PMC8548172_01
Appearances of the palm at (a) first visit and (b) 1 year after periodontal treatment. (a) Scaly erythemas with tiny pustules were scattered on the palm. (b) Marked improvement was observed after periodontal treatment.
CRIDM2021-5548760.001.jpg
PMC8548172_01_CRIDM2021-5548760.001.jpg
fig1
A 56-year-old woman with PPP was referred to a dentist with suspected intraoral disease deteriorating factors (Figure 1(a)). In addition, although more than 2 years had passed after complete remission, no recurrence was observed (Figure 1(b)).
Appearance of the patient's periodontal tissues at the first visit (a) and radiograph of the periodontium (b). Note the severe alveolar bone resorption and so-called "floating teeth" due to severe periodontitis (b) and moderate gingival inflammation (a). "Floating teeth" were indicated by arrows. In addition, many metal restorations are observed.
CRIDM2021-5548760.002.jpg
PMC8548172_01_CRIDM2021-5548760.002.jpg
fig2
It was severe (stage IV and grade C) (Figures 2(a) and 2(b)).
The course of dental treatment and the changes in hs-CRP levels, WBC, PISA value, and the ratio of PPD >4 mm. As periodontal treatment advanced, the value of inflammatory markers showed a decreased tendency.
CRIDM2021-5548760.003.jpg
PMC8548172_01_CRIDM2021-5548760.003.jpg
fig3
Upon her visit at our centre, we performed a regular examination and measured hs-CRP, white blood cell (WBC) count, and calculated PISA.  Figure 3 shows the results of the initial dental examination and the changes in each parameter according to the treatment. Periodontitis showed further improvement 3 months after periodontal surgery (Figure 3). The symptoms of PPP gradually improved, and complete remission was observed in the supportive periodontal therapy (SPT) phase.  Figure 3 shows the changes in laboratory and clinical examination data.