Paget's disease: Periodontal management case and literature review

| Posted in: Science

Journal name: Journal of Indian Society of Periodontology
Original article title: Periodontal management in Paget's disease: Case presentation and a brief review of literature
The Journal of Indian Society of Periodontology (JISP) publishes original scientific articles on periodontology (the study of supporting structures of teeth) and oral implantology. It is a bimonthly open-access journal with special issues for specific occasions.
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Original source:

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Author:

Gopalakrishnan Sundaram, Pramod, Uma Sudhakar, Jaya Kumar


Journal of Indian Society of Periodontology:

(A bimonthly open-access journal)

Full text available for: Periodontal management in Paget's disease: Case presentation and a brief review of literature

Year: 2012 | Doi: 10.4103/0972-124X.94622

Copyright (license): CC BY-NC-SA


Summary of article contents:

Introduction

Paget's disease of bone is a prevalent condition marked by disorganized and heightened bone turnover affecting one or multiple bones across the skeleton. The disorder disrupts normal bone structure, resulting in complications such as bone pain, deformities, and fractures. The exact cause of Paget's disease remains obscure, but genetic factors and environmental influences, such as paramyxovirus infections, have been established as potential contributors. The current case report discusses a 39-year-old female patient diagnosed with Paget's disease, highlighting her periodontal management which involved diagnostic procedures including CT scans and serum alkaline phosphatase tests.

The Role of Bisphosphonates in Treatment

One critical concept in treating Paget's disease involves the use of bisphosphonates, which are commonly prescribed to manage high bone turnover associated with the disorder. The patient in the case study demonstrated elevated serum alkaline phosphatase levels, indicative of osteoclastic activity, which were later reduced through bisphosphonate therapy. While bisphosphonates effectively mitigate bone loss and may alleviate symptoms, they carry a risk of osteonecrosis of the jaw (BRONJ). In this case, despite localized bone loss, the patient's good oral hygiene and the use of bisphosphonates contributed to a more favorable periodontal status than typically observed in Paget’s disease. Treatment included emergency endodontic therapy and phase I periodontal therapy, followed by surgical intervention to address persistent pockets.

Conclusion

Managing periodontal complications in patients with Paget's disease presents unique challenges due to the disease's progressive nature and the effects of bisphosphonate therapy. Comprehensive pre-treatment assessments can help mitigate risks associated with interventions. In this case, while the dynamic changes in jaw size and the potential for compromised healing posed difficulties, effective management strategies were employed that addressed the periodontal issues. Future treatment plans may involve ongoing monitoring and adjusted approaches depending on the patient's evolving condition, emphasizing the importance of tailored treatment in managing Paget's disease.

FAQ section (important questions/answers):

What is Paget's disease of bone and its characteristics?

Paget's disease is a common bone condition characterized by increased, disorganized bone turnover. It disrupts normal bone architecture and can lead to complications like pain, fractures, and deformities.

What are some symptoms of Paget's disease in patients?

Symptoms include hearing loss, headaches, bone pain, deformities, and nerve compression. Affected bones may exhibit disorganized growth, leading to weaker, lower quality bone.

How is Paget's disease diagnosed and monitored?

Diagnosis typically involves clinical examination, imaging techniques like X-rays and CT scans, and laboratory tests measuring serum alkaline phosphatase levels. Monitoring is vital for assessing disease progression and treatment effectiveness.

What treatment options are available for Paget's disease patients?

Treatment often includes bisphosphonates to reduce bone turnover. In cases involving periodontal disease, scaling, root planing, and surgical interventions may be needed to manage oral health.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Paget's disease: Periodontal management case and literature review”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Disease:
Paget's disease of bone is characterized by disorganized bone turnover, leading to abnormal architecture and various complications. The condition significantly affects bone health, causing pain, fractures, and deformities, necessitating clinical attention and management strategies to mitigate its impact and improve patient quality of life.

2) Pain (Paiṇ):
Bone pain is a common symptom in Paget's disease, often resulting from associated osteoarthritis and abnormal bone formation. Pain management is crucial for patient comfort and function, highlighting the importance of early diagnosis, treatment strategies, and ongoing monitoring to address and alleviate pain effectively.

3) Hygiene (Hygienic):
Maintaining proper oral hygiene is vital for patients with Paget's disease, especially since the condition can lead to complications like periodontal disease. Effective hygiene practices help prevent further alveolar bone loss and manage oral health, ultimately improving the overall treatment outcomes for such patients.

4) Mutation:
Genetic mutations, particularly in the SQSTM1/p62 gene, are associated with increased susceptibility to Paget's disease. Understanding these mutations assists in unraveling the disease’s etiology and provides insights into the underlying processes that contribute to abnormal osteoclast function and bone remodeling.

5) Activity:
In the context of Paget's disease, activity refers to the abnormal activity of osteoclasts and osteoblasts. Their increased and unregulated activity disrupts normal bone turnover, resulting in bone deformities and other complications that necessitate careful management and treatment to restore bone health.

