This patient is a 24 year old Caucasian female. Her chief complaint was that she wanted a dental cleaning. A complete medical history was taken at the initial appointment. Her blood pressure was in normal range at 74/54, pulse 82 bpm. She has intrinsic and extrinsic asthma. She placed her inhaler on the counter in arms reach. She reported that her doctor recommended her to eat more salt to increase her blood pressure. She was hospitalized in 2022 due to carbon monoxide exposure, but her doctor said she was okay. She takes prescribed medications: Apriso for ulcerative colitis, albuterol sulfate inhaler for asthma. She takes over the counter medications: Flonase for allergies and a prenatal vitamin because she is trying to conceive. She does not drink or smoke. Her last dental cleaning and exam were 6 months prior. Last radiographs exposed were 4 HBW images taken 9 months prior. Those radiographs revealed 3 new various lesions. She had not yet followed up with a dentist to get the cavities filled. Her oral hygiene routine consists of brushing with a manual toothbrush once per day, and cleaning her tongue with her toothbrush. She does not floss or use a mouth rinse.
Clinical Findings
All assessments were completed and here are the significant findings. She had a minor cheek bite on her left buccal mucosa. She had a coated tongue. Her overjet was 3mm, overbite 30%, and bilateral class 1 occlusion. Her gingiva was generalized pale pink, friable with rolled margins and generalized severe bleeding upon probing and exploring. Her periodontal charting revealed generalized 2-3 mm probing depths and localized 4-8 mm probing depths on posterior and anterior teeth. Her gingival margin was generally coronal to the CEJ. She had generalized heavy subgingival calculus. She was a high caries risk due to having active caries. Her radiographs revealed calculus on #20-distal, 3 areas of interproximal caries, and no bone loss. Her Plaque Index score was 2.3 (poor). Her periodontal status was generalized severe gingivitis.
Treatment
For oral hygiene instruction, I introduced string floss at the first visit, and Modified Bass toothbrushing method at the second visit. The treatment plan consisted of two visits total. At the first visit all assessments were completed and the right side of the mouth was cleaned using hand scaling. At the second visit, I completed scaling the remaining 2 quadrants. For pain management while scaling, I administered Oraqix local anesthetic. Once scaling was completed, I applied fluoride varnish. She was given a referral for caries, and to see a general doctor. I gave her a referral to see a general doctor because her gingiva was suspiciously pale while still exhibiting all the other signs of severe gingivitis, such as bleeding, friability, and pseudopocketing. The attending professor agreed with my assessment of her gingiva and the need for a referral.
Asthma
Due to her intrinsic and extrinsic asthma, I did not use the ultrasonic scaler to clean. She had reported to me that her asthma gets triggered easily and frequently from allergens such as dust, pollen, and poor air quality, and also by exercise. From the knowledge I have gained in my didactic studies, I decided she was not a good candidate for the ultrasonic. I exclusively hand scaled to avoid an emergency situation.
