Forum for Clinical and Surgical Oral Pathology

Case BBOPF 11-1

Dr. Stephen Rappeport (Private practice in Periodontics, Forth Smith, Arkansas) is requesting your opinion. Please send your comments in the window located below the images. This case will be posted from February 17-25, 2011. A summary of the responses will be made available in BBOP.

Clinical History

I have recently seen a healthy 15 years-old Caucasian female who was referred to me by her general dentist. The chief complaint is a horizontal boney defect between tooth #30 and #31.

The child has recently completed orthodontics and for the last two years has been treated for a mycobacterium infection which required drainage from a lymph gland in her neck. It was reported that pus was drawn from the node, cultured and by process of elimination the diagnosis of mycobacterium was determined. The child took zithromax and rifadin but the meds affected her stomach and were discontinued.

Except for the interproximal osseous defect in which approx 40% of the horizontal bone is lost between 30 and 31 and the fact that approx 10% of the distal root eroded away, the child is healthy. There is no fever and no lymphadenopathy at the present time.

Could a mycobacterium cause this defect and erode the distal root? Except for mild gingivitis the periodontium is otherwise normal. There is no lymph gland involvement at this time. No vitality testing has been done on # 30.

Please see the panoramic film below.

Images

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Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).