Case study #1 – Anemia (H/II-B)
New patient – 18 year old Hispanic female, diagnosed with Anemia but does not currently take any medications. Patient does not smoke or drink. ASA 2 due to anemia. Patient brushes with manual toothbrush twice daily with Crest fluoridated toothpaste. Patient flosses daily using floss pick but does not use any rinses. Patient does not use any tongue scrapers.
Patient presented with a maxillary tori, and round white and red ulcer localized to their labial mucosa due to accidental biting. Patient had diastema on #6-11 and mamelons on #7-10 and #25, 26 with a bilateral Class II occlusion with 30% overbite and 3mm overjet. Patients gingiva had localized cyanotic inflammation on lower anterior teeth, with gingiva being extremely friable to the point you can see the roots. Papilla appears pyramidal and soft to touch. Generalized inflammation and light stippling present. Patient had generalized 1-3mm pocket depths with localized 4-6mm. Generalized heavy BOP. Patient presented with generalized heavy sub gingival and supra gingival calculus with visible plaque. Heavy bleeding upon calculus detection. Treatment plan consisted of 4 total visits. Periodontal status was determined to be Stage 2 Grade B according to AAP classifications and guidelines. Radiographs were utilized for diagnosis.
Visit #1: Discussed thorough medical, dental, and social history. Completed all assessments (EO/IO, perio/dental charting, calculus detection). Disclosed with disclosing solution an educated patient on the modified bass technique for toothbrushing. Scaled teeth #2, 3, 4, and 5 using ultrasonic and handscaler. Patient had heavy sub and supra gingival calculus. Generalized bleeding with scaling.
Visit #2: Discussed any changes to medical, dental and social history. Re-evaluated previously scaled teeth for residual calculus. Exposed FMS radiographs, all findings were rendered to patient. Copy of radiographs were also given to patient. Educated patient on the correct flossing technique, as well as introduce interdental brush for diastema. Applied Oraqix (2.5% Prilocaine and Lidocaine) prior to scaling quadrant 1 and 4. Scaled residual calculus in quadrant 1 and 4 using ultrasonic and handscaler. Generalized bleeding with scaling.
VIsit #3: Discussed any changes to medical, dental and social history. Re-evaluated previously scaled quadrant for residual calculus. Disclosed with disclosing solution and educated patient on different rinses and toothpastes. Recommended patient to use an antiseptic rinse and consider buying an electric toothbrush for more adequate biofilm removal and minimizing inflammation. In addition, due to pseudopocket on their lower wisdom teeth, I gifted patient with an end tuft brush to help clean the hard to reach areas. Applied Oraqix (2.5% Prilocaine and Lidocaine) prior to scaling residual calculus in quadrant 4. Generalized bleeding with scaling. Due to heavy sub gingival calculus, patient had discomfort while scaling, discussed administering local anesthetic for the next visit.
Visit #4: Discussed any changes to medical, dental and social history. Re-evaluated previously scaled quadrant for residual calculus. Disclosed with disclosing solution and educated patient on how diet affects caries risk. Instructed the patient that certain foods causes higher caries risk, and to always wait 30 minutes after eating or drinking to brush teeth due to acidic environment in mouth. Administered 1.5 carpule of plain Lidocaine with 1:100k epi prior to scaling quadrant 2 and 3. Negative aspiration on all attempts. ASA, MSA, PSA, and papillary was completed. Patient achieved anesthesia. Scaled residual calculus from last visit and quadrant 2. Generalized bleeding with scaling. Sealant was also placed on tooth #3 and #14 on the occlusal surface using cotton rolls and dry angles. Engine polished with medium prophy paste and applied 5% sodium varnish. Post op instructions were given to patient. Recommended patient to come back every 3 months for recare.
