Case Study Presentation Jesika knitter

Meet Robert: Born 12-5-65 Eugene Native Has 2 sons His best friend is Daphie (his chihuahua)

Rationale Patient has severe periodontitis Chronic and acute infection and inflammation Patient is motivated but unaware of the severity of his condition NSPT (UR quad) started at previous dental office 2 months prior to LCC evaluation. Patient already equivalent amount of calculus compared to the other quads.

Health History Suffers from seizures Severe anxiety Smokes half a pack of cigarettes a day Has had 3 teeth extracted Takes Lexapro, Norco, Xanax, and, Cyclobenzaprine. Vitals are within normal limits

Assessments IO/EO: nicotinic stomatitis, fistula #30 Microscope: risk factor C, moderately mobile 10-100 spinning and gliding rods and spirochetes. Perio chart revealed generalized 4-6 mm pockets, localized 7+mm. Localized class I and II furcations Generalized moderate bleeding when probing Radiographically: generalized moderate horizontal bone loss, localized moderate to severe vertical bone loss. Restorative recommendations: #7 build-up and crown, #15 severe decay – may need Root Canal Therapy, #31 extract due severe decay

Assessments Periodontal Chart 1-30-15 Radiographs Taken 11/2014

Study Models

Initial Appointment Intraoral Pictures

Dental Hygiene Diagnosis Case type: Generalized moderate periodontitis; III Localized severe periodontitis; IV Deposit: 2.5/3.5 Tissue statement: Generalized moderate, papillary and marginal inflammation

Risk Assessment Periodontal risk factors: moderate subgingival plaque, moderate to heavy calculus, bleeding, moderate CAL Caries risk factors: radiographic caries, recession, moderate supragingival plaque, xerostomia, moderate sugar intake Goals: healthier mouth Interventions: sulcular brushing, “C” shaped flossing, soft picks Expected outcome: daily removal of plaque biofilm will decrease bacterial load and reduce inflammation.

Treatment Plan 1st appt: D1330 OHI D0150 Comprehensive Oral Exam 2nd appt: D4341 Scaling and Root Planing UR D4341 Scaling and Root Planing UL D4341 Scaling and Root Planing LR D9215 Local Anesthesia 3rd appt: D4341 Scaling and Root Planing LL D1206 Fluoride Varnish 4th appt: D4999 Re-evaluation

1st Appointment 1-30-15 Health history review Periodontal assessments Comprehensive oral exam Treatment plan – Discussed NSPT Home care instructions Demonstrated sulcular brushing, “C” shaped flossing, soft picks posterior interproximal. Patient brushes a couple times a week and does not use any interproximal aids or mouthwash.

2nd Appointment 2-5-15 Updated health history Evaluated homecare Compliance: somewhat compliant, brushed 4 times during the past week, did not use floss or soft picks. Modifications: Demo’ed sulcular brushing with light pen grasp, reiterated the importance of daily plaque removal with interproximal aids. Performed NSPT UR, UL, LR

3rd Appointment 2-3-15 Updated health history Evaluated homecare Compliance: Brushed daily since last visit, rinsed with hydrogen peroxide and water at night, Robert has been leaving toothpaste in his mouth without rinsing. Modifications: lighter grasp with toothbrush, introduced rinse with a fluoride mouthwash at the end of the night, patient likes to snack and drink chocolate milk. Completed NSPT LL

Motivation Patient was motivated from the beginning of treatment. Robert demonstrated a slow increase in homecare compliance. Once NSPT was initiated his motivation increased a lot. He said he could feel his gums and mouth becoming healthier and wanted to do his part in restoring a cleaner mouth. Even though Robert does not have running water in his trailer he made a strong effort to brush every day. He likes mouthwash for this reason and he was very compliant with rinsing daily.

Continuing Care 4-28-15 Periodontal case type: Generalized moderate periodontitis, localized severe periodontitis Calculus deposit: 2/2 Periodontal Chart: generalized 4-6mm pockets but showed improvement, one localized 7mm pocket. Microscope: risk factor B, less mobility and fewer spinning and gliding rods. OHI Compliance: Brushes consistently 5 times a week, rinses with Spryy mouthrinse daily, uses soft picks a couple times a week. OHI Modifications: Dispensed listerine to reduce bacterial load and inflammation. Gave patient an electric toothbrush to increase motivation and compliance. Robert was very happy to receive the brush.

Cont. Continuing Care Tissue statement: generalized moderate marginal and papillary inflammation. Treatment plan: 3-4 month recall periodontal maintenance Patient motivation: Robert was motivated to keep his mouth “feeling clean” after the initial NSPT. He has increased his homecare regiment and plans to maintain oral health by visiting LCC every 3-4 months for periodontal maintenance. Expected outcomes: Robert’s periodontal condition will be stabilized and no further CAL will be reported if he continues to remove bacteria daily and comply with periodontal maintenance appointments. Unfortunately, his smoking habit will hinder expected outcomes.

Comparison of NSPT and Continuing Care Initial 2.5/3.5 III/IV 57 104 Moderate Recare 2/2 III/IV 39 4 Moderate Calculus deposit…………………………………………… Perio case type……………………………………………. # of probing depths above 3mm……………….……. Bleeding points at initial appt…………………………… Degree of inflammation………………………………….

Recare Intraoral Photos