On examination, Manoj found she had generalised inflammation around her gums, with deep pockets of infection around her top front teeth (periodontitis). She also reported smoking four cigarettes a day for nine years as well as a suspected genetic susceptibility to periodontitis given her sister also had gum disease. She was otherwise medically fit, and used an electric toothbrush twice a day with occasional interdental brushes to clean in between her teeth.
Manoj diagnosed generalised aggressive periodontitis. Periodontitis is a pathological inflammatory disease of the supporting tissues of the teeth; progression of periodontitis results in the loss of gum attachment and bone support around teeth. As natural tooth positioning in the mouth is determined by a balance of forces between the tongue, lips, gums and teeth, any changes to the balance between any of these forces is likely to result in drifting of tooth position. Drifting typically occurs in patients who have lost periodontal attachment and bone support around some of their teeth, which had happened to Miss C’s front teeth.
Manoj prescribed non-surgical periodontal therapy, and advised Miss C to stop smoking in order to achieve optimal results. Miss C had stopped smoking by the start of her treatment, which involved full mouth non-surgical root surface debridement under local anaesthetic split over two consecutive days, with antibiotic follow-up to remove infection.
Manoj showed her how to use interdental brushes effectively, starting with the green ‘TePe’ interdental brush for the gap between her upper front teeth. She was also asked to use a 0.2% chlorhexidine mouth rinse for the first week following her non-surgical treatment. Initially, she found she had to use a bigger interdental brush size as the inflammation settled down.
Three months later Miss C saw Manoj for a full periodontal reassessment, which saw a marked reduction in bleeding and an improved mouth freshness. She remained an ex-smoker and had kept up excellent oral hygiene habits, having moved down in interdental brush sizes for the gap between her front teeth, which was reducing. She was pleased with her gum health and was not concerned about having any cosmetic treatment to close the gap between her front teeth.
Miss C saw Manoj every three months for specialist periodontal maintenance over a year, during which time she found the space closing between her upper teeth and smaller ‘TePe’ interdental brushes fitting in the gap.
The patient subsequently saw Adrienne, one of our dental hygienists, every three months for maintenance cleaning, and returned to see Manoj for her annual periodontal review. The gap between her upper front teeth had completely closed, and she could now only fit the yellow ‘TePe’ interdental brush in this space.
This patient is now being successfully maintained by her own dental hygienist in general practice.