Severe periodontitis associated with chronic kidney disease
A 35 year old female patient presented to Dental Department, Vardhman Mahaveer Medical College and Safdarjang Hospital, New Delhi, with chief complaint of mild pain and swelling in mandibular molars on both side. Her medical records revealed that she was suffering from stage four CKD. She was non-diabetic, non-hypertensive and cause of CKD was not established. She was not taking any drug which is known to cause gingival overgrowth.\nOn intraoral examination, she had bilateral periodontal abscess in relation to first mandibular molars, with deep periodontal pockets and pus discharge [Figures and ]. OPG revealed severe angular bone loss in relation to 36 and 46, and external root resorption of mesial root of 46 [].\nAbscess was drained under local anesthesia through periodontal pocket, and copious irrigation with CHX was done. Oral hygiene instructions were given and phase I therapy was started. Patient was recalled after one week. Opinion of nephrologists was also sought regarding dental treatment.\nAfter one week there was no pus discharge, but inflammatory gingival overgrowth persisted. Considering the medical condition of the patient and nephrologist's opinion, it was decided to manage the case non-surgically. Full mouth scaling and root planing was completed. Combination of Amoxycillin and Metronidazole was given for seven days (after dose adjustment in consultation with nephrologists). Patient was recalled every month for scaling and root planing.\nThe response to therapy was poor, inflammatory gingival overgrowth persisted in both the molars [Figures and ], there was bleeding on probing, but no pus discharge.\nAfter six months, the patient's CKD deteriorated to stage 5 and was put on haemodialysis twice a week. Though non-surgical periodontal therapy was being continued with monthly recalls, OPG revealed rapid periodontal destruction in 36 and 46 [] as compared previous OPG taken six months back []. The inflammatory gingival overgrowth persisted in both the molars.