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Case Study

Presentation
BY CHELSEA LITTON

Patient Qualifications
Patient presented with:

Deposit: 1.5 supra and 3 sub

Periodontal Case type II; slight periodontitis


With

localized periodontal case type III

NSPT Dates/ Health History


Summary

Patient began NSPT on 10/19/2015 and completed NSPT on


1/11/2016

The patient presented with no infectious or systemic conditions.

Existing conditions: the patient has smoked for 20 years at roughly


half a pack (10 cigarettes) per day.

Dental History: the patient reported brushing once daily

with fluoride toothpaste but not using any interproximal


cleaning aids.

Medications

The patient was taking Lisinopril for Hypertension and Wellbutrin for
smoking cessation.

Lisinopril

Pharm Category: ACE Inhibitor

Use: Hypertension

Considerations/Contraindcations: Xerostomia, taste disorder, monitor vital


signs.

Wellbutrin

Pharm Category: Antidepressane

Use: Anti-smoking

Considerations/Contraindications: vasoconstrictors to be used with caution,


possible xerostomia.

Vital Signs for NSPT and Re-Care


Appointment

10/19/2015:

BP: 142/74 HR: 86

11/2/015:

BP: 139/86 HR: 102

11/23/2015:

BP: 127/79 HR: 88

11/30/2015:

BP: 124/90 HR: 73

1/11/2016:

BP: 121/75 HR:96

Recare:

3/28/2016:

BP: 130/69

HR: 95

Intra-Oral, Extra-Oral and Perio


Findings

Intra/extra Oral: Within Normal Limits

Periodontal Chart:

Generalized 3-4mm pcckets with localized with Localized 5mm on #15


and #31.

Generalized 1-2 mm recession, generalized class I furcations, and no


mobility

CAL: Generalized 1-2mm with localized 3-4mm on molars.

Perio Chart on 10/19/2015


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Perio Chart on 3/28/16


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Perio-chart Comparison:

When comparing the two periodontal charts: pocket depths showed improvement and
all both 5mm pockets were reduced by at least 1mm.

Dental Chart:

Patient has had


#4,13,16, 17, 20, 29,
and 32 extracted.
Patient still has #1
but it is only partially
erupted.
The Doctor had no
restorative
recommendations
for this patient.

Microscopic Risk Factor

At the first appointment, the patients


microscopic Risk Factor was Class C- High Risk.
His slide included TNC gliding rods, spinning
rods, large spirochetes, and moderate
mobility.

At the patients re-care appointment we took


another microscope sample. Patient showed
improvement by slide showing Class B- At Risk.
With only ten per field of view of spinning rods
and gliding rods.

Radiographs: Panoramic Image

Radiographs: FMS

Radiographs: FMS continued

Radiographs: FMS Continued


Radiographs were taken on September
16, 2015 for a dental exam at LCC dental
clinic.
Radiographs showed Generalized slight
horizontal bone loss which contributed to
periodontal case type II
All findings on radiographs were WNL.

Study Model

Study Model Continued


The study model was shown to
the patient to emphasis areas of
gingival enlargement and
recession.
The quality of the study model
was good, patient tolerated
taking the impression well, and
pour-up went smoothly.

Periodontal Exam
Initial Appointment:

Color: Gen. Moderate Hyperemia

Contour: Gen. Moderate Enlarged, with gen. slight recession.

Consistency/Texture: Gen. Moderate Edematous

Bleeding on Probing: Generalized slight spontaneous

Re-care Appointment:

There was only slight changes in tissue: the moderate hyperemia


went from moderate to slight, and the maxillary edematous tissue
was more fibrotic upon the re-care appointment.

Dental Hygiene Diagnosis

Periodontal Case type: Generalized slight periodontitis with localized


moderate periodontitis in maxillary and mandibular molars(with no
change in diagnosis at re-care appointment)

Calculus Deposit: 1.5/3 at initial appointment. 1.5/1.5 at recare


appointment.

Statement of Inflammation: Generalized moderate marginal and


papillary inflammation, with slight decrease upon re-care
appointment.

Risk Assessment:

High Risk: Tobacco use

Moderate Risk: Root exposure (generalized slight recession), calculus


deposit (1.5/3), dental plaque biofilm.

Low Risk: Xerostomia (patient didnt complain of but possibility with


medications), visible plaque biofilm (generalized slight), and
bleeding on probing (gen. slight).

I explained to the patient that his greatest risk factor for periodontal
disease is his daily tobacco use.

Goals, Interventions, and Expected


Outcomes:

Patient Goals: brush twice a day and floss, remove stains, quit
smoking, remove infection and halt bone loss.

Interventions: Oral Homecare Instruction, NSPT, Selective Coronal


Polish, Fluoride Varnish, Tobacco Cessation Counseling.

Expected Outcomes: Reduce Inflammation, Reduce deep pocket


depths by at least 1mm, stop or reduce tobacco use, and halt bone
loss.

Treatment Plan and Rationale


The treatment plan consisted of:
Comprehensive Exam with Dentist
Periodontal Scaling by Quadrant
of UL,LL,UR, and LR quadrants.
Oral Hygiene instruction at each
appointment.
Local Anesthesia in all quadrants
Topical Fluoride Varnish
Reevaluation/continuing care
appointment.
The patient had to leave early on
two occasions, so it took more
appointments than expected.
Patient approved of fluoride
varnish and was interested at OHI
at each visit.

Chart Note 10/19/2016

Chart Note: 11/2/2015

Chart note: 11/23/16

Chart Note: 11/30/2016

Chart Note: 1/11/2016

Chart Note: 3/28/2016

Oral Hygiene Instructions/


Modifications:
At First appointment (10/19/15): OHI consisted of sulcular brushing
(emphasis on brushing twice a day instead of once), C-shaped Flossing,
and gum stimulator.
11/2/15 and 11/23/15 Appointments: Patient was not very compliant,
he reported still only brushing once a day, but he tried the gum
stimulator a couple of times.
11/30/16: Patients compliance increased a little. He reported brushing
1-2 times per day, using mouthwash once a day, and utilizing his gum
stimulator a few times per week. At this appointment the patient
mentioned liking floss picks and I recommended him to try to start using
those for interproximal cleaning.
1/11/16 Re-care Appointment: Patient reported brushing still 1-2 times a
day, and flossing sometimes. I encouraged continuing to use his floss
picks and twice a day. The patient was also shown how to use an endtuft brush to help clean his partially erupted third molar.

Motivation Strategies

Extrinsic Motivation:

This patient was very motivated by his children. He told me that he


brushed his 4 year old and 6 year old kids teeth and he would always
brush his kids teeth twice a day. I explained to him that it was important
for him to brush twice a day so he could be a good role model for his
children and help them make that part of their daily routine.

The microscope sample showing the high counts of spirochetes,


spinning rods, and gliding rods he seemed very concerned by this and
was than really wanting to learn how to rid of the bacterial infection.

Intrinsic Motivation:

The patient didnt like the generalized moderate staining he had on his
teeth, this motivated him to brush more often and try to quit smoking to
reduce staining.

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