UW School of Dentistry
COM January 2005
Dolphine Oda, BDS, MSc
Wesley L. Hanson, D.D.S., M.S.D., P.S.
Poulsbo Periodontics & Implant Center
Case Summary and Diagnostic Information
This is a 12-year-old healthy Caucasian male who presented at his General Dentist office for a routine dental examination, radiographs and dental prophylaxis.
Diagnostic Information Available
History of present Illness
This is a 12-year-old healthy Caucasian male who presented at his General Dentist office for a routine dental examination, radiographs and dental prophylaxis on 04/2004. The Panoramic x-ray revealed a deep, radiolucent area of bone loss at the distal of tooth # 31 (Fig 1) that extended distally to the follicular sack surrounding the developing crown of tooth # 32. The asymptomatic, periodontal pocket measured 10 mm along the disto-buccal of tooth # 31, which prompted the dentist to refer the patient for periodontal evaluation and treatment.
Figure 1. A curved line along the buccal aspect of tooth #31 corresponding to the 10 + mm pocket clinically detected along the distobuccal aspect of this tooth.
Other than a routine appendectomy surgery on February 2004, the patient’s medical history was unremarkable. Both Vicodin and Morphine had been prescribed post-surgically but no medications were being taken at the time of the initial examination at the periodontist’s office on 05/2004. The dental history was also unremarkable. There is no family history of similar dental problems within either parent’s background.
Clinical and Radiographic Findings
The patient presented with a generally healthy dentition and average plaque control for a teenaged boy. The periodontal health was unremarkable except for a 10+ mm pocket located at the distobuccal of tooth #31, which was found to have subgingival inflammation and suppuration during probing. The contra-lateral tooth # 18 had a 5 – 6 mm probing depth with thickened retro-molar gingiva on the distal root surface. Radiographically, the lesion between teeth #’s 31 – 32 appears as a narrow, buccal curve along the tooth with an osseous defect, with the developing crown of tooth #32 lying superiorly and horizontally impacted. The lamina dura and the periodontal ligaments around teeth #’s 18 and 31 appear to be intact. No radiographic change was apparent around tooth #18 (Fig 2). Tooth # 31 is vital and responded so endodontically to the application of ice.
Figure 2. Although a 5-6 mm probing depth was detected at the buccal aspect of tooth #18, there are no radiographic changes to correspond to it.
Figure 4. Low power (x200) histology shows small fragments of loose and vascular granulation tissue covered by non-keratinized and proliferative stratified squamous epithelium containing small clusters of neutrophils.
Figure 5. Low power (x200) Histology similar to Figure 4 demonstrating a supporting granulation tissue infiltrated by many acute and chronic inflammatory cells.
After you have finished reviewing the available diagnostic information