Question

In: Anatomy and Physiology

a 35 year medically fit non-smoking patient presents complaining of a buccal intraoral swelling associated with...

a 35 year medically fit non-smoking patient presents complaining of a buccal intraoral swelling associated with his lower right posterior teeth. In addition, the patient complains of bleeding gums and wishes to improve the appearance of the gingiva around tooth FDI 23 that clinically has associated class II gingival recession.   Initial clinical examination indicates an intraoral swelling with a draining sinus between teeth FDI 45 and 46, grade I mobility of 46, generalized clinical loss of attachment of 3-4mm and generalized pocketing of 5-6mm with bleeding on probing around all teeth.

question:
1- explain and justify the differential diagnosis.
2- discuss the investigations you would undertake and the findings that you expect, explaining their relevance to the clinical

Solutions

Expert Solution

1. Differential diagnosis include

A) trauma from occlusion- is a possible cause for 23 for recession(recession seen only in one tooth ) and this leads to over occlusal loads for 45 and 46 which can lead to periodontal abscess to 45 and 46 leading to swelling.

B) periodontal abscess- due to draining sinus between 45 and 46. And since , caries is not presented as in clinical examination, it is expected that 45 and 46 are vital and has pocket dept of 5-6mm.periodontal abscess only occurs in vital tooth.

C) generalized periodontitis- due to generalized pocket formation of 5-6mm depth and bleeding from gums.

D) Endoperio lesion in relation 46 which can be due to a interrelation with periodontitis. X-ray will reveal it if it is carious tooth or not.

2. Patient should first undergo vitality test for 45 and 46 ( since it can rule out whether it periodontal abscess or peripical issue).

A gutta percha can be placed through the sinus opening and x-ray shoild be taken. So that the tooth which has caused this sinus can be tracked and then do root canal treatment.

Opg should be taken- to check the bone level of each tooth. (Can check if there is horizontal or vertical bone loss)

Hope this helps you. Thank you ?

Sydney Mullin answered 1 year ago
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