DH 222 MALUHIA FARR JUNE 8, 2015 Case Study Presentation

The Patient Female Caucasion 37 years old Mother of four Full-time college student Seeking hygiene and restorative treatment Very self-conscious and embarrassed about her smile Friendly and motivated to achieve a state of oral health

Patient Selection Criteria Case Type IV 27 teeth present Evaluated as 3 sub, later adjusted to 4 sub I felt that her condition could be stabilized and improved through NSPT treatment

Pre-Treatment Assessment ASA: II Vitals: BP 122/88, Pulse 67, Resp. 14 2/13/15 Last exam, cleaning, and radiographs were 9 years ago. I: none S: none M: multi-vitamin & Wellbutrin for tx of depression & anxiety A: latex allergy E: Idiopathic Thrombocytopenia (ITP) blood disorder, needs to avoid blood thinners. Migraines 2-3 times/month. Quit smoking 5 months ago, smoked a pack/day for 23 years. Depression and anxiety. D: Brushes 2-3x/day with fl toothpaste, gums bleed, pain in UR posterior teeth due to “infx”, stopped drinking soda 3 yrs. ago, difficult to keep daily oral hygiene routine “sometimes depending on intense scheduling or mental status”. Has neglected her own treatment over the years.

IO/EO findings: NSF Dental charting: Restorative recommendations include root canals, crowns, amalgam and composite restorations, and one extraction.

Periodontal Assessment Generalized probe readings of 4mm and greater. Deepest pocket, 10mm. Loc 1-3 mm recession. Class I & II furcations. Generalized sl BOP. Localized mobility. Microscope: Risk Category C

Full Mouth Series F Findings: Extensive decay and generalized moderate to severe bone loss.

Study Models

Dental Hygiene Diagnosis Periodontal Case Type: IV Calculus Deposit: 4 sub Gingival Description: Generalized severe hyperemic Generalized severe enlarged with localized slight recession Generalized severe edematous

Risk Assessment Systemic and Behavior Risk Factors irregular dental care xerostomia-causing medication depression and anxiety Caries Risk Factors Several large, visible carious lesions Recently restored caries Sweetened coffee daily, fruit and yogurt smoothies daily Xerostomia-causing medication Periodontal Risk Factors Generalized moderate sub-gingival and IP plaque Generalized heavy calculus Generalized slight BOP Clinical attachment loss

Client Centered Goals To feel good about her smile. To get restorative work done. To get teeth cleaned. Interventions Provide hygiene treatment (NSPT) Treatment plan for & begin restorative treatment Expected Outcomes Improved tissue statements Resolution of pain Improved aesthetic appearance of smile

Treatment Plan & Rationale Appt #1: FMS & OHI (plus IO photos & impressions) Appt #2: OHI, Comprehensive oral evaluation, perio-scale UR with local anesthesia. Appt #3: OHI, perio-scale UL with local anesthesia. Appt #4: OHI, perio-scale LR with local anesthesia. Appt #5: OHI, perio-scale LL with local anesthesia, apply fluoride varnish. Originally treatment planned for 5 appointments because I knew her deposit level was high and because she expressed concerns over finding child care, so anticipated that we might have some shortened appointments. Adjustment to treatment plan, completed tx during 4 th appointment. Completed NSPT treatment on April 14, 2015

Treatment Progress Notes Notes were taken at each appointment regarding areas previously treated. In general, areas treated went from severe to moderate hyperemic, enlarged, and edematous. Appointments were spaced fairly close together so there was no calculus and decreased levels of plaque found in previously treated areas.

Oral Hygiene Instruction Appt #1: Show-tell-do sulcular brushing. Recommended xylitol gum and advised on its use. Appt #2: Doing well with brushing, show-tell-do perio- aid, and prescribed Phos-flur sodium fluoride mouth rinse for protection against further decay. Appt #3: Has been brushing well and using prescribed mouth rinse. Has not been using perio-aid, said that she misplaced it. Stress the importance of and reviewed its use, gave her a new one. Also discussed minimizing sugars and fermentable carbohydrate frequency. Appt #4: Has been using sulcular brushing technique, perio-aid, and mouth rinse as advised. Plaque levels have gone from moderate to very slight in IP areas.

Motivation Strategies Intrinsic motivating factors: Pain & aesthetics Extrinsic motivating factors: New knowledge regarding her periodontal condition. Patient was very motivated to make a change.

Continuing Care Appointment June 2, 2015 Case Type: IV Deposit: Microscope: Risk Category B OHI: Doing well with previous recommendations, however stopped use of mouth rinse because she said it was irritating one of her teeth.

Tissue Statements: Generalized moderate, enlarged, and edematous.

Treatment Plan OHI Intraoral Photos Periodontal Maintenance Fluoride Varnish Ended up placing Arestin in four areas where there were deep pocketing and tissue was not responding as desired to treatment.

Patient Motivation Patient expressed that she can tell a positive difference in how her teeth and tissue feel. She has set finances aside to continue the completion of her restorative treatment and has committed to 3- 4 month recall appointments. She remains highly motivated.

Comparison Inititial Assessments: 113 areas with 4mm or greater probe readings. 82 areas of BOP. Continuing Care Assessments: 103 areas with 4mm or Greater probe readings. 48 areas of BOP.

Restorative Before restorative of #7 & 10 After I completed a number of maxillary and mandibular facial composite restorations on my patient. Here is one before and after.

Reflection I had hoped for more change in appearance of my patient’s gingival tissue. I do think that she is moving toward stability. I was happy that I could not only provide her with hygiene treatment, but also with restorative treatment. I believe that my patient could benefit from curettage, I regret not providing this treatment for her.