6) Quality:
The quality of bone affected by Paget's disease is often compromised, characterized by disorganized architecture and the presence of immature bone. This poor quality leads to increased susceptibility to fractures and other complications, emphasizing the need for effective treatment strategies to enhance bone quality.

7) Pur (Pūr):
Poor bone quality in Paget's disease results from excessive and disorganized bone formation. This condition can lead to fractures and deformities, necessitating therapeutic interventions to improve bone health and reduce the risks associated with the disorganized bone architecture typical of the disease.

8) Measurement:
Accurate measurement of periodontal pocket depth and other clinical parameters is crucial in managing periodontal disease in patients with Paget's disease. It allows for tailored treatment strategies and effective monitoring of disease progression, ensuring optimal outcomes and overall improvement in oral health.

9) Antibiotic (Antibacterial):
Antibiotics may be used as part of the treatment regimen for patients with Paget's disease undergoing surgical procedures, particularly to prevent infections. Their use underscores the importance of proactive care in managing both periodontal disease and complications related to Paget's disease effectively.

10) Observing:
Observing clinical and radiographic changes in patients with Paget's disease is vital for diagnosis and treatment planning. It helps dentists monitor disease progression, adjust treatment approaches, and anticipate complications, ensuring comprehensive care tailored to the individual needs of the patient.

11) Composite:
Composite restorations can be used in dental procedures for aesthetic reasons in patients with Paget's disease. These materials allow for the restoration of tooth structure while maintaining functional and aesthetic outcomes, which is crucial for patient comfort and confidence.

12) Deafness:
Deafness can occur in patients with Paget's disease due to the involvement of the temporal bone. Understanding the relationship between bone remodeling and hearing impairment is essential for comprehensive patient management and may necessitate collaboration with other healthcare providers for optimal care.

13) Relative:
As Paget's disease can have hereditary components, understanding the relative risk of developing the disease based on familial history is crucial. This knowledge aids in early detection and management strategies, particularly in patients with identifiable genetic predispositions.

14) Chennai:
Chennai is mentioned as the location where the case study was conducted. This geographical reference highlights the importance of local healthcare providers in diagnosing and managing conditions like Paget's disease, suggesting that regional healthcare access and expertise play vital roles in patient outcomes.

15) Account:
Taking an account of clinical and radiographic findings is necessary for developing effective treatment plans for patients with Paget's disease. Such comprehensive assessments help guide surgical approaches and other therapeutic interventions, ensuring optimal management of the disease's multifaceted complications.

16) Kannan (Kannaṉ, Kaṇṇaṉ, Kaṉṉaṉ, Kaṉṉāṉ):
The reference to Kannan et al. signifies the scientific community's contributions to understanding Paget's disease. Their studies help contextualize findings and treatment approaches within the broader spectrum of medical knowledge, informing practitioners on effective strategies and outcomes related to the disease.

17) Reason:
Understanding the underlying reasons for the pathological changes in Paget's disease is essential for effective treatment. It can lead to the development of targeted therapeutic approaches that address both the symptoms and the root causes, ultimately improving patient management strategies.

18) Cotton:
The term 'cotton' is linked to the 'cotton wool appearance' seen in radiographic scans of bone affected by Paget's disease. This appearance acts as a diagnostic indicator, prompting further examination and management of the patient’s condition.

19) Kappa:
The term 'Kappa' relates to the involvement of the Receptor Activator of Nuclear factor Kappa-B Ligand (RANKL) in osteoclast activity. Understanding pathways like these is essential in Paget's disease research to uncover the mechanisms that drive bone remodeling and potential therapeutic targets.

20) Kani (Kaṇī, Kanī, Kaṉi):
The term 'Kani' may refer to specific genetic or molecular factors influencing Paget's disease but lacks specific context in this document. Understanding various contributors can offer insights into personalized treatment options and improve patient outcomes.

21) Wool:
The term 'wool' in 'cotton wool' appearance describes a distinctive radiographic finding in Paget's disease. This terminology aids in the visual interpretation of disease effects on bone structure, assisting healthcare professionals in diagnosis and subsequent treatment planning.

22) Food:
Food impaction is a significant concern in patients with Paget's disease due to altered jaw and dental structure. This condition emphasizes the need for ongoing oral care and dietary adaptations to ensure comfort and manage potential complications effectively.

23) Sign:
Signs associated with Paget's disease, such as bone deformities and hearing loss, are critical for diagnosis. Recognizing these clinical manifestations enables healthcare providers to develop appropriate management strategies tailored to the specific needs of affected patients.

24) Tai (Tāī, Ṭai):
The mention of 'Thai' refers to the Thai Moogambigai Dental College and Hospital, where the case study was conducted. This highlights the role of educational institutions in advancing the understanding and management of complex conditions like Paget's disease, fostering clinical excellence.

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