Periodontal Case

Study
Leslie Bebber
Fall 2009
PATIEN Jenny Gingivitis CURRENT MEDICATIONS
T: CURRENT MEDICATIONS
Age: 22
Gender: Female
Height: 5ft 10in
Weight: 175 SUMMARY OF MEDICAL
Vital HR: 64 HISTORY
Signs: Respiratory rate: 14 SUMMARY OF MEDICAL
Blood Pressure: 124/86 HISTORY
Temperature: 98.6

Chief
complaintBad breath and gums
bleed when she brushes
SOCIAL HISTORY AND DENTAL HISTORY
STORY
DENTAL HISTORY
SOCIAL HISTORY AND
STORY

ADDITIONAL
INFORMATION
ADDITIONAL
INFORMATION
PSYCHOSOCIAL ASSESSMENT
PSYCHOSOCIAL ASSESSMENT
 Psychosocial Cont
Coping Strategies:Patient states that she usually deals with
stress by exercising but has not found the time to do so in
the past 6 months

Appears to have a weak self-efficacy

Support: Patient states that she has a large family and

many friends that she relies on for support, however with the
move she has not had them there for support.

Obstacles: Work, school, distance from family

Radiographs
INTRAORAL
PICTURES
DENTAL CHARTING
EXTRA/INTRA ORAL EXAM
Extra/Intra Oral Exam Cont.
 Initial Gingival Description
● Marginal: red, edematous, rounded rolled (generalized)
● Papillae: red, bulbous (generalized)
● Attached: firmly bound down
● Consistency: soft, smooth and shiny
● Attachment is at the CEJ
● Generalized BOP
Note:Changes due to capillary proliferation, T & B
lymphocytes occuring in equal numbers, collagen
destruction, junctional epithelium thickens, rete pegs
extend into connective tissue
PLAQUE CONTROL RECORD

 96% upon 1stvisit

 68% upon 2nd visit 3 months later

 Goal is 15% next visit

 Patient is practicing better home care,
however stressful conditions still exist.
Improvement needed in the interproximal
areas of all quads.
PERIODONTAL
CHARTING
Periodontal Charting Mandibular
 Summary of Perio Charting
 Patient exhibited generalized bleeding
 No attachment loss
 Pockets of 4 and 5mm due to tissue
inflammation
 Positive FGM readings due to tissue
inflammation
CURRENT ORAL HYGIENE
 Summary of Patient's Current Oral Hygiene
Regimen

 Brushes once a day (am)

 Scope at night
 Often uses Scope in replace of brushing
 No interproximal device used
 Soft, manual brush
 Aquafresh toothpaste (whatever is on sale)
DIAGNOSIS TREATMENT PLAN
DIAGNOSIS TREATMENT PLAN

PROGNOSIS
PROGNOSIS
DATE TREATMENT RECORD
Comprehensive exam
Prophy
Polish, floss and fluoride
7/15/09
Comprehensive exam
Prophy
10/17/09 Polish, floss and fluoride

Patient's next appointment is scheduled for this date

3/18/09
 Other Treatment Information
 Patient was treatment planned for fluoride due to the high
potential of caries with her current status (she currently does
not exhibit any signs of caries)
 A 3 month recall was done to ensure patient was on the right
track and that the condition had improved
 At the 3 month recall there was great improvement in plaque
control but more improvement is needed. It was determined
that the patient could be put on a 4 to 5 month recall
 BOP was greatly reduced
 Plaque score went from 98 to 68
 OHI Instructions
 Sonic Care Toothbrush
 Waxed floss
 Recommended interproximal brushes and floss pics that patient
could use on the go due to her busy schedule
 Listerine 2x daily, 30sec prior to brushing
 Brush with PreviDent 5000+, spit well, do not
rinse, prior to bed time (patient does not exhibit caries at
this time, however this is a new condition due to patient's current
condition...thus the use of PreviDent for a prevenative measure)
 Post Treatment Results
● BOP reduced to less than 30%
● Plaque score reduced 30% (reinforced proper
home care)
● Probe depths reduced to 3mm with only three
sites of 4mm
● Marginal gingiva was still red in the lower
anteriors but little to no edematous tissue,
stippling and resilience has returned
● Goal: Plaque score of 15 to 20% at next visit
 Questions
Pocket formation associated with plaque-induced gingivitis may be
attributed to all of the following EXCEPT: (p.107)
a. edema
b. hypertrophy
c. migration of the PDL
d. deepened penetration of the periodontal probe

True or False
The bacteria associated with plaque-induced gingivitis are predominantly
gram-negative bacteria. (p.107)
 Questions Cont
Plaque induced gingivitis may be modified by local and systemic
factors. Alll of the following may be contributing factors
EXCEPT:
a. crowded teeth
b. circulating corticosteroids
c. changes in the endocrine system
d. NSAIDS

True or False
Bacteroides species will increase in the subgingival plaque as the female
hormones increase.
 One Final Question

True or False
The most common form of gingivitis is plaque-induced.
 References
Perry, A Dorothy and Phyllis L. Beesterboer. Perio for
Dental Hygienist. St Louis, Missouri, 2007.
Southern, N Elizabeth, Gayle B McCombs, S Lynn Tolle and Ken
Marinak. “The Comparative Effects of 0.12% Chlorhexidine and
Herbal Rinse on Dental Plaque-Induced Gingivitis.” Journal of
Dental Hygiene 80 (January 2006): 1-10.
Trombelli L, Scapoli C, Tatakis DN, Grassi L. “Modulation of Clinical
Expression of Plaque-Induced Gingivitis: Effects of Personality
Traits, Social Support and Stress.” Journal of Clinical
Periodontology 32 (2005): 1143-1150.

Slattery, J. M. “Psychosocial History.” Conseling Diverse Clients. 2004.

http://psy1.clarion.edu/jms/intpsychosoc.htm