Case 1 – Thyroid Cancer/Von Willebrand’s
Demographics: 36 year old, Caucasian American, Female
Assessments: Patient had a Thyroidectomy and neck dissection where lymph nodes were removed due to cancer. Patient also was on RAI treatment. Patient was given Medical clearance for dental cleaning and radiographs by her physician and specialist. Patient also has Von Willebrand’s as was given Factor X before and after surgery.
Medication: Patient is taking Synthroid (175mg 1x/day).
Extraoral and Intraoral exam: Thyroid gland was removed. Lymph nodes on the right side of the neck were removed .
Patient’s last dental visit was October 2017.
No reported history of extractions. Composite restorations on teeth #8-B and 9-B, third molars clinically present.
Medium case value, type III Perio (Periodontal disease).
Planning and Implementation: Patient’s Von Willebrand’s is a contraindication for the use of ultrasonic instruments. Only scaling using hand instruments is required.
Exposed FMS radiographs. FMS radiographs reveal no caries or visible calculus. Radiographs did reveal alveolar bone loss.
Oral Hygiene Instructions:
Demonstrated proper tooth brushing technique using the modified bass method of tooth brushing.
Proper flossing technique was shown to patient and practiced by the patient with my instruction.
Patient was recommended to rinse with Periogard 1x/day.
Evaluation: Patient kept up with oral hygiene instruction, but did not rinse with Periogard. She used diluted Listerine antiseptic rinse instead. Reiterated that she try to obtain Periogard.
Gingiva was tapered and contoured to teeth in previously scaled areas.
Recommended a recall interval of 3 months.
Case 2 – Arestin Placement
Patient W.Z. 31 y/old Chinese male, H/III. Patient was diagnosed with Hepatitis B 15 years ago and not under any current medication. Presented with pockets ranging from 5mm to 7mm. This patient was my classmate’s, but he allowed me to place Arestin on this patient on 8 sites. His situation was a rather unique one to me, being that I never treated a Hepatitis patient. The patient was told by his physician that the virus is not active, and lying dormant. The areas in which Arestin was placed were on teeth #9DB–7mm, 9DL–6mm, 10DB–7mm, 12DB–7mm, 12ML–6mm, 12DL–7mm, 13DB–6mm, and 13 ML–6mm. Please see charts below.
Below are before and after images of treatment, as well as, sealant placement.
Before scaling (Patient J.M.)
