PERIODONTAL CASE STUDY PROJECT

YOLANDA COLON

PATIENT PROFILE

● 27 YEAR OLD HISPANIC FEMALE

● HEALTH HISTORY REVEALS:

─ A FORMER SMOKER

─ FAMILY HISTORY OF DIABETES TYPE II

─ TAKES NECON TO REGULATE MENSTRUAL

CYCLE

─ VITAL SIGNS WNL

● DENTAL HISTORY REVEALS:

─ BRUSHES ONCE A DAY WITH HARD TOOTHBRUSH

─ NEVER FLOSSES

─ GRINDS TEETH

─ IRREGULAR DENTAL VISITS. LAST DENTAL VISIT WAS FOUR YEARS AGO

INTRA ORAL PHOTOS

INTRA ORAL PHOTOS

INTRA ORAL PHOTOS

DENTAL CHART

PERIODONTAL CHARTING

PERIODONTAL EVALUATION

ASSESSMENT FINDINGS

● NO FURCATIONS, MOBILITY OR MUCOGINGIVAL INVOLVEMENT

● BOP WAS OBSERVED ON ALL TEETH

● SLIGHT SPICULES OF SUPRAGINGIVAL CALCULUS ON TEETH # 22-27

● GENERALIZED RINGS OF SUBGINGIVAL CALCULUS

● GENERALIZED MODERATE BIOFILM ON INTERPROXIMALS

● BIOFILM INDEX SCORE OF 25%

● GENERALIZED TOBACCO STAIN

● CARIES ON # 6-F, # 18-O, AND # 31-O

●POOR MARGINAL RESTORATIONS ON # 2-O AND # 19-O

● FRACTURED RESTORATION ON # 14-O

GINGIVAL DESCRIPTION

• GENERALIZED PINK WITH SLIGHT MARGINAL RED, SHINY, SPONGY, ENLARGED, BULBOUS TISSUE

Contributory Factors

• Calculus• Faulty restorations• Food impaction• Position of teeth/malocclusion• Un-replaced teeth

Periodontal Risk Factors

• Smoking

RADIOGRAPHS

● GENERALIZED SLIGHT BONE LOSS ON MAXILLARY

AND MANDIBULAR ANTERIORS

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RADIOGRAPHS

● GENERALIZED SLIGHT BONE LOSS WITH MODERATE BONE LOSS ON TEETH #’S 14, 16, 18, 19

● RECURRENT DECAY ON # 14-O

RADIOGRAPHS

● GENERALIZED SLIGHT BONE LOSS WITH MODERATE BONE LOSS ON TOOTH # 2

PERIODONTAL DIAGNOSIS

● GENERALIZED MODERATE ACTIVE AGGRESSIVE PERIODONTITIS MODIFIED BY SMOKING

● AAP III

Dental Hygiene Diagnosis: Issues that need to be addressed with Dental Hygiene Treatment Circle issues present and provide summary below Wellness Systemic Head & Neck Pathology Tobacco Nutrition Malocclusion/Parafunctional habits Dental Condition/Caries/risk Periodontal condition/risk Self-care Trauma Staining/Esthetics Other: Dental Hygiene Diagnosis: Periodontitis related to insufficient home care and smoking

Goals Client Goals: To quit smoking and improve in dental care

Treatment goals: Obtain a quit smoking date and discuss role of periodontitis and smoking

Assessments (after initial assessments) Implementation Appt. 1

Appt. 2 Appt. 3 Appt. 4 Appt. 5 Re-evaluation

Radiographs X Additional diagnostics

Time needed 45 MIN Disease Prevention/Health Education Implementation

Appt. 1 Appt. 2 Appt. 3 Appt. 4 Appt. 5 Re-evaluation

Brushing Techniques X X Interdental Aids X X Periodontal Disease Dental Decay Tobacco Cessation X X X X X Nutritional Education Fluoride Therapy X Systemic Disease Other

Time needed 20 MIN 10 MIN 10 MIN 20 MIN 2 HOURS Procedures Implementation

Appt. 1 Appt. 2 Appt. 3 Appt. 4 Appt. 5 Re-evaluation

Review health history, oral exam, Indices X X X X Re-assess previously treated areas X X X Anesthesia (Type: Drug & delivery method) Power Driven Debridement /Area LL UL LR UR Hand Activated Debridement/Area LL UL LR UR Chemotherapeutic Procedures (type) Plaque Removal (method) POLISH

& TB

Fluoride treatment (Type of fluoride) GEL Desensitization Amalgam Polishing Athletic Mouth Protectors Study Models Sealants

Total Appointment Time 3 3 3 3 Re-care Interval : 3MRC

Referrals needed: RESTORATIVE, PERIO, SMOKING

Oral Self-Care Current Oral Self-Care Methods: TB FONES 1 X DAY WITH HARD TB, NEVER FLOSSES Recommendations: Indicate recommendations below and include type method and frequency as necessary Brush 2 X DAY Dental floss/tape FLOSS 3 X WEEK Oral rinse(s) Specialty Brush SOFT TB ( BASS) Floss threader/Aid Other: Interproximal device Fluoride product(s)

