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


  • 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.


  • 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.


  • 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.