1. Our Patient: 21 year-old female  Student & Bartender  Social Drinker  Smoker  No Exercise  Poor Diet  Anxiety Problems

2.  C.C. “My mouth really hurts and there’s a bad taste”

3. Medical Assessment  Recent Mononucleosis  Suffers from Panic Attacks  Insomnia  Vitals: BP 108/68, BPM 90, RPM 18, Temp is 100.7°F.

4. Medications  Xanax- treatment for panic disorder Significant xerostomia  Lunesta- treatment of insomnia Unpleasant taste, xerostomia  Ortho Tri-Cyclen- prevention of pregnancy Caution with prescribing antibiotics

5. Dental History  Carries: 2,18,31  Restorations: 2,3,12,13,14,18,19,3 0.  Last Visit: Over one Year. “I have been too busy.”

6. Oral Assessment  E/I Exam:  Bilateral, palpable, tender cervical lymph nodes  Geographic tongue  Fetid breath  Adequate salivary flow, but patient reports that mouth is “usually really dry”.

7. Caries:  Suspicious area at the CEJ between 7 & 8.  Buccal caries on 2,18, 31. Interproximal caries between 2 & 3, and 13 & 14. (Seen in Chart)

8. Periodontal Assessment/ Description:  Maxillary & Mandibular marginal erythema and edema & necrosis of anterior papilla, especially in the mandibular anteriors  OH is poor. PFI = 20%

9. MBI, Probings, BOP:  It was too painful to record full probe, however spot probe reveals 4mm interpoximal depths on the facial aspects of all cuspids and first molars.  BOP= 100% for all 16 sites probed.

10. Periodontal Classification:  AAP classification is class V- Necrotizing Ulcerative Periodontitis.  WLAC Calculus Code: WLAC- 2 Light.

11. Signs and Symptoms of Necrotizing Ulcerative Periodontits  Necrosis of interproximal papillae √  Bleeding √  Pain √  Fetid Odor√  Pseudomembrane over gingiva  Cervical lypmphadenopathy √  Fever√

12. Three Most Reliable Criteria For Recognizing ANUP:  Necrosis of interproximal papillae √  Bleeding √  Pain √

13.  It is an opportunistic infection of the gingiva.  It is associated with lifestyle risk factors such as stress & tobacco.

14. Commonly called ANUG but more correctly called NUP

15. Human Needs:  C.C. “My mouth really hurts and there is a bad taste.”  Protection from health risks, anxiety, and stress.  Functional Dentition  Periodontal Complication

16. Human Needs:  Pain Control  Specialist Referral and Diagnosis  Understanding of Oral Diagnosis and process.  Patient’s Oral Health Responsibility

17. Treatment  Treatment should progress daily during the acute phase of the disease because the pain often inhibits thorough cleaning by the client or hygienist at one time.

18. Day One:  Scale & Debride as much as pt. can tolerate. Ultrasonic may be more easily tolerated.  Encourage pt. to rinse with 3% Hydrogen Peroxide to sooth tissue and oxygenate anaerobic bacteria. .12% Chlorhexidine 2x a day.  OHI, Diet Counseling, Tobacco Cessation.

19. Day Two:  Scale & Debride as much as pt. can tolerate. Pain should be reduced considerably.  Reinforce OHI.  Continue 3% Hydrogen Peroxide for 1 week.

20. Day Seven: 3rd Appt.  Finish any necessary Scaling & Debridment.  Check patients OH with disclosing solution.  Discontinue 3% Hydrogen Peroxide.  Continue on 0.12% chlorhexidine 2x daily for 2-3 weeks.  Encourage use of xylitol products for dry mouth.

21. 1 Month: Reevaluation  Reinforce OH.  Scale and root plane if necessary.  Evaluate patients progression with lifestyle changes. Stress-Tobacco Cessation-Diet  Assess for Reduced Gingival Bleeding BOP<75%.  Switch to 10 mL clorhexidine rinse for 1 minute daily for 1 week each moth. -Caries protection.

22. Three Month Recare Appointment  Regular mechanical dental hygiene care.  Topical fluoride application.  Reinforce OH and lifestyle changes to prevent the recurrence of NUP.