Case Study Drug Research and Periodontal Disease
A21-year old white woman who works as a research analyst for the Food and Drug Administration was evaluating the results of a new drug for the treatment of periodontal disease. Her review of the phase III clinical data caused her to visit her dentist, since she was concerned that her oral cavity exhibited many of the signs of the subjects who were participants in the clinical study. A review of her periodontium by her dentist revealed swollen and tender gingiva that were accompanied by erythema and bleeding upon mild provocation. Her dental radiographs revealed no abnormalities, and her physician found her to be healthy at her last physical examination. She reports taking no medications and denies allergies to any medicine. She is concerned about her health because her gingiva will bleed when she eats fibrous foods (e.g., apples) and affects her appearance.
1. What do you think is the most likely cause of her periodontal disease?
2. Should she be referred to a physician for further physical examination for a systemic alteration that was overlooked at her last physical examination? If so, what problem should be considered, and what tests should be ordered?
3. Should an oral chemotherapeutic agent be prescribed for her periodontal disease? If so, which one would you prescribe and what would be the benefit and disadvantage of using this agent for this patient?
1. In most instances, dental plaque can cause erythema and gingival bleeding, but the gingival response can also be exacerbated by a variety of systemic conditions, including diabetes mellitus, leukemia, malnutrition, puberty and pregnancy.
2. An examination by the dentist should eliminate many of the potential systemic issues that can affect the periodontium of this patient. For example, the age of the patient, her appearance, and questions about her diet should be enough to rule in or out issues concerning puberty and malnutrition. However, if systemic conditions cannot be ruled out, an additional physical examination by a physician may be necessary. Additional tests to be requested could include oral glucose tolerance test for diabetes mellitus, human chorionic gonadotropin levels for pregnancy, and/or qualitative and quantitative evaluation of bone marrow cells and blood cells for leukemia.
3. If the patient's periodontal disease is the result of a leukemia or diabetes mellitus, the first response should be to treat the disease that is exacerbating the oral response to plaque. In these cases, an intensive oral physiotherapy program using over-the-counter toothpastes with triclosan would be warranted for home care. If the patient is pregnant, a thorough review of oral hygiene combined with over-the-counter toothpaste with triclosan would be appropriate. If persistent inflammation and gingival enlargement continue, the use of a prescription antiplaque rinse, such as chlorhexidine, would be warranted.
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