Periodontal Disease

Patient Profile Patient is a 68 year old male Health History  Presents with High Blood pressure  Medications: allertec and ¼ grain aspirin, multivitamin  Congenital heart defect, no per-medication required  Allergies to dust, mold, feathers, ragweed and gluten  History of arthritis  Allergy to Penicillin=causes rash Dental History Last dental visit was in January 2014 Orthodontics 55 years ago Extracted wisdom teeth 50 years ago Occasional canker sores Electric toothbrush once a day Flosses once a day ASA III

Extra and Intra Oral Exam Findings HEAD, NECK: 4 mm round brown mole behind left ear. LIPS: fordyce granules. MUCOSA: linea alba. varicosities in the corner of the mouth. PALATE: high vaulted palate FAUCES (TONSILS, PHARYNX): Fauces red. pt states it is due to post nasal drip. tonsils absent. TONGUE:coated

Dental Exam Findings Intrinsic stain: amalgam #14 Attrition: generalized slight attrition on anterior Abrasion: generalized abrasion Calcification: tooth #7 around a restoration Overbite: coronal 1/3 slight Over jet: 4 mm Labio/linguoversion: mild labioversion #21 & 25. Mild linguoversion #22 & 27. Crowding of all anteriors Occlusion: Molar right: Class I Molar Left: Class I Canine right: class I Canine left → Class II Caries risk factors: previous restorations Oral Habits: bruxism

Intra Oral Photographs

Intraoral Photographs

Dental Chart

Periodontal Chart

Periodontal Evaluation

Assessment Findings Class I furcation tooth #31 Mucogingival involvement: #12, 20, 21, 22, 23, 25, 26, 27, 29 Bleeding on probing: #2, 4, 5, 12, 21, 23 & 27 Periodontal risk factors: stress Periodontal contributory factors: calculus, faulty restorations, food impaction, position of teeth/malocclusion, and history of orthodontics Biofilm index: 56% Soft deposit generalized slight on the cervical 1/3 Extrinsic stain generalized moderate pits, fissures, and linguals of mandible Generalized ledges of supra and subgingival calculus

Gingival Description Maxilla is generalized pink, spongy, rounded, slightly edematous margins with localized redness #3, 8 & 12 with localized stippled, fibrotic with overlying edematous tissue on the anteriors. Mandible is generalized marginal redness, rolled, shiny, spongy, edematous tissue with McCall's Festoons on #4, 5, 21 & 28.

Radiographs

Radiographic findings #31 & 18 20% bone loss. Films are dark and hard to read. Date of radiographs 4/10/12

Periodontal Diagnosis Generalized moderate active chronic periodontitis AAP Case Type: III

Treatment Plan

Procedures First visit:  Reviewed and updated medical history  Sent medical consult regarding high blood pressure  Performed extraoral exam and intraoral exam.  Started Dental chart Second visit: Reviewed medical history Cursory Extra/intraoral exam. Finished dental charting Started periodontal charting

Procedures Third visit:  Medical history reviewed  Cursory Extra/intraoral exam  Continued to work on periodontal charting  Photos taken for periodontal project Fourth visit; Medical history reviewed Cursory Extra/intraoral exam Finished periodontal charting Received FMX from 4/12

Procedures Fifth visit:  Medical history reviewed  Cursory Extra/intraoral exam  Finished periodontal assessment  Performed deposit assessment  Bio film index 56%  Completed treatment plan  Debridment: started power driven maxillary right  Bio film removal: tooth brush method & interproximal brush

Procedures Sixth visit:  Medical history reviewed  Cursory EOE & IOE  Biofilm index: 50%  Debridment: hand instrumentation on maxillary right and anterior sextant  Other Dental Hygiene Services: Reviewed oral Home care Seventh visit: Medical History: reviewed Cursory EOE & IOE Debridment: power instumentation maxillary left sextant and mandible Soft deposit: tooth brush, selective polish and floss Applied 5% NaFl varnish DH report was given to patient

Summary It was difficult to assess this patient due to my inexperience and the extended time in between patient visits. I would have liked to reevaluate him to see if my probing depths were accurate from the first time. The patient will not let me retake pictures and will not come back for re-evaluation I still believe this patient to have generalized active chronic periodontitis.