CASE INFORMATION

Case ID: DENT-2025-04
Case Name: Michael Turner
Age: 47
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: D82 (Gingivitis), D83 (Periodontitis)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages effectively with the patient to assess oral health concerns 1.3 Explains the link between oral health and systemic health in simple terms 1.5 Uses shared decision-making to develop a management plan
2. Clinical Information Gathering and Interpretation	2.1 Conducts a thorough history and examination for gum disease 2.3 Identifies risk factors for periodontitis 2.5 Assesses for systemic conditions associated with gum disease (e.g., diabetes)
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between gingivitis and periodontitis 3.5 Recognises when urgent dental referral is needed
4. Clinical Management and Therapeutic Reasoning	4.2 Provides appropriate oral hygiene advice and initial treatment 4.5 Refers to a dentist or periodontist when indicated
5. Preventive and Population Health	5.1 Educates on proper oral hygiene practices 5.3 Discusses the role of lifestyle factors (e.g., smoking, diet) in gum disease
6. Professionalism	6.1 Provides a non-judgmental, patient-centred approach
7. General Practice Systems and Regulatory Requirements	7.1 Documents clinical findings and management plan clearly 7.2 Ensures appropriate referral pathways for advanced disease
9. Managing Uncertainty	9.1 Addresses diagnostic uncertainty by considering systemic causes of gum disease
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises when oral health issues may be linked to underlying systemic conditions

CASE FEATURES

Middle-aged male with bleeding gums, bad breath, and gum recession.
History of smoking and poor oral hygiene.
Concerned about loose teeth and pain when eating.
Has type 2 diabetes, which may contribute to periodontal disease.
Needs assessment for systemic and lifestyle factors impacting oral health.

INSTRUCTIONS

Review the following patient record summary and scenario.
Your examiner will ask you a series of questions based on this information.

You have 15 minutes to complete this case.

The time for each question will be managed by the examiner.
The time allocation for each question is roughly as follows:

Question 1 – 3 minutes
Question 2 – 3 minutes
Question 3 – 3 minutes
Question 4 – 3 minutes
Question 5 – 3 minutes

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Turner
Age: 47
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Metformin 1000 mg BD
Atorvastatin 20 mg nocte

Past History

Type 2 diabetes (diagnosed 5 years ago, poorly controlled)
Hypertension
No history of previous dental extractions or treatment for gum disease

Social History

Smokes 15 cigarettes per day
High sugar intake, frequent soft drink consumption
Does not see a dentist regularly

Family History

Father had early tooth loss due to gum disease

Smoking

Current smoker, 20 pack-year history

Alcohol

Drinks 2-3 standard drinks per night

Vaccination and Preventative Activities

No recent dental check-ups
Last HbA1c: 8.5% (poorly controlled diabetes)

SCENARIO

Michael Turner, a 47-year-old man with type 2 diabetes, presents with bleeding gums, bad breath, and occasional gum pain. He has noticed his gums receding and some teeth feeling loose. He brushes only once a day and does not floss.

He has never seen a dentist regularly and is worried that he may need tooth extractions. He smokes 15 cigarettes per day and consumes frequent sugary drinks, contributing to his oral health issues.

On examination, he has red, swollen gums with plaque build-up, gum recession, and pockets of pus around the lower molars. There is no evidence of facial swelling or systemic infection.

Michael is concerned about his long-term dental health and wants to know what he can do to prevent further damage.

EXAMINATION FINDINGS

General Appearance: No acute distress
Oral Examination:

Gums: Red, swollen, receding, bleeding on probing
Teeth: Some mobility in lower molars
Plaque and tartar build-up present
Halitosis (bad breath)
No oral ulcerations or facial swelling

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What aspects of history and examination are critical in assessing this patient’s gum disease?

Prompt: What risk factors contribute to periodontal disease?
Prompt: What systemic conditions are linked to gum disease?

Q2. Based on the findings, what is your differential diagnosis, and what is your working diagnosis?

Prompt: How do you differentiate between gingivitis and periodontitis?
Prompt: What makes this case concerning?

Q3. What investigations or management steps would you recommend?

Prompt: What role does diabetes control play in periodontal disease management?
Prompt: When is referral to a dentist or periodontist required?

Q4. How would you counsel Michael about his oral health and risk factors?

Prompt: How do you explain the impact of smoking, diabetes, and diet on gum disease?
Prompt: What are the key oral hygiene recommendations for this patient?

Q5. What follow-up plan would you implement?

Prompt: When should he return for review?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What aspects of history and examination are critical in assessing this patient’s gum disease?

A structured approach is essential when evaluating gum disease to determine the severity, underlying risk factors, and impact on overall health.

1. History

Symptoms: Duration and progression of bleeding gums, pain, bad breath, gum recession, loose teeth.
Oral hygiene practices: Frequency of brushing, flossing, use of mouthwash, regularity of dental visits.
Smoking history: A strong risk factor for periodontal disease.
Dietary habits: High sugar intake contributes to plaque formation.
Past dental issues: History of gingivitis, periodontitis, or dental procedures.
Systemic conditions: Diabetes, immunosuppression, osteoporosis, or medications affecting gums.
Family history: Genetic predisposition to early-onset periodontitis.

2. Examination

General oral inspection: Assess gum colour, swelling, recession, and plaque build-up.
Bleeding on probing: Key indicator of inflammation.
Gingival pockets: Depth of ≥4mm suggests periodontitis.
Tooth mobility: Advanced disease may cause loose teeth.
Halitosis (bad breath): Associated with bacterial overgrowth.
Soft tissue health: Look for ulcers, abscesses, or pus formation.
Signs of systemic illness: Pale gums (anaemia), oral thrush (diabetes/immunosuppression).

This comprehensive assessment helps determine if intervention is needed and whether a referral to a dentist or periodontist is warranted.

SUMMARY OF A COMPETENT ANSWER

Elicits symptoms and risk factors such as smoking, diabetes, and poor oral hygiene.
Differentiates between gingivitis and periodontitis using clinical history and exam.
Assesses gum health via bleeding, pocket depth, and plaque build-up.
Recognises the impact of systemic conditions on oral health.

PITFALLS

Failing to take a detailed history of smoking and diet, which are major risk factors.
Not assessing for systemic conditions (e.g., diabetes), which may worsen gum disease.
Overlooking the distinction between gingivitis and periodontitis, leading to inadequate treatment.
Neglecting to check for soft tissue changes (e.g., ulcers, abscesses) that may indicate more serious pathology.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

2. Clinical Information Gathering and Interpretation

2.1 Conducts a thorough history and examination for gum disease.
2.3 Identifies risk factors for periodontitis.
2.5 Assesses for systemic conditions associated with gum disease.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD