Using Evidence-Based Dentistry in the Clinical Management of Combined Periodontal Conditions

Area of Science:

• Periodontology
• Evidence-Based Dentistry

Background:

• Drug-induced gingival hyperplasia and generalized aggressive periodontitis are severe periodontal conditions.
• A 37-year-old female patient presented with symptoms of both conditions, exacerbated by hypertension medication.

Purpose of the Study:

• To propose a framework for integrating evidence-based dentistry (EBD) in managing complex periodontal cases.
• To illustrate the clinical management of a patient with co-existing drug-induced gingival hyperplasia and generalized aggressive periodontitis.

Main Methods:

• A systematic literature search was conducted on PubMed, Embase, and Scopus for articles on aggressive periodontitis and gingival enlargement.
• A 5-step EBD framework was applied: asking clinical questions, acquiring and appraising evidence, clinical application, and outcome assessment.
• A decision tree was developed based on scientific evidence, patient complaints, and clinical expertise.

Main Results:

• 34 publications were initially identified, with 31 relevant articles selected after review.
• The literature review informed a treatment decision tree for the patient's combined conditions.
• Nonsurgical therapy preceded surgical therapy, leading to successful clinical outcomes.

Conclusions:

• Integrating EBD principles provides a reliable approach for managing atypical and complex periodontal conditions.
• The proposed framework aids in systematically treating patients with combined drug-induced gingival enlargement and generalized aggressive periodontitis.
• Successful management was achieved through a phased therapeutic approach, starting with nonsurgical interventions.