A 40-year-old female with unremarkable medical history was examined at our department because of an asymptomatic mucosal alteration on the posterior, right side of the hard palate. The alteration was red/brown and located near the maxillary tuberosity (Fig. 1).
A seemingly uncomplicated punch biopsy was performed, with oral melanin hyperpigmentation as the histological diagnosis. Treatment consisted of the use of chlorhexidine gel twice daily and paracetamol per os.
Healing was confirmed one month later. It was noted that the patient had a bilateral prominent bony ridge, medial to the dental arch, extending posteriorly to the maxillary tuberosity. The mucosa at the site of the biopsy was very thin.
In retrospect, we would have preferred a scalpel for a thinner and longer biopsy, instead of a circular biopsy punch with a diameter of 5 mm.
The Conservative treatment strategy as presented here should be regarded as the primary option. However, in cases with increasing pain or increasing bone exposure, surgery is required to reduce the amount of bone exposure and to facilitate faster mucosal coverage.
Treatment of periodontal disease
In our long experience, most cases can be treated non-surgically with excellent results when done thoroughly and meticulously. Patients and referring dentists are often surprised that surgery is not required.
Rarely is surgery required for the treatment of periodontitis in our clinic.
However, there are other procedures that do require dental surgery eg Cosmetic procedures for correcting a “Gummy smile”, Crown lengthening surgery is done when a tooth is too short for the placement of a crown, grafting of the gum when there is the recession.
Teeth sometimes have to be removed because of very bad tooth decay, gum disease, badly broken after an accident or a severe crack extending down the root. Depending on the position of the lost tooth it can affect you when you smile or even cause some loss of facial support where the cheeks may look sunken in.