Case Study 1

Assessment: 34 years old, Caucasian male patient presents to dental clinic for a dental cleaning. BP 119/70, corresponds to normal. Patient reported he has pollen seasonal allergies, occasional sinus congestion and occasional migraines for which he manages with OTC pain medication. Patient reported no hospitalization or surgeries past 5 years. Patient does not take any medication regularly. ASA: 2. SH: Patient reported no drugs, non-smoker and consumes 3 drinks weekly. DH: Patient stated that his last dental cleaning was 5 years ago and does not remember when x-rays were last taken. Patient stated h/o ortho treatment as a teenager and currently does not wearing any retainers. H/o third molar extraction about. Patient stated that his gums bleed when he brushes. Patient reported he uses manual soft TB, Crest whitening TP, flosses twice a day, uses Listerine oral rinse occasionally. Patient reported he does not use a tongue cleaner.

Occlusion: Bilateral class I, OJ- 4mm, OB- 50%. Attrition on all anterior teeth. Gingiva appeared generalized pink, soft, non-stippled, rolled and inflamed gingival margins with bulbous interdental papillae. Generalized severe marginal gingival inflammation. Gingival margins generally located at or above to the CEJ with localized recession present on #11,21(1mm).

Perio charting: Generalized PD 2-5mm in the posterior, 2-4mm in the anterior. Heavy BOP. #24 class I mobility. No furcation detected. Note, in this visit since heavy calculus, it was not recorded on #22-26 (L). Generalized supra and subgingival calculus. Case type determined to be heavy. Generalized stain present on occlusal and interproximal areas.

**After removing caculus I recorded #22-26(L).

Diagnosis: With radiographic evidence, perio status diagnosed as generalized severe gingivitis. Caries risk was high due to suspicious caries, irregular dental care. CAMBRA done – encouraged to use fluoride products, regular dental care, oral hygiene. Encouraged to restrict sugary foods, take care of suspicious caries.

Discussed with patient the need to take radiographs. Patient approved for taking 4HBWs first and if there is 3rd molar visible, take panoramic x-rays. Exposed 4 HBWs and panoramic x-ray. Radiographic findings were #29(DO) incipient caries, #2(D), #18(D), #19(D), #22-27 and #7-10 calculus noted. No bone loss or PAP noted. Impacted #1,16.32.

Plan/ Implementation:

1. first visit – Completed assessment. Exposed x-rays. Acquire PI score: 1.0. OHI: Introduce modified bass manual toothbrush technique/ Patient was able to re-demonstrate it on his own. Ultrasonic scaled 1,4 quadrants. Re-eval and rescaling needed Q1,4.
2. Second visit – Reviewed med hx, EO/IO. Acquired PI score: 0.8- decreased. OHI: reviewed modified bass toothbrush technique and introduced flossing techniques/ patient was able to demonstrate it on his own. Hand scaled and used cavitron to scale all quadrants to completion. Engine polished, applied 5% varnish sodium fluoride/ post follow up instruction was given. Referral letter was given for evaluating enlarged tonsils, suspicious caries, impacted wisdom teeth. Tx completed.

Evaluate: First visit and second visit had about 3 weeks gap. Patient had heavy supra and subgingival calculus. First visit, used ultrasonics to remove most of the heavy calculus build-up. As a result of evaluating the patient’s gingiva after 3 weeks, a significant change in the condition of the gingiva observed. Patient diagnosed as gingivitis, but I recommended 4 months recall for now, because of heavy calculus build up. Patient understood.

***The patients gave photo consent to take and share the pictures.