|Year : 2012 | Volume
| Issue : 1 | Page : 113-114
Recurrent periodontal abscess associated with "teeth as a tool"
G Subraya Bhat, Vishal Singh, K Mahalinga Bhat
Department of Periodontics, MCODS, Manipal, Karnataka, India
|Date of Submission||23-Jan-2010|
|Date of Acceptance||24-Jan-2011|
|Date of Web Publication||3-Apr-2012|
G Subraya Bhat
Department of Periodontics, MCODS, Manipal, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
We report an unusual case of recurrent periodontal abscess in a 31-year-old male electrician due to his habit of using his teeth as a tool for stripping electrical wires. The patient was not aware of the consequences of this habit. Clinically, there was presence of moderate depth of periodontal pocket around the tooth and, radiographically, there was a vertical defect mesial to the involved teeth. The patient was educated about the consequences of his habit and surgical treatment was undertaken. A papilla preservation flap with regenerative periodontal surgical procedure was done, orthodontic and restorative treatment was planned at the follow-up. This case highlights the importance of eliciting a proper and complete personal history, including occupational details. In our patient these details helped us correlate the destruction of the periodontium to the unusual etiology.
Keywords: Combined regenerative procedures, habit, periodontal abscess
|How to cite this article:|
Bhat G S, Singh V, Bhat K M. Recurrent periodontal abscess associated with "teeth as a tool". J Indian Soc Periodontol 2012;16:113-4
| Introduction|| |
Periodontal injury with localized destruction often occurs due to inadvertent force applied to the periodontium. Such injury could be related to some psychosocial condition (i.e., stress related), habitual,  or related to the patient's profession.  Notching of the associated tooth with resultant extrusion and proclination and periodontal destruction  with or without periodontal abscess that is often seen in carpenters, cobblers, tailors, and musicians is due to the common habit of keeping nails, sewing needles, or a musical instrument (as the case may be) between their teeth.
In this case report we describe an electrician who habitually used his teeth to strip the rubber coating off electrical wires. The habit resulted in extrusion and proclination of the incisor and exacerbation of periodontal destruction, leading to recurrent periodontal abscess formation.
| Case Report|| |
A 31-year-old male presented to the Department of Periodontics, Manipal College of Dental Sciences, Manipal, India, with recurrent swelling and pain in the maxillary anterior teeth over the previous 6 months. The pain was dull and slightly increased whenever he used that particular tooth for biting. The patient had fair oral hygiene and was otherwise healthy.
On examination, the maxillary right central incisor was found to have a 5 mm pocket mesiolabially and a 6 mm pocket mesiopalatally. The tooth was noncarious and was slightly extruded and proclined [Figure 1]. The incisal edge in the center of the tooth had a notch (abraded). The tooth showed no evidence of fracture and was not tender on percussion. There was no abnormal mobility. The incisal edges of the lower right and left central incisors also showed notching.
|Figure 1: Maxillary right central incisor extruded and proclined. The notching of the incisal surface at the center can also be seen|
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Radiographic evaluation revealed the presence of a vertical defect [Figure 2] mesial to the right central incisor. An orthopantomogram revealed no periodontal involvement of any other tooth in the arch. When the clinical findings were correlated to the radiographic findings, it was evident that the cause of such localized destruction was either trauma or an endodontic-periodontic lesion. Since the tooth was not discolored and not tender on percussion, we sought for history of possible trauma.
|Figure 2: IOPA shows a vertical defect mesial to the maxillary right central incisor|
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Enquiries related to his work as an electrician revealed that he often used his incisors to strip the outer rubber coating off electrical wires. He would hold the wire between his maxillary anterior and mandibular anterior teeth and pull the wire, thus removing the outer tubing and exposing the tungsten core.
In view of the localized destruction and the recurrent attacks of periodontal abscess, it was evident that the lesion was related to his occupation. Based on the history and the clinical and radiographic findings, we made a diagnosis of chronic periodontal abscess.
The relationship between the recurrent attacks of periodontal abscess and periodontal destruction and his professional habit was explained to him and he was advised to stop the habit. Oral prophylaxis was given and the patient was advised to return after 15 days for surgical treatment. Open flap debridement in the form of a papilla preservation flap, combined with a regenerative periodontal surgical procedure, was done. The combined regenerative procedure consists of citric acid root conditioning, bone graft (Bio-Oss® , Geistlich Biomaterials), and guided tissue regeneration (GTR) (Bio-Gide G® ) [Figure 3] and [Figure 4]. The patient was recalled ater 15 days for suture removal and then advised to come for follow-up at 6 months. Orthodontic intrusion of the tooth is planned.
|Figure 3: After debridement mesial to the maxillary right central incisor, the twowalled defect on the mesial surface and dehiscence in the facial aspect can be seen|
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|Figure 4: Papilla preservation flap sutured after combined regenerative procedures|
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| Discussion|| |
There are several etiologies for periodontal abscess formation. Chronic continuous trauma, pernicious bruxism is one of them.  When there is leverage effect on the tooth, supragingival calculus becomes subgingival. A subgingival calculus acts as a continuous source of infection.  Continuing trauma to the periodontium results in the destruction of the periodontal ligament fibers and abscess formation.
| Conclusion|| |
The present case highlights the importance of eliciting a proper case history. Our patient was unaware of the deleterious effect of his habit on the periodontium. This was clearly explained to the patient and he was advised to stop the habit. An interdisciplinary approach in the management of such cases would be beneficial.
| References|| |
|1.||Pradeep AR, Sharma DC. Gingival recession and pathologic migrationdue to unusual habit. J Int Acad Periodontol 2006;8:74-7. |
|2.||Schour I, Sarnat BG. Oral manifestations of occupational origin.JAMA 1942;120:1197. |
|3.||Deepa P, Bhat KM, Bhat GS. An adventurous habit of bottle- cap opening resulting in an endodontic- periodontal lesion: A case report: Quintessence int: 2009;40:449-51. |
|4.||Carranza FA. Chapter 29, Periodontal response to external forces. In: Newmann, takei, klokkevold, carranza. Text book of carranza's clinical periodontology. 10 th ed. St Louis, Missouri Saunders, Elsevier, 2006 p. 468. |
|5.||Carranza FA, Camargo PM. Chapter 27: The periodontal pocket. In: Newmann, takei, klokkevold, carranza. Text book of carranza's clinical periodontology. 10 th ed. St Louis, Missouri Saunders, Elsevier, 2006 p. 448. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]