Assessments

Mrs. R is a 47-year-old Hispanic female who takes Vitamin D gummies every day for her health benefit. She does not take any medications and does not consume alcohol, tobacco, or recreational drugs. No significant allergies. BP: 107/76, P:78. ASA: 1.

Mrs. R has a history of wearing removable partial dentures for teeth #7 to #10 for over 25 years. She never takes them out. Her dentures are ill-fitting. Denture stomatitis, papillary stomatitis on the palate, and retractable gingiva tissue are present due to denture overwear. Missing teeth include #5, #7-10, #12, #18, #19, #30, and #31.

In the initial visit, the gingiva appeared as generalized erythematous, generalized bulbous papilla, spongy, with localized areas of recession. Probing depths ranging from 2-7mm with generalized heavy BOP. Calculus case value is medium; generalized moderate subgingival calculus and localized moderate supragingival calculus on the mandibular anterior teeth.

 

Radiographs 

Horizontal bitewings

 

Periodontal charting 

 

Staging and Grading

Based on radiographic evidence, there is generalized crestal bone loss >33%. The patient is a Periodontitis Stage 3, Grade B case.

 

Treatment plan

The patient needs denture education and needs to visit her dentist for denture rebase/reline. Mrs. R has to remove the dentures every night and soak them in room-temperature water. When dentures are not removed at night, the gums are not allowed to rest and she runs the risk of gum irritation. Additionally, when the dentures are not brushed properly, tartar builds up which can cause bad breath. Usually when people get home, they take off their shoes to give their feet a break. Why not do the same for her gums and take out the dentures?

Visit 1: Complete assessments, expose radiographs, provide oral health education, scale Q1.

Visit 2: Re-evaluate, provide patient education, and scale Q2 and Q3.

Visit 3: Re-evaluate, provide patient education, scale Q4, and apply Arestin on #2ML, #2DL, #3DL, #14DL, #15DL with post-op instructions. Apply fluoride treatment.

Visit 4: 6 weeks later; Arestin placement evaluation.

 

Evaluation 

Tooth#  Pre-treatment Post-treatment
#2-ML 6mm 5mm
#2-DL 7mm 4mm
#3-DL 6mm 5mm
#14-DL 6mm 4mm
#15-DL 6mm 3mm

 

After 6 weeks, all Arestin sites showed an improvement in probing depths. Mrs. R was very impressed with the improvement. Ever since Mrs. R’s initial visit to the clinic, she started to take out her dentures every night and soak them in Polident denture cleanser.  The gingiva where the dentures rest on top of showed minimal erythematous and less puffiness.

 

Before treatment- Initial visit 

 

After treatment- Last visit 

Recare- 3 months.