The Initial Periodontal Therapy for Chronic Periodontitis with Gingival Hyperplasia in a Diabetic Patient : A Case Report

Abstract

 Purpose: Gingival hyperplasia is induced by inflammation, drugs, heredity, tumors, etc., but cases that are frequently encountered in the clinic have gingival hyperplasia and are taking drugs for hypertension. In addition, diabetes and periodontal disease have been shown to have an interactive relationship, even considering the high frequency of onset. In this paper, we report a case of chronic periodontitis with drug-induced gingival hyperplasia in a diabetic patient who received initial periodontal therapy, for whom a good prognosis was obtained.

 Case: A 44-year-old man was referred by a local doctor with the chief complaint of swollen gums. From the results of periodontal pocket examination, the average probing pocket depth (PPD) was 4.9 mm, and pockets of 4 mm or more were found in 80.4% of the sites. The patient was diagnosed with generalized moderate chronic periodontitis (new classification: stage Ⅲ grade C) and drug-induced gingival hyperplasia. By thoroughly controlling inflammation with initial periodontal therapy, the periodontal pockets were significantly reduced (PPD average, from 4.9 mm to 2.5 mm). In addition, gingival hyperplasia, which was suspected to be affected by the drug, disappeared with the control of inflammation, so no drug change consultation was given to the medical department. After the swelling of the marginal gingiva disappeared, caries treatment and prosthetic treatment were performed to remove the plaque retention factor.

 Results: The periodontal inflamed surface area (PISA) value decreased from 2,291.0 mm² at the initial visit to 91.4 mm² at the latest SPT. The HbA1c level decreased from 7.9% at the initial visit to 6.9% at the latest SPT. It is considered that the remarkable decrease in the inflammatory surface area of the periodontal pockets may have helped to improve the control status of diabetes.

 Conclusion: We were able to obtain a good prognosis for this diabetic patient with chronic periodontitis accompanied by drug-induced gingival hyperplasia with only initial periodontal therapy without changing the drug. The control of risk factors such as drugs, diabetes, and smoking that could greatly contribute to the progression of periodontitis depends largely on the patient’s environment and personality; in actual control, cooperation with the medical department is important. When collaborating, it is necessary to avoid requests that affect the underlying disease control in hospitals and clinics as much as possible. At the same time, intensive periodontitis control in dentistry is good for systemic disease control and it is important to perform dental treatment while recognizing its strong influence.