History of Present Illness

This is a 39-year-old white female with a history of mental retardation. She presented in August 2003 to Hospital Dentistry for severe periodontitis, halitosis and loose teeth (Fig 1-3). In September 2003 she presented to Keesler Medical Center emergency room and was later admitted to the hospital for an unspecified protein-calorie malnutrition, anemia and hypokalemia (her potassium level was 2.5mmol/L; the normal level is 3.6-5.1 mmol/L). She also had severe periodontitis and calculus accumulation. Her diet consisted entirely of Kraft Mac and Cheese, peanut butter and soda. Her mother did not recall vegetables or fruits in her daughter’s diet.

Figure 1.  Patient at presentation demonstrating, swollen, red gingiva and bleeding and ulcerated lips. Figure 2.  Patient at presentation demonstrating severe periodontitis and focal gingival bleeding.

Figure 3. Panoramic view at first presentation demonstrating severe periodontitis and calculus accumulation.