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Nutritional Counseling

-more fruits and dairy

OHI

Recognition of

-tooth decay

-oral cancer

-gum disease

*Bass Method Brushing

*C-shape flossing

*Electric toothbrush

*Mouthrinse daily

The patient tolerated all of the treatment very well. He reported at his 30 day re-evaluation appointment that he could tell a big difference in the bleeding and soreness of his gums. He had began flossing daily and using mouthrinse daily as well as changing his diet some. He still has some pocketing but over all the condition of his mouth improved vastly.

As a dental hygienist, I learned that the tissue may look healthy from the outside (because of his chronic condition) but that further investigation can enlighten you more on what is really happening in someones oral cavity. Spending a few extra minutes educating your patient can go a long way.

Treatment Plan

OBJECTIVES:

1. Reduce gingival inflammation

2. Preserve tooth attachment level

3. Maintain alveolar bone

4. Maintain the dentition throughout the life of the pt.

Appt 1: assessments

Appt 2: petechiae on lower lip resolved, nutritional counseling, CPD quadrant 1

Nutritional Counseling

  • Hand scaled quadrant 1
  • Removed moderate subgingival calculus and soft debris
  • Moderate-heavy generalized bleeding

-Patient filled out 7 day diet plan

-Showed pt. diet deficiencies

-Explained importance of the food groups.

-2 goals set:

1. Eat more fruit

2. Eat more dairy

Re-evaluation:

Pt. showed improvement in consumption

of fruit and dairy products

Appt 3: CPD quadrant 2-4, Arestin placement

  • Hand scaled quadrant 2-4
  • Removed moderate-heavy subgingival posterior calculus, moderate anterior calculus, and soft debris
  • Light-moderate bleeding
  • Arestin placement in DL pockets of #28 and 29 (6mm). Gave post-op instructions of no brushing/flossing for 12 hrs, no crunchy foods for 10 days.

Appt 4: 30 day re-evaluation, fine scale all quads, oral irrigation, polish, floss, fluoride, post op photos

Gingival Exam After

Calculus Detection After

Papillary Tissue

Generalized pink, pyramidal, firm, stippled with blunting in sextant 1 and 3

Marginal Tissue

--Fine scaled all quads and removed light plaque and localized cliques of calculus.

--Very light bleeding

--Used .5 mL of chlorhexidine to sub-oral irrigate in localized areas of pocketing

--Nutrition improved: pt. had increased the intake of fruits and dairy in his diet

--Polished and flossed entire dentition

--Applied 5% NaF varnish

Generalized pink, knife-edged, firm, stippled

Attached Tissue

Generalized pink, adequate, firm, stippled

DOD I

  • Pocket depths range from 2-5 mm
  • Some pocket depths decreased
  • Other areas stayed the same
  • #28 DL- decreased 2mm (Arestin)
  • #29 DL- decreased 1mm (Arestin)
  • PHP- .6 GOOD

Papillary Tissue

Calculus Detection

Generalized pink, pyramidal, firm, scalloped, and stippled with localized blunting in sextants 1 and 3

Marginal Tissues

Angular bone loss #19,20,30 mesial

Generalized moderate horizontal bone loss

Loss of lamina dura #23,24,25

Generalized widening of the PDL

Retained root #32

Pulp stone #2, 15

Dilaceration #13,30

Generalized pink to red, slight rolling, soft, spongy, and smooth with localized ulcerating on the facial of #22, localized marginal redness on the lingual of #15, and localized knife edge firm, and stippled margins on the facial of sextant 2

  • Class I malocclusion on all molars and canines
  • 2 mm midline shift to the left
  • slight overbite
  • 3 mm overjet

Initial Gingival Exam

Periodontal Status

Generalized subgingival calculus on posterior and anterior teeth.

DOD III

Class I Amalgam: 3,14,15,18,20,30,31 Class II Amalgam: 2,5,12

Class I Composite: 19 Class V Amalgam: 31

3rd molars extracted in 1983

Attached Tissues

Generalized pink, adequate, firm, and stippled

  • Probing depths range from 1-6 mm
  • class I furcation #14
  • Recession ranging from 0-5 mm
  • 5 mm F #27
  • CAL from 1-7 mm
  • O'Learys: 69%

Dental Chart

Anatomic

linguoversion #26

distoversion #24

mesioversion #23

Diagnosis:

Perio Case Type II Generalized moderate chronic periodontitis

Occlusal

Trauma

  • Attrition in sextants 2 and 5
  • generalized moderate to severe fluorosis
  • # 8 super-erupted
  • Linguoversion # 26
  • Mesioversion #23
  • Distoversion #24

none

LOCAL

ETIOLOGIC

FACTORS

Contribute to the overall status and extent of the Mr. Perry O.'s condition

Calculus

Iatrogenic

Medications the pt. is taking can cause candida and xerostomia.

generalized moderate subgingival calculus with localized supragingival calculus on mandibular lingual anteriors

Patient: Mr. Perry O.

Age: 50 yrs.

Race: Caucasian

Sex: M

Marital Status: Married

Extraoral Findings

~ generalized freckles

~ wears glasses

~ 3x3 mm round, raised, brown mole on left cheek

~ generalized facial hair

Medical History

ASA II

Oral Habits

Medical Conditions

Snacking

Tobacco/Alcohol

- Controlled hypertension

- Mild asthma

- Very rare in between meals snacking

- smoked in younger years

- 2 alcoholic beverages per month

Vitals

BP: 118/78

Pulse: 66

Respiration: 16

*Pt. visits physician every 6 months

Extraoral and Intraoral Findings

Medications

montelukast - 10 mg

Combivent Respimat

losartan - 50 mg

Classification:

bronchodilator

Classification:

angiotensin receptor blocker (ARB)

leukotriene receptor antagonist

Side Effects:

Side Effects:

  • cough
  • dry mouth
  • hypertension
  • candidiasis
  • headache
  • dizziness
  • sore throat
  • rhinitis
  • cough
  • persistent cough
  • dizziness
  • nasal congestion
  • when taken with NSAIDS, losartan can cause kidney failure or reduced effect of the drug

Intraoral Findings

Dental History

Last visit to dentist for cleaning was at least 25 years ago.

~ bilateral linea alba

~ slight palatal tori

~ skin tag on uvula

~ fordyce granules on labial commisures

Knowledge/Feelings

  • Somewhat anxious/afraid of dentist
  • Does NOT recognize oral cancer, tooth decay, or gum disease
  • Feels oral health is somewhat important

* coated tongue

* 1x1 mm petechiae on lower right lip

Complaints

  • sensitive teeth
  • bleeding gums
  • sore gums

Oral Self Care

  • soft toothbrush
  • fluoride/multiple benefit toothpaste
  • brushes 2-3 min/ 1 time a day
  • no flossing

Dental Hygiene Case Study

Taylor Johnson

Northeast Texas Community College

Dental Hygiene Practicum

March 24, 2014

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