39 Gingival bleeding and enlargement
Kayleigh has noticed bleeding when she has been brushing for the last year. She is frightened of brushing because of the bleeding and feels that the bleeding is getting worse. She is also very socially conscious of her gums because they look very red and are ‘bigger’ than normal.
Kayleigh has insulin-dependent diabetes. She takes her insulin by subcutaneous injection at 07.30 and 17.30 hours. She has a regulated gram intake of carbohydrate at 07.30, 11.00, 13.00, 15.00, 17.30 and 21.00 hours. Apart from this she is an active girl who plays basketball and hockey at school and has learnt to increase her carbohydrate intake appropriately to cover her sporting activities. Her mum reports that Kayleigh has had the occasional ‘rebellion’ against her condition and at these times diabetic control has been poor, but generally her control is now good with a stable regimen. She is seen every 2 months by her doctor, and she monitors her blood glucose and urinary glucose at home herself.
Extraoral examination is normal with no signs of infection. Intraorally there is widespread marginal gingivitis, which is particularly bad in the upper right quadrant anteriorly (Fig. 39.1). Clinical and radiographic examination of the teeth reveal a low caries rate with only the need to replace a cracked and deficient restoration in a lower first permanent molar that has recurrent caries.