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Abstract: The patient came to the clinic with swollen and painful bleeding gums, and was found to have periodontitis on radiographs and less than ideal oral hygiene. After oral hygiene education, the patient actively quit smoking and cooperated with treatment by performing supragingival scaling with topical butylboron cream and maintaining brushing habits, the disease was controlled and good treatment results were received.
Basic information】Male, 23 years old
Disease Type】 Periodontitis
Hospital】The First Hospital of Harbin Medical University
Date of consultation】December 2019
Treatment plan】Surgical treatment (ultrasonic supragingival scaling) + topical medication (butylboron cream) + oral hygiene education
Treatment period】Outpatient treatment, regular follow-up
Treatment effect】The patient’s condition was stable and the gum swelling and bleeding symptoms were relieved.
I. Initial consultation
Patient Xiao Li is a 23-year-old college student who came to our hospital because of frequent gum bleeding. The patient reported that the gingival bleeding was low, sometimes accompanied by gum swelling and pain, and the earliest appearance of symptoms was unknown. We performed a preliminary oral examination and found that the patient’s oral hygiene was not ideal, with tartar and soft tartar present and accompanied by swollen gums.
After combining the patient’s clinical manifestations, we initially judged that it might be gingivitis or periodontitis, and gave a whole-jaw surface tomogram to clarify the diagnosis, which showed mild alveolar bone resorption and confirmed the diagnosis of periodontitis.
While making the diagnosis, I told the patient that plaque produced by inadequate cleaning was the initiating factor of periodontitis, but the patient thought that he usually did a good job of oral cleaning and used an electric toothbrush to brush his teeth every morning and evening, and after questioning I learned that he smoked every day, even after brushing his teeth, so I explained to the patient the fact that smoking would affect his oral health and advised him to quit smoking.
II. Treatment history
The basic treatment of periodontitis includes supragingival scaling and subgingival scaling. The patient currently has mild periodontitis and he is afraid of subgingival scaling, so he did not take this approach for the time being and finally decided to remove calculus by ultrasonic supragingival scaling first. However, I also informed the patient that if the disease progressed further in the future, scaling might be required, and the patient agreed.
Ultrasonic supragingival scaling, commonly known as scaling, is performed with high power to quickly remove large pieces of tartar, followed by low to medium power to remove tobacco stains on the tooth surface, and finally polishing the tooth surface. A small amount of gum bleeding during the scaling process and within 1 week of scaling is normal and should not be alarming. For better treatment of periodontitis, patients are recommended to brush their teeth with butylboron cream instead of their usual toothpaste for 1 month, after which they can use fluoride toothpaste as usual.
III. Treatment effect
Periodontitis usually has no cure, but mainly focuses on symptom control. Except for the slight bleeding of gums within 3 days of scaling, I followed up with the patient by phone 3 months after the completion of treatment, and the patient indicated that there were no more symptoms of bleeding gums and swollen gums, and no new tartar was formed, indicating that the condition was under control and the treatment effect was satisfactory.
In addition, I advised the patient to have a follow-up visit every 3-6 months to observe the progress of the disease. It is gratifying to note that the patient attached great importance to oral health and proceeded to quit smoking as soon as he learned about the effects of smoking on periodontitis, and succeeded in quitting within one month, and his condition was stable in this respect.
IV. Notes
We are glad that the patient’s symptoms improved after treatment, but since plaque and calculus are the causes of periodontitis, the focus of disease prevention is to identify the factors that cause plaque and calculus formation and to avoid these problems in daily life. Since smoking causes plaque and tartar to be deposited on the teeth more easily, and since patients smoke all the time, quitting smoking becomes a key concern, and patients should continue to maintain the habit of cleaning their teeth.
In addition, since patients have been using electric toothbrushes for a long time, they need to be careful not to brush back and forth horizontally when using an electric toothbrush, and should brush one area before switching to the next. Brushing horizontally from side to side will not have the desired cleaning effect and will make the oral cavity poorly cleaned, aggravating or triggering periodontitis. At the same time, patients should also pay attention to observe whether the gum bleeding and redness will still occur after 1 week of scaling, and if the symptoms are still found to exist, they need to promptly consult the doctor.
V. Personal insight
Smoking is harmful to health, but many people are concerned about the specific dangers of smoking only in terms of causing lung disease. Smoking is also harmful to oral health, which can easily be overlooked. The best thing to do to maintain good oral health is not to smoke in the first place, but it is better to mend your ways than to do it alone. In this case, the patient listened to the doctor’s advice and had the perseverance to quit smoking. This positive spirit is commendable and gives me more confidence to help more patients, which is a kind of patient “healing doctor”.
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