Initial Visit

• Recare visit
• 27-year-old African American male
• CC: In need of hygiene services
• Patient reports that he is allergic to penicillin.
• He is also under the care of a cardiologist for hypertension.
• He is prescribed 5mg of amlodipine daily.
• Vitals: 135/90 P: 85, corresponding with stage II hypertension.
• ASA II

Assessments

• Patient has bilateral, palpable, submandibular lymph nodes. Approximately 2mm in size each and asymptomatic.
• Patient presents with a lip ring on the right aspect of his lower lip.
• Bilateral linea alba.
• Exostosis along the mandibular anteriors and the maxillary premolar area.
• Bilateral mandibular tori.
• Bilateral class I occlusion
• 3mm overjet, 95% overbite.

Dental Charting

• Patient is missing #s 1, 16, 17, and 32. He reports that they were extracted.
• #s 5 and 13 are rotated.
• A fracture was observed on incisal edge of #8.

Periodontal Charting

• Patient has generalized probing depths ranging from 1 to 4mm, with a localized area on the left mandibular molars of 5mm.
• There is generalized, mild BOP.
• The gingival margin is coronal to the CEJ, possibly due to his prescribed amlodipine which is known to cause gingival hyperplasia.

Gingival Description

• The gingiva are pink but appear shiny and lack stippling. There is generalized, moderate, marginal inflammation present.
• The gingival margin is coronal to the CEJ, possibly due to his prescribed Calcium Channel Blocker which is known to cause gingival hyperplasia.
• Patient was advised to visit the clinic for hygiene services every 3 months as biofilm and calculus can potentially exacerbate gingival hyperplasia.

About Calcium Channel Blockers

• Calcium channel blockers are a class of anti hypertensive drugs that disrupt the absorption of calcium into the smooth muscles of the heart and arteries.
• Calcium is responsible for the contraction of these muscles and blocking their entry allows the heart rate to slow and the arteries to dilate which in turn lowers blood pressure.
• These medications have the potential to cause xerostomia, orthostatic hypotension, altered sense of taste, and gingival hyperplasia.

Radiographs

• The patient had an FMS exposed in November of 2020 at 7mA and 70 kVp.
• No suspicious lesions were observed.
• Generalized calculus deposited can be seen on the images.
• There is bone lose ranging from approximately 5 to 10%, corresponding with stage 1 periodontitis.

Diagnosis

• Patient has been determined to have stage 1 periodontitis, grade A.
• He has a low caries risk and no active lesions.
• Medium case value due to generalized moderate calculus deposits and well as localized areas of moderate supragingival deposits.

Treatment Plan

• Visit 1: complete assessments, review Bass method of brushing, and hand scale quadrants 1 and 4.
• Visit 2: Review proper flossing method with patient, hand scale quadrants 2 and 3, engine polish with medium grit prophy paste, apply 5% sodium fluoride varnish.

Treatment Plan Implementation

• Visit 1: Completed assessments. PI: 1.3. Reviewed Bass method of brushing with patient. Also recommended Phillips Sonicare electric toothbrush to patient for superior plaque control. Scaled quadrants 1 and 4 to completion.
• Visit 11: Reviewed proper flossing method to patient. Scaled quadrants 2 and 3 to completion. Engine polished with medium grit prophy paste. Applied 5% sodium fluoride varnish and provided after care instructions.
• Next visit in 3 months.