periodontal case study project

DENTAL HYGIENE CLINIC I ICASSANDRA LIGOR

Periodontal Case Study Project

Health History : Dental History

45 year old Caucasian female.

Non – contributory health history

Job related stressNo contraindications to TXASA IVital signs WNLNo dental anxiety Routine 6 month re-care

Brushes with soft tooth brush 2xd

Flosses 1xdUses night guardGrinds teeth

Patient Profile

EXTRA ORAL AND INTRA ORAL FINDINGS

Bilateral linea alba on the buccal mucosa

Slight tori on the palate Petichiae on the orifice of the right

tonsil Slight scalloped tongue and a short

lingual frena. Attrition on teeth 22-27. 8 and 9 had

chips on the incisal edge Class I occlusion. 70 % overbite and 3mm over jet Caries risk factors is moderate due

to previous restorations and eats candy.

No oral cancer risks patient never smoked.

Oral habits are grinding at night and patient wears a night guard

Intra Oral Photos

Intra Oral Photos

Intra Oral Photos

Intra Oral Photos

Intra Oral Photos

Intra Oral Photos

Dental Chart

Perio Chart

Assessment findings

BOP on 4, 30 , and 31Plaque index was 16% on initial visitSupragingival calculus on 2,3,14,15,23-26Subgingival on 2,3,13,14,15,29,27-23,18 and

18Soft deposit on buccal and lingual of

maxillary and mandibular premolars and molars.

4,5,12,13,18 faulty restorationsCarious lesion on 3,18 and 19Localized recession on buccal of 19, 20 and

21

Gingival Description

Generalized pink, normal, knifelike margins, stippled tissue, with localized recession on teeth number 19, 20 and 21.

Risk factors Contributory factors

Stress- work relatedHormones

Faulty restorations Position of

teeth/malocclusion Occlusal

discrepancies Parafunctional

habits-grinding clenching

Calculus

Factors

Radiographs

Radiographs

Radiographs

Slight/moderate horizontal bone loss on teeth number 4, 5 and 6. and slight/moderate horizontal bone loss on tooth number 31.

18 and 19 have slight/moderate vertical bone loss and there is slight triangulation throughout these x- rays.

Radiographs

Periodontal Diagnosis

Generalized slight inactive chronic periodontitis, with localized active chronic periodontitis on # 4,30,31

AAP II

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: moderate biofilm on facial related to selfcare, caries risk related to faulty restorations.

Goals Client Goals: client would like restorations checked

Treatment goals: reduce biofilm on molars and have dentist check restorations

Assessments (after initial assessments) Implementation Appt. 1

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

Radiographs Additional diagnostics

Time needed Disease Prevention/Health Education Implementation

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

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

Time needed 25 min Procedures Implementation

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

Review health history, oral exam, Indices X X Re-assess previously treated areas X Anesthesia (Type: Drug & delivery method) Power Driven Debridement /Area X X Hand Activated Debridement/Area Chemotherapeutic Procedures (type) Plaque Removal (method) X TB Fluoride treatment (Type of fluoride) X

sodium/trays

Desensitization Amalgam Polishing Athletic Mouth Protectors Study Models Sealants

Total Appointment Time 3 hours 3 hours Re-care Interval : recare visit Referrals needed: dentist to check restorations Oral Self-Care Current Oral Self-Care Methods: brush 2 times a day and floss 1 time a day Recommendations: Indicate recommendations below and include type method and frequency as necessary Brush Mod stil mans Dental floss/tape floss Oral rinse(s) Specialty Brush Floss threader/Aid Other: Interproximal device Fluoride product(s)

Treatment Plan

Procedures

First visit completed indices and assessments.

Second visit: review and update medical history and cursory exams. Biofilm index and reviewed self care and flossing techniques. Started debridement with power driven scaler.

Third visit: review and update medical history and cursory exams. Biofilm index improved by 5%. Debridement with the power driven scaler, toothbrush, and fluoride trays.

Summary

This patient was very compliant and visits the dentist regularly, so the calculus buildup wasn’t very severe. Scaling with the ultrasonic went very well although the patient experienced sensitivity on the upper left side, and lower right side. Most of the recession was on the left side of the mouth. Especially on the mandibular pre-molars.

Although this patient has normal healthy gingiva, the AAP case type is II due to the amount of recession present, which was why the CAL’s were between 2 -3. After reviewing the x-rays there is not a lot of bone loss present, only slight on a few teeth, horizontal and vertical. This patient has taught me how important it is to look at the details when determining the case type and periodontal diagnosis.

This was my first patient and I realize how the perio chart could use adjusting. For example the Gm’s on the posterior are 0 and since the papillae are not blunted it should be plus 1 or even 2. the dental chart also needs to be changed, with some of the watches on the restorations. This project really helped me to evaluate my work and see how much I have improved in perio and other dental hygiene services.