradually extended to half a year when the disease is stable.
IV. Precautions
We are glad that the patient’s condition is under control after the implementation of treatment. In daily life, patients should pay attention to personal oral hygiene, including brushing teeth in the morning and evening, rinsing mouth after meals, and scaling teeth regularly. In terms of diet, patients should consume more foods rich in high quality protein, such as soy products, meat, eggs and milk; eat more fish rich in polyunsaturated fatty acids; consume more vegetables and fruits rich in coarse fiber to supplement multivitamins; avoid eating greasy and stimulating foods, such as fried foods and pickled products, and forbid smoking and alcohol. If patients experience redness, swelling and pain of the teeth during the consolidation period of treatment, they should immediately visit the clinic for a review.
V. Personal insight
Acute periodontitis is dangerous and patients need to be properly guided to receive timely treatment and regular review if they experience dental discomfort. When diagnosing, first exclude the interference of systemic and local factors, and carefully differential diagnosis. After the diagnosis is established, a complete treatment plan is developed to improve the local metabolism of periodontal tissues and remove the granulation in periodontal pockets through conventional treatment + medication + surgery to facilitate the recovery of the disease. As in the patient of this case, the treatment effect is relatively satisfactory after timely consultation, active treatment, good lifestyle habits and regular review after treatment.