ADC OSCE HUB SAMPLE CASE

-Dr. Poulami Ghosh

 SET 1, STATION 3
Chronic Periodontitis with Abscess

53 Y.O John has swollen gum at tooth 11 and pain. He is a smoker. You have completed
the examination and have found out that probing depth in mesial of 11 is 6.0 mm. You
have checked the other areas as well and found pockets of 4 to 5 mm in posterior teeth.
11 tested positive for vitality test, but had moved a bit downwards/incisally acc. to the
patient.
Radiograph: Bitewing both sides showing bone loss and calculus . Manage, give D/D and
explain the treatment options to the patient.
Pointers
● Station 3 calls for diagnosis of the case and management.
● Finish taking a short history and verify information given in the scenario in 2 minutes.
● Explain investigations, and pathophysiology and explain diagnosis by 6 minutes.
● After this give the overall management plan. (Short and long term)
● Differential diagnosis to be mentioned in conjunction with the fact that it is a layman
we are talking to. (Explain in non-medical language) Guide the OSCE, don’t get
guided.
● Reassure the patient that their concern will be addressed today, and not to worry.
● Answer every question, don’t cut them in between, and get back to your point if they
try to deviate you.
● DO NOT FAIL TO GIVE DIAGNOSIS AND TREATMENT.

Start
◦ “Thank you Mr/Mrs. X, for letting me examine you. I will shortly explain my findings
to you, but before that is it okay if I ask you some questions regarding your concern?”
◦ Reconfirm and additional questions.

HOPC
◦ The time since which the pain is happening? (“Since when have you been
experiencing this pain?”)
◦ Type of pain : SOCRATES in brief
◦ Is it the first time?
◦ Any foul smell or bad taste in mouth?
◦ Is the tooth wobbly? Any other tooth that is wobbly?
◦ Does food get stuck in b/w teeth?
◦ Any recent trauma on 11 or hard biting?
◦ Any bleeding tendency from gums or any other gum problems?
◦ Any pimples in that area?
◦ Any systemic signs? (Fever/Lymph Nodes/Swelling)
◦ Any medication taken?
Medical History
◦ Any medical condition?
◦ And medications?
◦ Any allergies?
◦ Last sugar level check (Important for perio cases) (“When was the last time you got
your sugar level tested?”)
◦ Last GP visit and blood tests (“When was the last time you visited your GP? When
was the last time you got a blood test done?” )

Dental History
◦ Last visit? (“When was the last time you visited a dentist?” )
◦ OH maintenance?- BRUSH/MW/floss (“How do you maintain your oral hygiene”)
◦ 3. Any habits like grinding/clenching ? (Correlate to the front tooth being affected)

Social History
◦ Diet (“Do you follow a healthy diet?”)
◦ Smoking/alcohol (“Do you smoke or consume alcohol?”)
◦ Stress (“Have you been under stress lately?”)

Family History
◦ Anyone else in the family with a similar history? (“Does anyone in your family have
the same condition?”)
◦ Say “thank you for sharing all the details” and continue.

Pathophysiology

◦ The bone loss, gum measurement and the history you have given me, indicates a
gum condition called “chronic generalised periodontitis” with periodontal abscess in
11 (Provided vitality is given in scenario, if not, say that we need to verify).

◦ Reassure: Tell the patient that the term may sound quite alarming but this is nothing
but a long standing (chronic) generalised periodontitis disease (around the tooth)
which occurs due to various risk factors.
 ◦ They are: (ENUMERATE EACH BRIEFLY)
a) Smoking
b) OH
c) Stress
d) Age
e) Family history
f) Sugar levels if elevated

◦ Plaque which is a sticky film with bugs in it accumulates around your tooth, which
hardens with time, and if not cleaned properly it can lead to this kind of a problem
along with other risk factors.
◦ Cause for 11: This tooth has something called periodontal abscess where the
infection has aggravated. This could be because of many factors like trauma, hard
biting or just generally. Infection has built up causing loss of bone, leading to the
elongated appearance. It could be due to the tooth nerve(pulp), but your tooth is
alive (vital) hence it is not. (Only if mentioned already)
◦ It is painful due to the infection, and once that is resolved, the pain and position both
will be normal . Needs to be treated ASAP to avoid loss.
◦ Even though this gum condition is not reversible (bone can’t grow back), it can be
controlled and early intervention is prudent to avoid further loss of teeth.
◦ The pimple indicates infection is present in your gums due to spreading, causing a
tunnel there. (if vital)

Diagnosis:
Periodontal abscess in 11 with chronic generalised moderate to severe periodontitis.

Treatment: Pros & cons of each to be mentioned in a gyst

Short Term:
1. Do nothing: Always an option but I won't advise because it may lead to further
worsening of condition.
Pro: Avoid any treatment at the moment
Con: Infection worsens with time and can spread more and cause an emergency
2. Drain the abscess through either the gums with a blunt instrument or through the
tooth if possible (if pulpal pathology). (+ Superficial clean up)
 Pro: Infection stopped from spreading
Con: May be a little time consuming
OR
◦ Incision and drain under LAor numbing solution ( if too mobile then exo option)
Pro/Con: Same as above
◦ Plus: Painkiller given (PCM for two days and give dosage)
◦ Antibiotic: If the patient has systemic signs, increasing swelling,
immunocompromised, only then.
◦ Only as a conjunct, active dental treatment is a priority.
3. EXO : If rapidly spreading and very mobile
Pro: Gets rid of infection, fast & cost effective
Con: Needs replacement in the future since it is the front tooth.

◦ Review no. 1: For abscess : 3-5 DAYS

◦ Review no. 2 : 1 to 2 weeks 🡪 If no improvement or worsening of condition within
those 2 weeks, refer to specialist.
◦ Long term review in 2 weeks to control the CGP and control it from worsening,
deeper cleaning by Specialist.
4. Specialist: Direct referral to the specialist for further intervention, they are much
more expertised, experienced in this field and can do deeper cleaning.
Pros: Expertise/experience/stabilize gum and bone condition
Cons: Expensive, time consuming to get an appointment
(Reassure Constantly)

Long Term:
◦ OH instructions in detail. Brushing twice daily (modified bass technique), floss, usage
of mouthwash twice daily (dose only if asked)
◦ Blood sugar check + GP referral
◦ Smoking cessation

SEEK CONSENT TO PROCEED AND WRAP UP.

◦ D/D : (Not told unless asked)
◦ Pulpal abscess
◦ Periapical abscess
◦ Cracked tooth
◦ Root fracture

◦ Sinus Significance
◦ Can be traced with GP to show which tooth is the cause
◦ Infection drainage site
◦ Pulpal: Through tooth (RCT), Perio : Through gums
Periodontal Grading And Staging- ADJ
AAP Guidelines Grading
---------------------------------------------xx-----------------------xx-------------------------------------------------