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Do you know this gingivitis? #1

For three years, Mr. X, aged 82, complained of gingival bleeding and gingival pain that prevented him from brushing his teeth and eating well. He doesn’t smoke and has no allergy. He has a medical follow-up for high blood pressure, gout and hypercholesterolemia. Medications : Acébutolol®, Axeler®, Adénuric®, Crestor®, Avodart®.
The patient has seen several practitioners, dentists or doctors, but no treatment (descaling, root scaling, chlorhexidine, hydrogen peroxide mixed with bicarbonate, antibiotic, antiseptic, antifungal) has yielded healing of the gingiva. The gingival disease continues to expand and is getting worse even though no oral mucosa is affected. Furthermore, the patient loses weight steadily.
Moreover, there are still edentulous and a widespread moderate horizontal bone loss. But few teeth are mobile. Palpation reveals the absence of lymphadenopathy.

  • What are the primary lesions?
  • What are your diagnostic hypotheses?
  • What is your attitude?

Commentaires

dbrown

La biopsie doit se faire à cheval sur la bulle et la zone saine.
Puis s’il existe encore la collection intra-bulle, avec un écouvillon stérile on peut recueillir le liquide pour une analyse cytologique.
La bulle sur l’érythrose suggère un mécanisme auto-immun. Aussi faut-il rechercher sur le corps des bulles cutanés.
Il faudrait peut-être faire un bilan sanguin avec NFS, CRP et VS : pour objectiver un syndrôme inflammatoire ou une déficience immune (neutropénie, agranulocytose…)

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