Case 1: Arestin Antibiotic
J.S, 33 year old male
M/II
ASA: II
BP 93/70 P:83
33 year old Hispanic male. Patient does not present with any systemic conditions. No medications. No known allergies. No recent hospitalizations or surgeries. Pt reports smoking 2 cigarettes per day but “has been trying to quit” recently. Last dental examination in November 2017
Oral pathology: EO: Multiple 1-2 mm sized moles noted on face and Neck. The patient mentions being aware of these finding. They are presently asymptomatic. IO: WNL
Dental: Class I occlusion, Overjet: 3mms Overbite: 10% . All existing restorations intact. Attrition noted on teeth #7-10 and #23-26. Grade I mobility noted on #23-26.
Periodontal: Generalized inflamed to gingiva with generalized 3-6mm Probing Depth. Moderate localized BUP, recession and staining. Patient was Classified as type II periodontitis indicated by generalized 3-6mm probing depth and localized bone loss on FMS radiographs. This patient was determined to be a suitable candidate for Arestin placement due to these clinical findings.
Oral Hygiene: Patient was classified as a Medium case value due to moderate localized calculus accumulation. Notably on posterior teeth.
Radiographs: Patient had an FMS exposed in 2017, which was utilized during treatment.
Treatment:
Visit 1: Completed assessments. Demonstrated proper flossing technique to moderate plaque accumulation on interproximal surfaces of teeth. Scaled UR/LR quadrants using ultrasonic and hand scalers.
Visit 2: Demonstrated proper brushing technique. Scaled UL/LL quad using ultrasonic and hand scalers. Polished using medium grit paste and applied 5% fluoride varnish.
Visit 3: Patient returned for Arestin evaluation and placement. Appropriate sites were chosen and Arestin was placed. The sites chosen were DL #19, MB #2, MB #3, D #4, ML # 5. The patient was advised to return approximately 6 weeks subsequent to Arestin placement for evaluation.
Looking at this case. I would say my strengths were patient management and treatment implementation . Being able to determine the necessary treatment protocol and make the appropriate recommendations to the patient made the process run smoothly considering this was the first time I placed the antibiotic. Having the confidence at this final stage of my student hygiene career showed and I was able to manage the entire treatment without much doubt. I thought the placement of the Arestin was a relatively easy process. Determining the appropriate sites for placement was probably the most challenging part of the treatment. All in all, I would say the treatment process and placement of the Arestin went well and according to my expectations.
If I had to choose one weakness during this treatment it would probably be managing the logistics of the treatment. By that I mean getting in touch with the patient in a timely manner In order to reevaluate the sites. It was challenging to bring the patient back for evaluation due to scheduling conflicts. Ultimately a date was set to have the patient return for evaluation. My hope is that the antibiotic did an excellent job in helping reduce the patient’s pocket depths.
Case 2: Patient Evaluation
A.W, 26 year old male
M/I
ASA: II
BP 143/90 P:76
26 year old black male. Patient does not present with any systemic conditions. No medications. No known allergies. No recent hospitalizations or surgeries. Pt reports smoking marijuana everyday and 4 packs of cigarettes daily. Last dental examination in 2015
Oral pathology: EO:WNL IO: Moderate white coating noted on dorsal surface of tongue.
Dental: No restorations present. Pt present with supernumerary tooth #7. Pt had root canal on tooth #7 Class I occlusion. Slight crossbite Overjet: 5 mms Overbite: 70%. Attrition noted on teeth #21-26. Moderate localized staining present.
Periodontal: Generalized inflamed gingiva with generalized 3-6mm Probing Depth. Moderate generalized BUP. Localized recession noted o teeth #26-22. No bone loss present. Patient was Classified as type I gingivitis indicated by generalized 3-6mm probing depth, localized recession and no bone loss on exposed PAN and Bitewings radiographs.
Oral Hygiene: Patient was classified as a heavy case value due to heavy generalized supra and subgingival calculus accumulation. Notably on posterior teeth and anterior teeth.
Radiographs: During treatment I exposed a PAN and 4 Bitewings. had an FMS exposed in 2017, which was utilized during treatment.
Treatment:
Visit 1: Completed assessments. Demonstrated proper brushing technique due to moderate plaque accumulation on proximal surfaces of teeth. Exposed 4BWs and PAN. Scaled teeth 7-9.
Visit 2: Demonstrated proper flossing technique. Scaled UR/LR UL/LL quad using ultrasonic and hand scalers. Polished using medium grit paste and applied 5% fluoride varnish. Recommended 6 month relate appointment for the patient.
Analyzing this case a strength that I would say I demonstrated was time management. I was able to proceed with the treatment in a time efficient manner. I felt as though two visits of full mouth scaling was appropriate for a patient of this case value. I managed the treatment in a way that was comfortable for the patient while providing the best possible care.
In all, I felt as though I managed the treatment in an efficient manner. I noticed personal growth from my previous semester in hygiene school where I was able to make treatment plans and recommendations in a way that was much more confident and efficient. The process of becoming a well rounded and competent hygienist has been a challenging one, but I’ve given my all to be able to say I’ve grown throughout. The process is ongoing but I’ve optimistic of the great days ahead.
