CLINICAL FEATURE
DENTAL FINDINGS The patient has full dentition with a total of 28 teeth. There were noteworthy erosions and attritions. (Figs. 4 and 5). Due to bruxism, the patient has been wearing a splint with an adjusted bite block at night for many years. The erosions were caused by long-term consumption of isotonic beverages. No periodontal bone loss or active caries were observed. PERIODONTAL FINDINGS At 1-3mm, the clinical probing depths were within the physiological range. Maxillary recessions of up to 1mm were observed from teeth 13 to 16, and teeth 23 to 27. The BOP was 15%. RADIOLOGICAL FINDINGS Full complement of adult teeth with no caries or radiologically recognisable bone loss was observed (Fig. 6). Radiological enamel and cusp loss were particularly evident on teeth 36 and 37. TREATMENT RECOMMENDATION BASED ON THE INDIVIDUAL PREVENTION CONCEPT It is critical to assess the individual patient risk profile prior to treatment.
The patient profile is derived from the general medical history and state of intraoral health. Based on the general medical history, the risk of complications during treatment is classified as low for both the patient and dentist. The risk of intraoral disease is currently classified as moderate due to the patient smoking up to 10 cigarettes per day. Smoking is associated with an increased risk of periodontitis and of developing cancerous tumours. 4 From the perspective of intraoral health, the risk of disease progression, deterioration of intraoral health or potential development of periodontal disease are classified as moderate. Smoking is also a decisive factor in this regard. Good home-based intraoral hygiene, combined with consistent, periodic, professional appointments at the dental practice and motivating statements are crucial for maintaining the current, favourable intraoral state. The patient is at moderate risk of current and future intraoral disease, based on their smoking status.
Due to the otherwise favourable general medical condition, the needs determined during the intraoral examination will be decisive for their treatment. It will be essential to periodically determine the probing depths. Gingival bleeding decreases in smokers, which is why the clinical diagnosis of periodontitis can only be made by probing (Fig. 7). Placing exclusive focus on the determination of bleeding indices may obscure existing periodontitis or gingivitis. 5 The periodontal status should be thoroughly examined once a year. The detection of plaque using a staining agent may be a source of motivation. The assessment of intraoral findings, buccal surfaces and lingual mucosa are particularly important in smokers, as they will facilitate the detection of any pathological changes at an early stage. 6 Photographic documentation allows the assessment of the development of potential pathological mucosal lesions over time. Referral to a specialist may be required to obtain and test tissue samples. Imaging procedures also
Fig. 4: Occlusal view of the mandible
Fig. 5: Close-up view of teeth 45 to 47. The green arrows show dental attrition and erosions of the buccal cusps with partial enamel loss
Fig. 7: Pocket probing (BOP) with depiction of tooth 36 lingual
Fig. 6: Panoramic x-ray image
39 DENTAL ASIA SEPTEMBER / OCTOBER 2024
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