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Hi everybody.its been a while since my last interacting whith the forum and i hardly recognize some of the members.i have a question,i would apriciate your help.here we go, A 17 years old patient, sensible teeth, bleeding gums,whith residual heart dammage from rheumatic arthritis,tooth brushing once a week,last dentist visit 3 years ago.clinical exam:localized bleeding at probing whith plaque accumulation,not found perio pockets of more than 3 mm,subgingival caries on multiple teeth.For the exam they provide also a radiographs which i dont have.the question is;What is the most probable cause of gingival bleeding in this patient A) calculus and plaque presence or b)plaque presence only. The other 2 possibilities (leucemia and cyclic neutropenia) not correct.From Carranzas book we know that calculus does not irritate the gingiva but provides a fixed nidus for the accumulation of plaque and holds it against the gingiva.its the thinned, degenerated, ulcareted sulcular epithilium and dilateted capillaries(as result of bacterial invasion ) that cause gingival bleeding under ordinary stimuli. Normally by the book the answser should be B,but in a clinical judgement exam i dont know what is the most appropriate anwser.Thanks in advance for the help.
