A 57-year-old man with inflamed, enlarged gingivae and associated bone loss.

JADA 143(1) http://jada.ada.org January 2012 43 THE CHALLENGE A 57-year-old man sought care at the oral medicine clinic at the University of California, San Francisco, with a chief complaint of red, swollen and painful gums of approximately 18 months’ duration. The anterior maxillary and mandibular gingivae and teeth were involved persistently (Figure 1). The patient’s lips appeared normal on inspection and palpation. The rest of the oral examination findings were within normal limits. The patient’s periodontist had performed deep scaling, prescribed antibiotics and splinted the maxillary anterior teeth. The patient reported a history of hypothyroidism and anxiety but otherwise was in good health with no other signs or symptoms. His only medication was 75 milligrams per day of levothyroxine, and he reported no known allergies. On examination by three of us (C.B., S.S., N.C.-W.), mandibular and maxillary anterior gingivae extending to the premolars appeared enlarged, boggy and erythematous. Periodontal pockets ranged from 6 to 9 millimeters around the affected teeth, which had grade II mobility.