(Disclaimer: This article is for general use only, and the following information has been processed to protect patient privacy)
Abstract: The patient visited the clinic for “bleeding from brushing teeth for 1 year”, and the examination revealed poor oral hygiene, red and swollen gums throughout the mouth, and obvious bleeding on probing; the imaging report showed mild to moderate resorption of alveolar bone, and the patient was diagnosed with chronic periodontitis, and the root cause of the patient’s bleeding gums was chronic periodontitis. The patient was given periodontal basic treatment + long-term maintenance treatment, after which the gingival bleeding completely disappeared and the periodontitis was controlled and stabilized without recurrence.
Basic information】Female, 33 years old
Disease Type】Chronic periodontitis
Hospital】Stomatological Hospital of Guangzhou Medical University
Date of consultation】January 2017
Treatment plan】Basic periodontal treatment (scaling + scaling + oral hygiene instruction + ciprochloride-based rinse) + long-term maintenance treatment (ultrasonic periodontal scaling)
Treatment period】3 months of outpatient treatment, 1-2 times a year for review
Treatment effect】Gum bleeding completely disappeared after scaling, periodontitis control is stable, no recurrence
I. Initial consultation
The patient came to the clinic with “bleeding from brushing teeth for 1 year”. In the past year, he had frequent bleeding from brushing his teeth, and he also had bleeding from eating fruits or slightly hard foods. The patient had a healthy physical examination, but seldom visited the dentist, and usually brushed his teeth once a day, occasionally twice, for 1-2 minutes each time. Due to bleeding from brushing, the patient used an ultra-soft bristle toothbrush and tried to use a flosser when she heard someone recommend it, but she was afraid to use it again because of obvious bleeding. The patient was found to have no missing teeth, no dental caries, poor oral hygiene, large amount of plaque and tartar on the dental surface, extensive redness and swelling of the whole gum, obvious bleeding on probing, probing depth of 3-5 mm, large amount of tartar detected under the gum, and yellow tartar filled in the lower anterior teeth. Based on the examination, the doctor diagnosed “chronic periodontitis (limited, moderate)”.
(Panoramic film)
II. Treatment history
Based on the medical history, examination and diagnosis, the patient was recommended to undergo basic periodontal treatment first, and then to undergo regular review and maintenance treatment after control and stabilization. At the 1st visit, the patient was scheduled for scaling (supragingival scaling). The patient was also informed that oral hygiene was the key to achieving results with periodontal treatment, and was given detailed oral hygiene instructions, including brushing, flossing and crevice brushing. On the 2nd and 3rd visits, the patient was subjected to zoned subgingival scraping, which was performed using ultrasonic fine work tips without anesthesia, allaying the patient’s fear of anesthesia and scraping pain. For each scraping treatment, one bottle of ciprofloxacin gargle was prescribed for use with the treatment. Three months after the scaling treatment, a fourth visit was made and the patient reported that the gingival bleeding had disappeared. The doctor performed an evaluation of the effectiveness of periodontal treatment and found that the patient’s ability to remove plaque was substantially better than before treatment, the gingival redness had largely disappeared, only a small amount of subgingival tartar remained, bleeding on probing was significantly improved, and the probing depth was reduced to less than 3 mm. The patient was informed that the periodontal inflammation was basically controlled, and then entered the long-term periodontal maintenance treatment period. Maintenance treatment with ultrasonic periodontal scaling was performed on that occasion to remove plaque and residual tartar, and the 1st periodontal review was scheduled in 3 months. Thereafter, the periodontal examination and periodontal scaling maintenance treatment were performed 1-2 times a year, and gingival bleeding did not recur for more than 2 years.
III. Treatment effect
After scaling, the patient’s bleeding from brushing improved significantly immediately, but still bleeding with flossing and toothbrushing. The bleeding from brushing disappeared completely 1-2 weeks after scaling. 1 month after scaling, no more bleeding with flossing and interdental brushing. 3 months after scaling, the periodontal efficacy assessment was reviewed and the gingival redness and swelling basically disappeared, and the gums were pink in color, tough in texture, tight to the roots, and less likely to bleed on probing. The patient did not see any further bleeding from brushing, flossing, or eating any food. Based on the long-term follow-up review, the patient’s periodontitis control was stable and did not recur.
(After 3 months of treatment as above)
(The picture above after 2.5 years of treatment)
IV. Precautions
The patient insisted on active treatment and regular review, the dental condition was well improved and the physical discomfort was gradually reduced, as a doctor, we are truly happy for the patient. However, it should be noted that tartar and bacteria are the cause of periodontal disease, plaque is formed every day, and daily oral hygiene is the key to periodontitis control. For this patient, a toothbrush with medium hard bristles is recommended to enhance plaque removal efficiency. For cleaning between teeth, floss + toothbrush is recommended. In the early stage of treatment, flossing is the mainstay, supplemented by crevice brushing; after 1 month of treatment, when the gum swelling and shrinkage have subsided and the crevice has become larger, crevice brushing is the mainstay, supplemented by flossing. After the active treatment of periodontitis, regular periodontal review and maintenance treatment are needed to keep the periodontal health and stability for a long time.
V. Personal insight
Bleeding gums are a common manifestation of periodontal disease and the most direct feeling of periodontal disease for patients. From the doctor’s point of view, seizing this claim and providing professional periodontal treatment can help patients to relieve their pain and enhance their trust and compliance in long-term follow-up. Many patients think they are doing a good job of oral hygiene, but the actual situation is very different from the doctor’s examination. Therefore, patient and professional oral hygiene instruction is a guarantee of effective and long-term patient outcomes. Patients should also look at themselves and check their oral conditions frequently at the dental clinic, and if periodontal disease is found, diagnose and treat it early.