Gingival Hyperplasia with Bone Loss and Anorexia Nervosa

By: Brenda McNevin RDH

November 13, 2018

The Challenge:

A 15-year-old patient with multiple years of periodontal concerns being co-managed with a periodontist without resolution.

The Background:

  • Age: 15
  • Sex: F
  • Medical History: Behavioral concerns, at age 15 has not begun menstruation
  • Home Care: Chronic poor home care
  • Periodontal Assessment: History of referral to periodontist before orthodontics with minimal resolution. After orthodontics were removed, the radiographs revealed more bone loss. Referral to periodontist again. When patient appointed for maintenance care revealed gingival hyperplasia along with pliable gingival margins.

Additional Comments: Her appearance was pale and very thin. The mother reports for several years being unable to motivate the patient in areas of oral and personal hygiene.

The Solution:

  • MyPerioPath® collected June 20, 2018
  • 4 quadrants of scaling & root planing
  • Administer systemic antibiotic per MyPerioPath® results recommendation
  • Possible low dose doxycycline if inflammation persists
  • Recommended to perform MyPerioPath® Progress (post-therapy test)

Additional comments: Further medical investigation was recommended such as checking of Vitamin D levels, estrogen & progesterone levels and thyroid.

The Result:

Therapy has been suspended. In consult with the mother about the MyPerioPath® results and the recommended treatment plan, he mother reluctantly revealed the daughter was diagnosed with anorexia nervosa. I informed the mother I would be forwarding the test results to the daughter's pediatrician and periodontist. She made me aware that the daughter's Vitamin D level was very low and being tested every other day. In addition the daughter’s thyroid and hormone levels were significantly low too. The mother stated the daughter is now in a 6-week eating disorder program followed by outpatient care. The mother agreed to therapy once the eating disorder is under control. Upon a visit by the mother for another sibling’s care, the mother stated the daughter was improving but still has a long way to go.

I am appreciative of the level of care and concrete information I can now provide to my patients by utilizing OralDNA® salivary testing services. In conclusion, the underlying cause for this patient’s gingival hyperplasia and low to moderate bone loss is anorexia nervosa. Early in this patient’s care, I was suspicious there may be some depression concerns. This in addition to the clinical signs was a reason for referral to the specialist and a non-conclusive diagnosis. Now with testing I can rule in or rule out bacteria being a cause for the inflammation so we can explore other possible reasons for the inflammation and provide more timely care.

About the Author:

Brenda graduated from Northampton Community College in 1998 with a degree in Applied Science. She holds double licensures for PA and NJ. For three years, she practiced in adult dentistry and since 2000, she has practiced strictly in pediatrics. Over the years, she practiced mobile dentistry providing hygiene services to schools and low-income communities. Under a grant program at Lehigh Valley Hospital, she was able to assess the need of mobile dentistry with in the surrounding counties. In February, she dresses as the Tooth Fairy for Children’s Dental Health month to educate preschool through elementary school about the importance of dental hygiene. She is quoted “What I enjoy the most is the interactions I have with my patients. I love watching them grow from 2 years through college. I enjoy being able to help them keep their beautiful smiles healthy.” Brenda is a mother of triplet girls age 13. She enjoys decorating, gardening, traveling and being at the beach.