Question

Your small private dental practice, which is within an urban city, has many long-standing patients. A number of patients within the practice are on public assistance and struggle with money issues. Dr. Gordon is very generous and understanding about her patients’ limitations and often provides free dental services. Your next patient of the morning is jason S, a 14 year old junior high school soccer player. His mother has made an emergency appointment, as he was hit in the mouth during a soccer game yesterday. His mother is concerned that jason’s front teeth may be loose as a result. His mother reports that jason has a thorough “cleaning” in another dental office 4 months ago. Clinical examination reveals no trauma but some mobility, so you take radiographs. Clinically, jason presents with no obvious signs or symptoms of disease, with lack of tissue inflammation and minimal amounts of plaque biofilm. Jason’s radiograph, however, shows moderate vertical bone loss around the maxillary central incisors and mandibular central incisors. Bitewing radiographs also indicate moderate bone loss around the maxillary and mandibular first molars. Probe readings on his incisors and molars are in the 4 to 6 mm range. You present your finding to Dr. Gordon, who asks you to perform thorough periodontal instrumentation on jason. You remind Dr. Gordon, that jason had a dental hygiene appointment in another office 4 months ago and that his insurance only allows for periodontal instrumentation every 6 months. Dr. Gordon states that jason is in dire need of this treatment and ask you in instruct the office manager to hold off on submitting jason insurance claim until it is within the 6 months time frame.

1. How would you classify jason’s periodontal condition?

2. What ethical principles are in conflict in this dilemma?

3. What is the best way for you to handle this ethical dilemma?

4. What should you do when treating future patients?

Answer 1

The radiographic features are characteristic feature of Localised Aggressive Periodontitis.(LAP)

Localised aggressive periodontitis has following radiographic features-

• arc shaped radiolucency(vertical bone loss) involving the first molars.(the radiolucency extends from distal surface of second premolar to mesial surface of second molar)
• vertical bone loss involving anterior teeth

the probing depth in LAP is 4-8mm.

It occurs in otherwise healthy individuals and the extent of periodontal destruction does not co-relate to amoint of plaque and calculus present on the tooth surface.(Note the lack of tissue inflammation and minimal amount of biofilm in this case)

the major cause for LAP is Actinobacilllus actinomycetumcomitans and is isolated in large number from the diseased site.

holding onto Jasons documents until it falls onto 6 months gap is the violation of CODE OF PROFESSIONAL CONDUCT. (by ADA point 5.B.5)

Non-surgical therapy with systemic antibiotics(amoxicillin and metronidazole ) is effective for LAP in permanent dentition