Case presentation:
4 years old child male came to the clinic presenting with severe generalized gingival inflammation, etching, mucosal lacerations & papillae impingement and gum recession especially around molars.
Due to such inflammation it created etching sensation which caused bruxism that explains why the child used his sharp nails & knife in the area between teeth ” to relieve etching ” which aggravates the condition and resulted in mucosal lacerations & impingement.
Medical history of the patient reveals that he is under brain electricity regulating drugs since 2 years that is Depakin ” sodium valporate act anti-convulsions”. Lately, child went in 2 times or more into comma due to unstable medical condition. Child has hyperactivity so was highly uncooperative but psychologically managed.
Clinically, the gingiva was red with deep erythematosus areas due to the habit of using sharp elements especially in papillae between molars.
Mild gum recession around Es but moderate to severe around C, D in mandible. Maxillary teeth were in better condition but moderate recession around Es.
factors: including food impaction, lowered immunity and abnormal habits.
Diagnosis process:
– Clinical examination of his hands, legs, chest skin and palms which were normal —-> excludes papillon le fêvre syndrome.
– Lab test measures ( Alkaline phosphatase, serum phosphate, Calcium, PTH ) All were in normal ranges. But CBC showed Anemia and neutropenia ” opportunistic infections”.
– Panoramic x ray showed absence of lower primary first molar and permanent first premolar —–> D was extracted ” before my intervention” thinking it is the cause of etching but the socket inflammed and hyperplasia occur due to child habit and upon surgical removal 4 avulsed.
So diagnosed as juvenile periodontitis and child abnormal behavior is main causative factor.
** Treatment plan:
1- Simple scaling & root planning but no changes or improvement.
2- continue scaling and root planning but with some local therapy as gengigel ” hyaluronic acid”, hard acryl night guard and antibiotics.
** Relieve of symptoms was in same day of work and recurrence was so fast. So plan modified.
3- Upon consultation with his neurologist and pediatrician, Systemic Antibiotics prescribed and Hard acryl night guard was used as drug stent ” gengigel was applied on the walls so can contact the gingival all night. The work was 2 visits per week.
After 5 months of continuous work, the case stabilized and inflammation highly decreased with significant improvement in healing and child habit totally disappeared.
” Treatment journey& follow up”
Recessions.
The avulsed 4 replaced with permanent lateral incisors.
Follow up is every week. And some investigations for early detection of any syndromes.
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