Periodontal case study project Dental Hygiene Clinical Practice II Shannon Kelleher

Patient profile Health history reveals: Dental history reveals: 59 year old Caucasian male Health history reveals: Job related stress High blood pressure controlled with medication Vitals WNL ASA Class II Dental history reveals: Brushes with electric toothbrush 1x daily Flosses occasionally Clenches 3 month recall

Extra oral & Intra oral findings Bilateral linea alba Sl pronounced rugae Sl scalloped & coated tongue Sl maxillary right resorption of alveolar ridge Moderate generalized attrition 20% overbite 4mm over jet Torso version #8,9,10,21,23,28 & 29 Linguoversion version #4,5 & 12 Labioversion #6,10,11,21,23 & 25 Angles Class I molar & canine left Angles Class I tend to II canine right Maxillary frena tag Amalgam stain #12 & 27 Abfraction #4,6,11,27,27 & 28

Intra oral photos

Dental chart

Periodontal charting

Periodontal evaluation

Assessment findings Class I furcations on the buccal aspect of #18 & 31 Class I furcations on the lingual aspect of #2,17,18 & 30 Class II furcations on the buccal aspect of #2,14,15 & 17 No mobility Mucogingival involvement #17 Sl BOP #13,14,15,17 & 23 Generalized spicules of subgingival calculus Sl localized spicules of supragingival calculus on mandibular anteriors Generalized moderate interproximal biofilm Biofilm index 52%

Gingival description Generalized slight cyanotic, recessed, rounded, firm stippled tissue with localized bleeding on probing.

Contributory factors Calculus Faulty restorations Root morphology Root resorption Mouth breathing Food impaction Malocclusion Occlusal discrepancies Un-replaced teeth Clenching

Periodontal risk factors Stress Nutritional deficiencies Obesity

radiographs See hard copy (scanner not working)

Periodontal diagnosis Generalized moderate inactive chronic periodontitis with localized severe inactive chronic periodontitis on teeth #2,5,18,21,29 & 31 with localized severe active chronic periodontitis on teeth #14,15, & 17 AAP IV

Treatment plan

Procedures First & second visit completed assessments Third visit Medical history, EOE, IOE, vital signs Biofilm index & homecare Review electric TB technique, floss technique & how to use proxi-brush Debridement on UR with cavitron slim insert & hand instrumentation Fourth visit Biofilm index Reinforce good job done at home & improved biofilm index Re-assess UR Debridement of LR with cavitron slim insert & hand instrumentation

procedures Fifth visit Medical history, IOE, EOE, vital signs Biofilm index Still doing a great job with homecare Re-assess UR & LR Debridement of UL with cavitron slim insert & hand instrumentation Sixth visit slightly more interproximal biofilm reinforced importance of flossing & technique Re-assess UR, LR & UL Debridement of LL with cavitron slim insert & hand instrumentation Selective motor polishing of mandibular anteriors Fluoride treatment with NaFl gel trays

summary Although this case had many challenges I learned a lot from it. There were many things from text books and class that I got to see first hand with this patient. He had furcations, mucogingival involvement and extensive restorations among other issues. I was proud of myself for doing as well as I did with this case with the little experience that I had. There were a few areas around furcations that I had left some tenacious calculus but I don’t feel as though I had the experience level to remove it and in the future I expect to learn techniques to deal with that type of situation. I would love to have this patient in for a follow up to see how his condition progresses now that I have a base line. Being able to see if removing calculus or the homecare education made a difference in the patient would be a valuable experience. I look forward to implementing the things I learned with this patient in the future.