Dr Rishi Bhimani
Non-surgical Periodontal Management of Severe Generalized Gingival Enlargement in a HIV-positive patient
Case history- 32-year-old female patient with a chief complaint of swollen gums since 1½ years. Gradually, she started to develop swelling of the gums in the maxillary and mandibular anterior region that was spreading posteriorly, to involve the entire gingiva.
The patient developed difficulty in mastication and was also
concerned about the esthetic disfigurement.
Medical history revealed that the patient was diagnosed
as HIV positive 7 years ago and had been on HAART,
composed of a fixed drug combination of lamivudine
(150 mg), nevirapine (200 mg) and zidovudine (300 mg)
twice daily and had well-maintained systemic health. Her
CD4 counts ranged between 450 and 700 cells/mm3 and
were checked bi-annually as a protocol.
PRE-TREATMENT- frontal, right, left and occlusal showing grade 2 to grade 3 gingival enlargement (Bokenkemp & Bonhorst, 1994), pathologic migration irt 11, 21, extruded lower anteriors and severe deep bite.
TREATMENT PROTOCOL- Scaling and root planing were performed over three sittings
following the standard precautions for the treatment of
HIV patients using the HIV-AIDS kit (EXCELLENT
ASEPTIC PRECAUTION PRODUCTS, Madurai,
India). A pre-procedural mouthrinse was performed using 0.2% chlorhexidine. Ultrasonic scaling was followed by subgingival irrigation with 5% povidone-iodine (bectadine) and saline, in equal mixtures. The patient was advised home gargles with 2% povidone-iodine (betadine) mouthrinse twice daily, for reducing the microbial load and bleeding. The patient
was motivated to start brushing with a soft toothbrush to
prevent gingival trauma. NSPT was repeated every 4 weeks and an astonishing improvement was seen.
3-MONTHS FOLLOW UP- Photos show a nearly normal gingival contour, stippling and resilience.
EXTRACTION of compromised anterior teeth was done.
Local drug delivery with resorbable tetracycline fibers was done to treat a pocket between 45 and 46. The pocket probing depth was reduced from 6 mm to 3 mm.
Prosthetic rehabilitation was planned with fixed partial dentures in both arches.
The patient understood the importance of this therapy and maintained her oral cavity well. She was followed by for 6 months post-prosthetic treatment and is doing well till date. the entire case took about 1.5 years from the start up to final follow-up.
So, Non-surgical periodontal therapy is an extremely powerful tool and this case proves it. Power of NSPT and Supportive periodontal therapy should never be underestimated.
