All I Want for Christmas is My Two Front Teeth
Shivali Gohel DMD ‘12 presented her Grand Rounds case titled, “All I Want for Christmas is My Two Front Teeth,” on Dec. 14, to a packed auditorium of students, faculty and staff. The presentation focused on a 24 year-old female patient that she treated during her externship at Blackstone Valley Community Health Care from July 25 to Sept. 30. Her preceptor was Dr. Lalita Bhatticharya. 
Gohel’s patient was suffering from a case of aggressive periodontitis, which is very rare and affects only two percent of the African American population, one percent of the Hispanic population, and 0.1 percent of the Caucasian population. Gohel’s patient was Hispanic and likely had a genetic predisposition to aggressive periodontitis, as others in her family suffered from the same disease.
Dr. Carl McManama, who served as moderator, said, “Shivali’s presentation has real value, as it is about a problem you don’t see very often as a general dentist. I’ve personally only seen one significant case of aggressive periodontitis, when I was a senior in dental school, and I haven’t seen another case since.”
The patient’s chief complaint was that she wanted her front teeth to look better. She was reluctant to smile and had been for some time. The patient was completely healthy except for the aggressive periodontitis—she had good oral hygiene, showed up regularly for appointments, and never had a cavity. However, as a result of the disease she suffered from severe bone loss and recession, impacted mandibular molars, anterior crowding, cross bite issues, and poor esthetics.
A very composed Gohel explained to the audience that her accepted treatment plan included diagnostic procedures, addressing the emergent problems, scaling and root planning on four quadrants, extractions of the effected teeth, immediate transitional partial dentures, and then cast partial dentures. Another treatment plan that she devised ended with placing implants instead of cast partial dentures. The patient selected the cast partial dentures plan based on concerns related to finance, time, and compliance.
“As a dental student I felt good about treating this patient, however I can’t say I felt great about extracting so many teeth from a 24-year-old,” said Gohel. “But the patient healed nicely and was smiling more after receiving the immediate partial dentures.”
The patient is currently saving up for her cast partial dentures and Gohel is cautiously confident that she will continue to comply with her accepted treatment plan and follow-up visits.
Aggressive periodontitis is rare and therefore not widely documented. As a topic for Grand Rounds it generated a great deal of discussion among the audience on the risk vs. reward of potentially placing implants in this patient, as well as the treatment of the disease itself.
Submitted by Laura Mackin, GSDM Communications.