Question:
I have been treating a patient for chronic gingivits now for six months.
He has moderate anterior crowding, but the inflammation is profuse on the
maxillary anteriors. Slight pressure causes heavy bleeding. I have
exhausted so many treatment options with him, and my dentist/employer
suggested that he have a physical exam to rule out any systemic problems.
Result: he's in perfect health.
I've had the patient on chlorhexidine rinses and stannous fluoride rinses;
he's been in every four weeks for prophys; his home care is impeccable;
he's not a mouth breather; he's been on systemic antibiotics (doxy). I am
at a loss. The patient refuses to see the periodontist. Any suggestions?
Answer:
Does this patient have anterior crowns?
Does this person smoke ?
I have used Flagyl in combination with other antibiotics such as doxycycline , for refractory periodontitis with good results.
Put him on some folic acid also.
Interestingly, I saw a case very similar to yours presented at the AGD
meeting last summer by Dr. Michael Siegel, an oral medicine specialist.
The case turned out to be an allergy to Cinnamon ("Cinnamon Induced
Stomatitis", O.O.O. 1992;73:708-16). Similar cases have been shown to be
contact allergies. The problem is isloating the offending substance.
