Question

Your next two patients are identical twin sisters who are new to the practice, mary and Katherine. They request that you review their health histories together. You learn that they are 68 years old, both widowed, and live together. They have received routine dental care from their longtime friend and dentist Dr. Lipman, who just retired at 80, so they have decided to become patients in your dental office. They inform you that their mother is still alive at 90, but is edentulous, as she lost all of her teeth due to “gum disease”. They both state that they are in good health, however, Mary was diagnosed with type II diabetes a few years back. She states that she hasn't paid much attention to it.

Your examination and radiographs of katherine reveal that she has generalized periodontitis , and vertical bone loss on her mandibular posterior teeth. She exhibits attached loss in the 4- to 5-mm range, with localized posterior reading of 6 to 7mm. Some of her mandibular posterior teeth are mobile. She too has good self-care but becomes very agitated when you present your findings to her. She states that she and Katherine “always” went to Dr. Lipman together and received the same treatments. She questions why her outcomes is so different than that of her sister and ask if you think Dr. Lipman provided substandard dent care.

1. What factors may have contributed to the patient's disease progression?

2. How will you discuss the host immune response in periodontal disease and periodontitis with katherine?

3. Are there any ethical dilemmas involved?

Answer 1

Q. No. 1. Answer :

The factors may contributed to patient disease progression :

* due to some of the factors periodontitis may come like

* smoking habits,

* tobacco chewing,

* stress,

* age factors,

* genetics,

* Any systemic diseases,

* poor nutrition and obesity.

So in those we can't change some of the factors like genetics, age ect.

But remaining factors we can modify and contribute to progression of disease.

Like good oral hygiene maintainance,

By using mouth wash for cleaning mouth,

By maintainance of good healthy weight and diet,

By reducing stress,

Using doctor prescription regularly.

These are the factors may contribute to progression of her disease.

Q. No 2. Answer :

Host immune response In periodontal disease and periodentitis :

It is one of the inflammatory disease due to gingivitis caused by microorganisms, like porphyromonas gingivalis, aggregatibacter, when these organisms affects the gums and infection and inflammation may arises.

And plaques formation and loss of tissues.

So that there is a pain and bad breath, tooth ache, loose tooth, tender gums, tooth loss ect.

Q. No 3. Answer :

Yes, because both sisters are taking same care but only one is having the problem, even though the doctor Lipman is providing good care to both of them , there is a chance to develop this disease due to genetic history, and ,age factors so, with knowing that the clients may get confusion regarding care, whether the doctor is providing good quality care or not.

So it is one of the ethical dilemma here.