- Key Words:
Smoker, hypothyroidism, depressed, heavy calculus.
The patient is a 36 years old Asian female and needs a dental cleaning. Blood pressure 102/77, pulse 84 bpm. With no past hospitalization, no past surgeries, and no known drug allergies. However, she is a smoker, and she is taking 5 cigarettes per day. She has had a hypothyroidism medical condition since 2015, and she is taking Levothyroxine Sodium 50mcg tab once a day before breakfast, and it is well controlled. Also, during the pandemic, she felt depressed, and she had been taking Escitalopram 10mg tab once a day before bedtime for around 2 years. Due to her medical condition, she is classified as ASA 2. The patient also states that she has not done any dental cleaning and X-rays before.
This case is considered periodontitis- Stage I/B based on clinical evaluation and radiographs. This is a heavy case- generalized moderate sub-gingival and heavy supra-gingival calculus, also with heavy stains. Moderate caries risk.
- Treatment Plan:
Visit 1- Assessments/ Build up the trust
I did all the assessments for her. After reviewing her medical history, I realized that it was her first dental cleaning, and she was acting upset. She told me that she had taken anti-depressants before coming in and wished she hadn’t misbehaved. I decided to get close to her and build her trust. She told me she often felt dry mouth. I told her it was a side effect of medication, but there was no need to worry. I recommend she rinse the Biotene oral rinse to moisten the mouth.
Visit 2- Smoking cessation/ Scaling/ Homecare recommendation
During the second visit, she looked relaxed, and she was willing to talk more about her job. She is a waitress, and she told me that she hates her job, that is why she smokes per day to release the pressure. I told her that smoking has many harmful effects on our oral and body health. I persuaded her to quit it as soon as possible to get a healthy mouth. And I advised her that when she feels stressed, try to get some exercise instead of smoking. Besides, I did quadrants 1&4 scaling for her with ultrasonic and hand instruments and admitted 1cc oraqix for pain management. Patients responded well with no complaints. In addition, I demonstrated to her how to use a modified bass technique: make it circles, place the bristles at a 45-degree angle between the gums and the teeth, and brush 2-3 teeth at a time.
Visit 3- Scaling/ Homecare recommendation/ Follow up for smoking cessation
On the last visit, I reviewed OHI with the patient to see how she responded to the manual toothbrush method. Also, I introduced the flossing technique. It is to use the middle finger to roll the floss together, and the thumb and index fingers are to control the strength. The floss must be pulled under the gums and up to the tooth surface, preferably maintaining the “C shape.” Then, I continued to finish quadrant 2&3 with ultrasonic and hand instruments. After that, I did the engine polish and applied 5% fluoride varnish to her. I also asked my patient to see if she reduced smoking and advised her it was never too late to quit.
- Patient’s Outcome:
Patient reported that after scaling, her mouth breath refreshed. She also used the modified bass technique for brushing twice a day and using the “C shape” floss method before bedtime. Also, she decided to quit smoking. She tried to watch TV shows instead of smoking when she felt stressed. And the patient was satisfied with scaling root planning and will come back for 4m recare.