PROCEDURES

● FIRST VISIT

─ MEDICAL HISTORY, VITAL SIGNS, EOE, IOE, DENTAL CHART, GINGIVAL MARGIN

● SECOND VISIT

─ MEDICAL HISTORY, VITAL SIGNS, EOE CURSORY, IOE CURSORY, PERIODONTAL ASSESSMENT

● THIRD VISIT

─ MEDICAL HISTORY, VITAL SIGNS, EOE CURSORY, IOE CURSORY, PLAQUE INDEX (25%) AND DEPOSIT ASSESSMENT, TREATMENT PLAN & HOME CARE

● REVIEW BRUSHING TECHNIQUE – CONCENTRATE ON CERVICAL 1/3 OF THE TOOTH WITH A MODIFIED BASS METHOD

● FOURTH VISIT

─ MEDICAL HISTORY, VITAL SIGNS, EOE CURSORY, IOE CURSORY, PLAQUE INDEX (25%) & HOME CARE

● REVIEWED BRUSHING TECHNIQUE ( PATIENT IS DOING GREAT )

─ DEBRIDEMENT ON THE LOWER LEFT QUADRANT WITH MAGNETOSTRICTIVE POWER INSERTS FOLLOWED BY HAND INSTRUMENTS

PROCEDURES

● FIFTH VISIT

─ MEDICAL HISTORY, VITAL SIGNS, EOE CURSORY, IOE CURSORY, PLAQUE INDEX (24%) & HOME CARE

● REVIEWED FLOSS TECHNIQUE – FLOSS WITH WAX FLOSS TO AVOID SNAPPING FLOSS DUE TO TIGHT CONTACTS

− RE- ASSES LOWER LEFT QUADRANT

─ DEBRIDEMENT ON THE UPPER LEFT QUADRANT USING MAGNETOSTRICTIVE POWER INSERTS FOLLOWED BY HAND INSTRUMENTS

● SIXTH VISIT

─ MEDICAL HISTORY, VITAL SIGNS, EOE CURSORY, IOE CURSORY , PLAQUE INDEX (9%) & HOME CARE

● REVIEWED FLOSS TECHNIQUE ( PATIENT IS DOING GREAT )

─ RE-ASSESS UPPER LEFT QUADRANT

─ DEBRIDEMENT ON THE UPPER RIGHT AND LOWER RIGHT QUADRANT WITH MAGNETOSTRICTIVE POWER INSERTS FOLLOWED BY HAND INSTRUMENTS

− MOTOR POLISHED

− FLUORIDE TREATMENT WITH 1.5% NAFL GEL, FOUR MINUTES

PROCEDURES

● SIXTH VISIT

REVIEWED MEDICAL HISTORY, VITAL SIGNS, EOE CURSORY, IOE CURSORY

− FMX

● RE-EVALUATION VISIT

PATIENT CANCELLED RE-EVALUATION VISIT DUE TO FAMILY EMERGENCY

SUMMARY

• THE CASE I CHOSE FOR MY PERIODONTAL CASE STUDY WAS VERY CHALLENGING FOR MANY REASONS. FIRST, THE PATIENT HAS GENERALIZED MODERATE ACTIVE PERIODONTITIS MODIFIED BY SMOKING. UNFORTUNATELY, AGGRESSIVE PERIODONTITIS IS DIFFICULT TO TREAT, AND INSTRUMENTATION USUALLY HAS NO EFFECT ON CURRENT SMOKERS. ADDITIONALLY, THEY USUALLY HAVE SLOW WOUND HEALING. SECOND, THIS PATIENT HAD DEEP TENACIOUS CALCULUS ON EVERY SINGLE TOOTH, AND I DID NOT FEEL AT THIS TIME IN MY DENTAL HYGIENE EDUCATION, THAT I COULD EFFECTIVELY TREAT THIS PATIENT DUE TO LACK OF EXPERIENCE IN THIS FIELD. NONETHELESS, I DID MY BEST ON THIS PATIENT. I STARTED BY USING THE MAGNETOSTRICTIVE POWER INSERTS FOLLOWED BY HAND INSTRUMENTS. I EXPLORED ALL AREAS AFTER DEBRIDING AND DID NOT DETECT ANY CALCULUS. THE PATIENT WAS SCHEDULED FOR A RE-EVALUATION FOUR WEEKS AFTER TREATMENT BUT UNFORTUNATELY CANCELLED DUE TO A FAMILY EMERGENCY. THIS PATIENT IS ON A THREE MONTH RECALL, AND THEN I WILL SEE HOW WELL I DID, AND HOW WELL THE PATIENT RESPONDED TO TREATMENT. UPON REFLECTION, I VALUE THE LEARNING EXPERIENCE AND I LOOK FORWARD TO TREATING THIS PATIENT IN THE FUTURE.