1. P3 Project Gerardo Viadas, RDAEF

2. Personal History Personal: 62 year old Male Hispanic Single Retired Medical: Hypertension HIV Coarctation of the aorta Periodontitis Seasonal Allergies Herpes Simplex II

3. Medical History Continued BP 144/56 P 54 R 18 BP 120/60 P 70 R 18 BP 150/60 P 86 R 20 ASAIII Premedication required for coarctation of the aorta. Epivir Antiviral HIV Drug Viramune Antiviral HIV Acyclovir Antiretroviral HSVII Hydrochlothorizide Diuretic Hypotension Proklor Potassium supplement uptake Clarinex Seasonal Allergies (Antihistamine)

4. Review of Symptoms Neurological: None Psychological: None Functional : None Respiratory: None Cardiovascular: Coarctation of the aorta Dermatological: None Gastrointestinal: None Hematological: None Endocrine: None Immunological: HIV Dental History BW’s: 6/2006 FMX: 6/2006 Latest exam: 7/2008 Latest dental prophylaxis: 6/08

5. Dental History Continued Patient presents w/ restorations on teeth #’s 2MO, 3O, 8RCT, 14PFG, 15MOD, 18OB, 19DO, 28O, 29O, 30O, 31MO Missing teeth: #1,12,13,16,17,23,24,25,26,& 32. Patient present w/ generalized 3 mm recessions on all teeth. Abrasions and abfractions are not present.

6. Clinical Examination: First Visit Extraoral exam: WNL (max. opening 45mm) Intraoral exam: Hard tissues WNL, soft tissue WNL except for generalized 2-3mm gingival recessions on existing teeth, salivary flow WNL. Patients presents with a lower partial denture replacing teeth #’s 23,24,25, &26 (lower anterior incisors), and an upper partial denture replacing teeth #’s 12 and 13.

7. Clinical Examination Continued Occlusal relationship: Class I Facial profile: mesognatic Overbite: 5mm Overjet: 3mm Mobility: WNL Furcation: WNL Generalized 2-3mm probings w/ localized 4-5mm probings. Gingival description: Maxillary attached gingiva: pink, firm, and stippled. Maxillary free gingiva: pink, firm and smooth. Mandibular attached gingiva: pink, firm, and stippled. Mandibular free gingiva: pink, smooth with localized rolled borders. Initial PI: 65% PFI:35% Initial BOP: 1% Calculus description: Light 2 supra and slight subgingival. 25% interproximally. Radiographic interpretation: Consistent horizontal bone loss. Periodontal classification: Generalized severe periodontitis.

8. Pre-operative Images

10. Treatment Plan OHI: Modified Bass technique Flossing instructions: using the “C” method of wrapping the floss around each tooth. Interdental Aids: Proxybrush for open contacts. Tongue scraper: Coated tongue. Flouride tx: 2% sodium fluoride for 4 minutes. Full–mouth scale Re-Evaluation 3-4 weeks, to reassess the OH, to assess improvement, and new problems, and to evaluate the frequency of follow-up with dental hygiene appointment.

11. Nutritional Recommendations PT should exercise 30 minutes (suggestion). PT should drink more water instead of coffee and bottled coffee flavored beverages. Nutritional Counseling: Patient needs to consume more wholesome foods. Such as milk products, vegetables, fruits, whole grains, and low fat meats.

12. Re-evaluation Visit Gingiva: Generalized pink, firm, and stippled Probings: Generalized 2-3mm (localized 5mm decreased 1mm). PI: 39% PFI: 61% MBI: 0% WLAC Calculus Code: Light 1 OHI: Modified Bass technique, C-fold flossing technique, with interproximal cleaning aids (proxybrush). Nutritional recommendation: Based on patient’s data.

14. Cambra The patient is considered a high risk patient because the patient has a history of restorations within a three year period. Cambra recommends high risk patients to brush twice a day with a toothpaste containing 1.1% NaF. Use a 0.2% NaF mouthrinse daily. 3-4 month recall to evaluate caries risk and apply flouride varnish. Saliva test and bacterial culture. Chlorhexidine gluconate 0.12% (10ml). Xylitol gum (6-10g daily). Two tabs a gum four times a day. Use MI paste twice a day.

15. What would I have done differently? Premedication is a must for patients with coarctation of the aorta according to the American Heart Association. Try to manage clinic time accordingly. My patient left on a two week vacation that prolonged the treatment plan. Overall time management needs improvement.

16. References Removable prosthetics: Clinical Indication and Treatment Principles (2008). Retrieved June 10, 2009 from www.http//www.dentistrytoday.comwww.http//www.dentistrytoday.com Rx for the Durable Partial Denture: Proper Maintenance Plan (2006). Retrieved June 10, 2009 from www.http//www.dentistrytoday.comwww.http//www.dentistrytoday.com Dentures: Frequently asked Questions (2009). Retrieved June 10, 2009 from www.http//www.ada.org www.http//www.ada.org