A 22 year-old male presented for a cleaning with normal blood pressure. He is a daily marijuana smoker with seasonal allergies and asthma, but never had an actual asthma attack. However, patient reports smoking and strenuous exercise occasionally causes asthma-like symptoms. His last cleaning and radiograph (panoramic) was done in 2021. The patient had poor oral hygiene and his homecare only consists of usually brushing 1x/day.
Patient was informed about potential increased risks in oral cancer, periodontal disease , caries development, and xerostomia before assessments. Xerostomia and development of dental caries are twice as likely due to smoking and use of asthma inhaler, which contains glucose. It was suggested for the patient to rinse his mouth with water for oral clearance and chew xylitol gum to increase salivary flow. Smoking cessation was also offered – patient said he does want try quitting or not smoke daily and is 1.5 weeks sober.
The treatment was divided into 2 visits – patient was asked to have his asthma inhaler out in case of a medical emergency every visit
Initial visit: For oral hygiene instruction, the patient was taught Modified bass toothbrushing method with emphasis on focusing around the gingival margin. Radiographs (4HBWS) was also exposed due to his high risk of caries and history of fillings. Although the patient showed minimal bone loss, there was a suspicious lesion on #32-O. Cleaning was done on Q1 and Q4 with cavitron and handscaling.
Second visit: Gingiva showed major improvement since the last visit; there was less inflammation and bleeding when exploring for residual calculus. Oral hygiene also improved as there was less accumulated plaque around the margins. Flossing was introduced this visit. However, the patient had difficulty using string floss so dental picks were recommended. Cleaning was done on Q2 and # with cavitron and handscaling. Afterwards, 5% sodium fluoride varnish was applied for caries prevention and any possible sensitivity.
Although the patient is a gingivitis case, the patient had heavy tenacious calculus. Therefore, the recare interval will be set to 3-4 months to check on his oral hygiene until it has improved to the extent the recare can be changed to every 6 months.
