Solve The Case

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Telephonic conversation between two doctors!!

Doctor 1 calls his colleague Doctor 2 for suggestion on a case!

Doctor 1 – Hello doctor! Are you free to talk now? I need suggestions from you over a case.

Doctor 2 – Yes sure! Tell me about the case.

Doctor 1 – Thank you. I wanted to discuss about one of my old patient. She is a female patient, around 42 year old and came to me 6 months ago with chief complaint of loose teeth and swollen gums.

On examining oral cavity, I noticed little plaque and calculus, gingiva was bulky and firm and on insertion of probe there was bleeding. Few of her posterior teeth had lost some amount of bone support and her front lower teeth were loose. She gave medical history of high blood pressure and was on medication.

I advised to get OPG done and blood test to rule out diabetes mellitus. OPG showed mild bone loss in all posterior teeth and around 35% loss of bone support in lower anterior teeth. Her blood report showed she was non diabetic.

Doctor 2 – Okay I understood the history of the patient. What treatment did you provide her with?

Doctor 1 – Yes after getting all the tests done, I went ahead with scaling and performed full mouth flap surgery over a period of 1 month to treat the periodontal disease. I also performed gingivectomy combined with gingivoplasty to correct her swollen gums.

I taught her oral hygiene practices and instructed her to follow them strictly. She is a very good patient of mine and she follows them diligently.

Now after 6 months she came returned to my clinic with the same complaint!!

Today morning when I examined her oral cavity her lower front teeth had become very loose, gingiva was bulky and more bone loss in all areas.

All this happened inspite of she maintaining good oral hygiene and all the proper treatment!! I am puzzled and not understanding what to do next?

Doctor 2 – No need to worry, but you missed one important point in this patient. The entire treatment plan for this patient is depended on keen observation of clinical appearance and patient history.

Doctor 1 – Please guide me doctor and let me know where I went wrong?

Question

1 – Why did the treatment fail? What did doctor 1 miss while diagnosing?

2 – What should have been the treatment plan?

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