TYPE III GENERALIZED MODERATE

PERIO WITH TYPE IV LOCALIZED

CHRONIC SEVERE PERIO
Presented by Barbara Carter
 WHAT IS CHRONIC SEVERE PERIODONTAL
DISEASE
• Chronic periodontitis is the most common type, affecting mostly adults,
though children can be affected, too. This type is caused by plaque buildup
and involves slow deterioration that may improve and get worse over time
but causes destruction in the gums and bone and loss of teeth if not treated
over a long period of time.
• Severe periodontal disease is also associated with clinical attachment loss of
7 mm and above, grade III - IV furcation involvement, and heavy subgingival
calculus.
• There may also be clinical signs of gingival bleeding associated with
bacterial infection causing bone destruction.
TREATMENT OPTIONS FOR CHRONIC SEVERE
PERIODONTAL DISEASE
• Non surgical treatment - scaling and root planning (SRP) – a.k.a. “deep
cleaning”
• Antibiotic medications (such as Arestin, chlorhexidine rinse/chip, and many
others) that can be placed directly into the periodontal pocket or taken
systemically, although the direct rout is more effective.
• Once SRP has been complete then periodontal gum surgery can be
considered.
 PATIENT PROFILE

• Patient is a 59-year old African American male, 6’0” and weights 185 lbs. He
lives in the Midwest and works as a cell runner at factory.
• Has irregular dental visits
 SOCIAL HISTORY
• Married for 35 years
• Has three kids
• Four grandchildren
• Loves to fish
• Loves to go camping with his wife and friends
 CHIEF COMPLAINT
• Pt does not have a chief complaint at this time but is participating in
enhancing his daughter's education by providing his oral cavity.
 DENTAL HISTORY
• Has irregular dental visits
• One occlusal restoration placed many years ago
• Pt had an adult prophylaxis in March of 2018 because his daughter made
him the appointment and they referred him to a periodontist.
• Before the cleaning in March, pt was not certain when the last time he had
a cleaning was, maybe when he was in the Army 20 years ago.
• Pt was concerned about the financial aspect for the periodontist.
• Had the following teeth extracted: #16,17, and 30 about 25 years ago
related to decay.
• Pt reports using a phenol mouth rinse 2 x/day.
 MEDICAL HISTORY
• Pt had Scarlet Fever as a child
• In 1988 pt injured his neck while working in the Army, doesn’t remember if he
was hospitlized but had to wear a neck brace
• Pt claims he does not work out but appears to be physically fit
• Pt is taking the following medications once a day every morning:
• Tamsulosin – .4 mg – treatment for enlarged prostate
• Ranitidine HCL – 150 mg – reduces acid in the stomach
• Atorvastatin calcium – 40 mg – lower LDL levels
• Aspirin – 81 mg – reduce the risk of having a heart attack or stroke
 ORAL EXAMINATION

• Extral oral and intraoral exam is all WNL with a few skin tags noted on both
sides of his neck and face. Coated tongue also noted, provided OHI on
tongue brushing during appointment.
• After completing a full OE, perio chart, dental chart, and obtaining x-rays pt
is diagnosed with type III generalized moderate perio and type IV localized
chronic severe perio.
• Explored and detected heavy subgingival calculus build up. A little
supragingival calculus build up on the lingual surface of the mandibular
anteriors noted as well.
 HEALTH BEHAVIORS

• Brushes 2 x/day – morning and evening

• Started using an electric toothbrush in the past year
• Uses fluoridated toothpast
• Uses floss picks every once in a while
• Uses a phenol rinse 2X/day – morning and evening
PERIO CHART PRE SRP TREATMENT
PRE PROPHYLAXIS CLEANING X-RAYS

X-rays acquired by Barbara Carter

PRE-SRP TREATMENT X-RAYS

X-rays acquired by Barbara Carter

PRE-SRP TREATMENT X-RAYS

X-ray acquired by Barbara Carter

INTRAORAL IMAGES PRE SRP TREATMENT

Images acquired by Barbara Carter

 EXPECTED PERIO CHART MEASUREMENTS
AFTER SRP TREATMENT

• Expect pocket depts to be reduced by 1-3 mm after SRP treatment, Arestine

placement, and nightly chlorhexidine rinses before bed.
• Expect the healing of the gingival tissue to heal WNL.
• Recession, furcation, and mobility will be expected to be arrested and
maintained to their current condition.
 POST CLEANING X-RAYS
Quadrant 4
completed on 2nd appointment Quadrant 1
completed on 3rd appointment
 REFERENCES
• https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-
causes/syc-20354473 Mayo Clinic published March 06, 2018 written by Mayo
Clinic staff – slide 2
• http://www.toothwisdomu.com/periodontal-disease-treatment.html –
Treatments for perio disease – slide 3
• Images on slide 12-15 and 17 - by Barbara Carter