1. Periodontal Case Study Reina Ligeralde DEH 23 5.30.08

2. Patient Profile and Chief Complaint Name: Abby Fraction Age: 27 Ethnicity: Asian Occupation: graduate student Chief complaint: teeth cleaning

3. Medical History Childhood vaccinations in 1981 Completed hepatitis B vaccination series in 1997 Menstruates regularly, every 30 days Paternal grandfather had liver cancer and type II diabetes mellitus Practices birth control: Ortho Tri-Cyclen Lo Takes a multivitamin daily BP: 110/65, P: 73, R: 16 ASA II

4. Dental History Four 3 rd molars extracted 3/00 Porcelain crown on 7 in 2006 Last dental exam and teeth cleaning: 9/07 Last dental x-rays: FMX at RCC 4/08

5. Clinical Findings E & I Periodontal Exam Calculus Radiographic Exam ADA and AAP Classification

6. E & I Bilateral 3 mm X 2 mm nevi on auricles Bilateral palpable submandibular nodes Left side of TMJ clicking Bilateral mandibular tori Torus palatinus Bilateral linea alba Erythemic papilla on the anterior portion of the dorsal surface of the tongue

7. Periodontal Exam Free gingiva  generalized coral pink with localized cyanotic gingiva between 6 and 7 due to P crown on 7, generalized scalloped, generalized firm, generalized smooth Attached gingiva  generalized coral pink, generalized firmly bound down to underlying bone, generalized stippled Adequate salivary flow Skeletal classification: mesognathic Angle’s classification: class I bilateral molar relation with crowding in the mandibular anteriors Maximum opening: 44 mm

8. Periodontal Exam (continued) MBI: 0%, BOP: 8.3% Probing depths range  1-3 mms with localized 4 mms 30D & 31M Recession  2 mm 2B, 3B; 1 mm 4B, 5B; 1 mm 10F, 11F; 2 mm 12B; 1 mm 14B; 1 mm 15L, 14L; 1 mm 3L; 2 mm 2L; 3 mm 31B, 30B; 1 mm 29B, 28B; 3 mm 27F; 3 mm 22F, 21B, 20B, 19B, 18B; 1 mm lingual surfaces of 18, 22, 24-26, 28-31 Clinical Attachment Loss  2 mm 2B; 1 mm 3B; 1 mm 12B; 1 mm 15L; 1 mm 3L; 2 mm 2L; 3 mm 31B, 30B; 1 mm 29B, 28B; 2 mm 27F; 2 mm 22F, 21B, 20B; 3 mm 19B, 18B; 1 mm 18L, 31L Mobility: + on 5, 7-10, 20-27 Fremitus: + on 8-10, 12 Furcation: none noted

9. Periodontal Exam and Calculus Abfraction: 2-4, 11-12, 18- 20 Attrition: 22-27 RCC calculus code: light

10. Radiographic Exam 1, 16, 17, 32 extracted Restorations  7 has a P crown, 8 & 9 have facial composites, margins intact Tooth findings  Possible decay: none noted  No radiolucencies around the apices of teeth noted  No internal or external root resorption noted  No dilacerations noted  Atypical tooth findings: 24-26 attrition

11. Radiographic Exam (continued) Critique of angulation  Because the vertical angulation is off in the PAs, I would use the BWX for the periodontal interpretation. Trabecular pattern  Consistent throughout Lamina dura  Present and consistent throughout, becoming fuzzy Alveolar crest  Blunted in the posterior teeth and sharp in the anterior teeth, greater than 1.5-2 mm apical to the CEJ, 1 mm bone loss at 3M, 12M, 13M, 15M, 20M, 21M, 28M, 29M, 30M PDL space  3D, 4M, 5D, 6MD, 14M, 18M, 19D, 20D, 21D, 24M, 26D

12. Radiographic Exam (continued) Furcation - interradicular radiolucency  19 noted Calculus  7M noted General osseous interpretation  No radiopaque or radiolucent lesions noted

13. Critique of Radiographs  Vertical angulation Can see the occlusal plane in all the posterior PAs  Maxillary right posterior PAs and maxillary left molar PA need to increase angle of PID  Maxillary left premolar PA and mandibular posterior PAs need to decrease angle of PID The maxillary premolar PAs should have been placed more parallel to the arch.  Horizontal angulation The following films should have been adjusted to see interproximally.  Slightly: mandibular right molar PA and mandibular left posterior PAs  Severely: premolar BWXs, anterior PAs, maxillary right posterior PAs, maxillary left premolar PA, and mandibular right premolar PA

14. ADA and AAP Classification ADA II AAP: generalized slight chronic periodontitis due to mechanical forces modified by plaque and calculus

15. Dental Health Education Oral plaque therapy aids Appt 1 Appt 2 Appt 3 Type/ Agent Method taught Disclosing5.1.08GUM Toothbrushing5.1.08softBass: – twice/day Floss5.15.0 8 GlideC-shape: once/day Pockets/ Probing 4.24.08 Nightguard5.15.0 8 daily

16. Rationale for Case Selection Medical history/systemic health  Birth control Systemic & oral risk factors  Grinding, mechanical forces Dental hygiene diagnosis  Perio: uncontrolled  Caries: controlled  OHI: adequate  Influencing cultural & social factors: young with stress as a graduate student

17. Rationale for Case Selection (continued) Oral health education/strategies  Soft brush with Bass method  Floss  ACT mouth rinse with fluoride  Nightguard Reevaluations  19 buccal due to decay  Abfraction areas: 2-4, 11-12, 18-20

18. Rationale for Case Selection (continued) Referrals  19 buccal due to decay  Abfraction areas: 2-4, 11-12, 18-20 for possible restorations  Nightguard Recall: interval: 4 months Rationale: check referrals and bone levels

19. Goals Maintain good oral homecare and bone levels Maintain MBI & BOP to less than 10% Reduce PI each appointment

20. Treatment (Tx) Plan & Implementation Treatment Plan SequenceStart Date Finish Date Appt 1 X-ray check4.24.08 FMX4.24.08 Assessments4.24.08 DDS Exam4.24.08 Appt 2 2nd check-in5.1.08 PI, OHI5.1.08 LR scale5.1.08

21. Tx Plan & Implementation (continued) Treatment Plan SequenceStart Date Finish Date Appt 3 UR, LL, UL scale5.15.08 Selective polish5.15.08 Fluoride5.15.08 4-month recare

22. Pictures Facial

23. Maxillary arch lingually

24. Pictures Mandibular arch lingually

25. Pictures Abfraction on 11-12 & 18-20

26. Questions?