Arestin Patient

2/4/13
S.D. Patient is a 36 year old female, non smoker, B.P. 105/73 Pulse: 75. Medical Dental History-WNL- Patient does not have any systemic condition and is not on any medication. Restorations were intact, with active caries on teeth #1, 15, 16, 18. Pt has a class 3 occlusion with edge to edge bite.IO/EOExams were within normal limits. Patient exhibited moderate marginal inflammation with moderate BUP, inflamed gingival, average probing depth of 6-8mm.Generalised heavy sub gingival calculus with stains on lingual of upper and lower anteriors. PT is a heavy, Type 111 periodontitis. Disclosed patient, plaque score of .8 which is good. Pt does not floss, taught spool flossing and advised to use soft toothbrush as she uses a hard one. Given the case I decided to do quadrant scaling. Hand and ultrasonic scaled LRQ using Oraqix. Pt tolerated well. Pt revisited 2/11/13, re-evaluated LRQ, gingiva well adapted to teeth. Disclosed pt, plaque score of .6 – I complimented pt for the improvement. Taught modified Bass method tooth brushing and scaled URQ. Pt did not want Oraqix or Local anesthetic infiltration. Pt revisited on 3/11/13. Re -evaluated URQ gingival tight with little soft deposits. Disclosed pt again, and plaque score was .5. Wow! Pt is doing well with oral hygiene instructions. Pt reported that she has been brushing three times daily as she now takes toothbrush to work and she has been flossing daily. Hand and ultrasonic scaled UL and LLQs. Pt tolerated discomfort well. Polished teeth removed stains and applied APF fluoride. Pt is a good candidate for Arestin considering pockets of 6mm. Placed Arestin in teeth # 30 DB, #29 DB, #28 DB and MB. These pockets all measured 6mm respectively. Recall pt for 2mths for Arestin evaluation. Exposed pt for FMS and give DDS referral.
5/13/13.

Patient revisited for assessment of Arestin placement. Teeth # 30 DB, #29 DB and # 28 DB and MB were probed and all pockets measured 3mm. Omg (Oh my goodness), this was awesome! Prognosis is good. Patients recall for perio scaling will be in 3 months.

Referral Case

D.D. Patient is a 37 year old female, non smoker. Medical history revealed no systemic condition and pt is not on any medication. Vital were BP 121/80, Pulse: 67. Extra oral exam revealed TMJ deviation to the left and right. Intra- orally white spots on crypts of tonsils. All (2) restorations were intact, no active caries, tooth # 31 mobile, #32 erupted mesio-facially and # 4 was retained root. Pt had a class1 occlusion with 3mm over jet and 20% overbite. Pt exhibited generalized moderate marginal inflammation with rolled margins and receded embrasures. Generalized recession at lower anteriors and posteriors was seen. Generalized aggressive periodontitis with average probing depths of 4-8mm. Moderate BUP with generalized sub and supra gingival calculus deposits. Pt is a Heavy Type 1V periodontitis. Last FMS was 2008. Patient was exposed for FMS radiographs which showed generalized periodontal bone loss.
When faculty came to assess case it was found that this patient had a generalized rapidly advanced aggressive periodontitis. She had a family history of early tooth loss. Pt had been told by a dentist four (4) years ago to see a periodontitis but she did not see one. She had been told regarding her periodontal bone loss when she was in her twenties (20’s). Patient reported that her mother had lost all her teeth at age 20. Pt was informed about her condition and that it was beyond my scope of care. She was given a referral to see a periododntist for treatment and a copy of her radiographs.