Case Study III

 

• Demographics

1. A.G., 22 year old, Med/Type I

• Assessment

1. African American female, ASA II. Patient has asthma and takes ventolin HFA – 90 mcg when needed. Patient is also allergic to nail polish. During initial visit, vitals were taken and her blood pressure was 101/71 with a pulse of 83.
2. Patient states she does not smoke.
3. No premedication was required prior to the appointment.
4. No systemic conditions were present.
5. The patient is currently taking ventolin HFA – 90 mcg to prevent bronchospasm. Patient states she only takes this medication when she suspects sudden onset asthma.

• Oral Pathology

1. EO: Generalized acne scars were present on the left and right sides of the buccal areas approximately 5 mm and circular in shape. IO: Chapped lips were present. Bilateral mandibular tori and maxillary torus was also present. Trauma to the linea alba on the left side was present due to patient biting cheek.  

• Dentition

1. Bilateral Class of Occlusion I. Overjet: 5 mm. Overbite: 10% Tooth #17 and #32 are partially erupted.
2. Fluorosis was indicated on tooth #6-11. Patient was explained what fluorosis is and ways to prevent new presence of it.
3. No caries activity present.

• Periodontal

1. Periodontal Type II with generalized 4-5 mm pockets  and moderate BUP. No mobility or furcations present.
2. Generalized soft pigmented gingiva with stippling present. Rolled marginal papillae present on #22-27 and #8-9. Mild inflammation was also present on marginal surfaces of #22-27 and 31.

• Oral Hygiene

1. On the second (final) visit, the plaque score was 1.5 – Fair. I explained findings to the patient and visually showed her where plaque was mainly present. I was not able to determine plaque score improvement because I finished this patient in two visits. During the initial visit, I was not able to perform plaque index due to insufficient time. Light extrinsic stains were also noted.
2. Generalized subgingival calculus was present on #22-27 and #29, 15, 19 and 10, and 21. Localized supragingival calculus was present on #23-25.
3. Oral hygiene interventions were originally found from the plaque index findings. Due to plaque being present on the cervical one third of posterior teeth and #8-9, I introduced the patient to the modified bass toothbrushing method and explained to the patient to hold the brush at a 45 degree angle so that she can try and get into and slightly above the gingiva. I also expressed the importance of using small circular motions and ending each tooth with a sweeping down stroke. I also demonstrated how to brush the occlusal surfaces of the teeth using a horizontal movement. The patient was also informed to use a soft bristled toothbrush and to at least brush twice daily.

• Radiographs

1. The patient was recommended for bitewings due to suspicious areas.
2. Radiographs were taken during assessment collection. The findings were explained to the patient. Slight horizontal bone loss was present on #30-31 and #15 and no caries activity was shown. Patient was explained that she should see a dentist to discuss further diagnosis and to floss daily to help stop the bone from further loss.

• Treatment Management

1. Visit 1: Reviewed medical and dental history. Took vital signs. Completed EO/IO exam. Recorded dental and periodontal charting. Completed calculus detection.

Visit 2: Reviewed medical history to determine any new changes. Reviewed EO/IO exam. Performed plaque index with disclosing solution and explained findings to the patient. Introduced oral hygiene instruction; modified bass toothbrushing method. Physically taught patient how to brush and allowed patient to independently brush. Completely hand scaled UR, LR, UL, LL quadrants. Provided toothbrush prophy using Crest toothpaste. Recare in 6 months.

Evaluation

1. The patient’s response to the intervention that was introduced and taught showed signs of interest and care. The patient revealed to me that she has never used the modified bass toothbrushing technique before. She also expressed to me that she has always used a medium bristled brush, therefore I made sure to express to her the importance of changing her toothbrush to a soft bristled brush to help decrease the risk of gingival trauma and abrasion. The patient stated that she wanted to spread this information to her siblings and parents. She was very interested in learning how to maintain her oral health.
2. After showing the patient her teeth in my mirror when treatment had finished, the patient was extremely joyful with the results. Ever since treatment, she has texted me numerous times, expressing how she can feel a difference in the lower anterior teeth. I had also asked her if she has been using the modified bass technique and she stated that she has been using it.
3. I was not able to visualize and inspect gingival changes because I completed the patient and hand scaled all four quadrants on the second visit.
4. During treatment, I additionally introduced the patient to flossing after I reviewed and explained her radiographic findings.

• Reflection

1. I believe that I accomplished everything I had planned both educational and mechanical. I feel that I provided a good amount of knowledge to the patient about her own teeth and how to maintain good oral health. I also was able to explain radiographic findings and implement new techniques, such as flossing to ensure plaque removal and help decrease the risk of further bone loss. Furthermore, I successfully hand scaled two quadrants with no rescales and had minimal tissue trauma.
2. A positive experience I had during clinical treatment was getting positive feedback from my instructor. My instructor expressed to me that I maintained correct ergonomics during treatment. She also helped me effectively remove calculus from the lower anteriors by expressing to me the importance of keeping the terminal shank parallel to the long axis of the tooth
3. Reflecting on my clinical treatment, I do not feel I had a negative experience because I was able to completely hand scaled all four quadrants in one visit. I was extremely proud of myself.