36 /m c/of oral pain and loose teeth since 1year. H/O loosing 4 teeth spontaneously within 6 months. C/0 increased thirst, polyuria. Dehydration +. S.E ..revealed hypernateraemia. Diagnosis? .

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Premature loss of teeth with hypernatremia indicates diabetes mellitus. Send hba1c, fbs, ppbs, RFT.

Hypernatremia is due to renal water bcoz of osmotic diuresis secondary to hyperglycemia
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Thanks Al of u. X ray image shows 2 radiolucent scooped out lesions of the mandible with floating tooth. Biopsy . of left mandibular lesions ..showed sheets of inflammatory cells and S100 +CD1a +langerhans cells . Mri brain showed increased T1 w signal in posterior pituitary and thickning of infundibulum. Dx. ..multi organ langerhans cell histiocytosis with Diabetis insipidus. Patient was treated with curettage and desmopressin.

Amazing case never seen this level of bone loss in agressive periodontitis!! @Dr. Rustom Lahon Sir how does that even happen

Such conditions are often related to systemic diseases.... first we have to correct them... this very case certainly needs bones grafting or plating...
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A chronic case of aggressive Periodontitis.....

Sir I beg to disagree with you... there is no such terminology or description of a case which could be chronic case of aggressive... as if it's aggressive it will remain that. Also without looking for all criteria simply based on the bone loss you can't term a case as aggressive. Kindly share your opinion.
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Symptoms are suggestive of Diabetes. So do bs-f, bs-pp , hb1ac etc. There's aggressive periodontitis. also.

Omg...severe bone loss is dere respect to mandible even including d lower border of mandible in 3rd quadrant... Rule out diabetes status...requires extrctn of hopeless teeth... Is it associated wd extraoral sinus (3rd quadrant)....?

Severe bone loss in the mandibular molar regions that resembles advanced periodontitis. These symptoms may associated with systemic disorders. D.diagnosis may Langerhans cell histiocytosis.

It can be Esinophilic granuloma Papillon levefre syndrome As discussed vd my favourite Dr house @Dr. Syed Wakeel Ah

Run the tests
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व्रजर्दन्ति।।मौलश्री।।की छाल को यवकुट करें और फिर उसे पानी में उबालकर उस पानी से कुल्ला करें। योग परिक्षित है पिछले 40 वर्ष से प्रयोग कर रहा हूं

Diabetes mellitus for sure. Get all the blood and urine test done with, fasting and post prandial levels along with HbA1c which gives report of last 3 months. This is the reason for this severe bone loss. Diabetes has to be treated to get rid of this issue. Thanks

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