Implementation of 2017 classification system

Case discussion
Example from clinical practice
Case #4

“What should I do with my lip & tongue piercings?”

Patient: Female 32 years old

Chief complaints: Swollen gums on the inside of lower front teeth, with bleeding on brushing and sensitivity. She also experienced difficulty in cleaning lower wisdom teeth, reporting that the gums on top of them were often swollen and painful.

MHx: Asthma and anxiety, taking Ventolin and Symbicort

Dental history: Never had any major dental treatment or orofacial trauma, visiting dental hygienist twice a year.

Allergies:  Allergic to penicillin.

Social history: Non-smoker, wearing tongue and lower lip piercing for 7 years now.

Family history: Family history of periodontal diseases and tooth loss.

Oral hygiene: Brushig teeth with a manual TB twice a day; uses dental floss twice a week.

E.O. Examination: Lower lip piercing

I.O. Examination: Minor biofilm and calculus deposits detected.

Localised, round soft fluctuating swelling associated with tooth 31 lingual. On pressure it oozes some pus. Painful on palpation. 31 is tender on horizontal and vertical percussion.

Tongue piercing, barbell type present

From the practice….

Case: Dr Resnik

Initial periodontal chart

Initial visit – OPG

Initial visit, 31 PA

Questions to ponder

  1. Would you apply/perform any additional diagnostic tests prior to your final diagnosis? If so, which tests would you apply?
  2. Provide and discuss diagnosis of the patient’s oral condition/s.
  3. Identify risk factors for the patient’s oral condition/s.
  4. Describe bone loss type/pattern/severity associated with tooth 31.
  5. Outline your full treatment plan for the patient.

*Suggested reading:

De Moor RJG, De Witte AMJC, Delme KIM, De Bruyne MAA, Hommez GMG, Goyvaerts D. Dental and oral complications of lip and tongue piercings. British Dent Journal 2005;199:506-509.

Poll questions

What is the most likely periodontal diagnosis for Case #4 according to the latest classification (2017)? (single choice)

What is/are the best treatment option/s for Case #4? (multiple choices)

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