History: New/H/II – 58-year-old, Asian female. Vitals of 101/70, pulse: 74 (according to normal). History of breast cancer (in remission) and chronic Hepatitis B. Prescribed Exemestane (25 mg) daily for hormone replacement and Entecavir (1 mg tab) daily for chronic Hepatitis B. ASA II. The patient uses a soft manual toothbrush using vertical/horizontal brushing with Sensodyne toothpaste twice a day, uses Flosspik sometimes, has no oral rinses, and scrapes their tongue with a metal tongue scraper twice a day. The last dental visit was 1 month ago for a composite filling and 1 PA and the last dental cleaning was 2 years ago. Itraorally presented with short lingual frenum, bilateral linea alba, bilateral mandibular tori, torus palitinus, and mildly inflamed tonsils. Generalized amalgam, composite, and crown restorations, root canals, a 3-unit bridge on #19-21, mild attrition on the anterior incisors, and suspicious caries present. Gingiva appears blueish-purple, with enlarged diffuse gingiva, inflamed blunted and bulbous interdental papilla, moderate inflammation and rolled gingival margins, leathery consistency, and smooth and shiny appearance. Periodontally presented with pockets of 2-5 mm, recession of 1-2 mm, CAL of 3-7 mm, class I furcation on #18 (L) and 30 (B), class II furcation on #19 (B) and 30-31 (B), and moderate BOP. Generalized heavy subgingival calculus on the interproximal and cervical thirds with light extrinsic staining. PI score of 1.7 (poor).
Diagnosis: The patient is at high risk for caries due to generalized restorations and suspicious caries present. Classified as generalized heavy periodontitis stage III, grade B, due to CAL pockets of 3-7 mm, and furcations present.
Treatment and Hygiene care plan:
1st visit: A referral was given for generalized caries evaluation. Educated the patient using the C-string flossing method for the interproximal. Disclosed PI. Performed prophylaxis using Ultrasonic and hand scalers on teeth #2-4.
2nd visit: Patient did not follow up with referral yet and OHI. Informed the patient of the importance of visiting the dentist and OHI on the oral cavity. Reevaluated gingival assessment on teeth #2-4; generalized pale enlarged diffuse gingiva, mild bulbous interdental papilla, mild blunted gingival margins, soft and leathery consistency, and non-stippled and smooth appearance. Reeducated the patient using the C-string flossing method on the interproximal of the posterior teeth. Disclosed PI. Performed prophylaxis using Ultrasonic and hand scalers with 20% topical benzocaine and administered 1.0 carpule (1.7 cc) lidocaine HCL2% with 1:100,000 epinephrine via right mental block.
3rd visit: The patient did follow up with a referral and had a crown prep done on #3, currently has a temporary crown placed in. The patient did follow up with OHI and noticed less bleeding and inflammation after a few days. Educated the patient using the Modified Bass Brushing technique for the cervical thirds of her teeth. Disclosed PI. Performed prophylaxis using Ultrasonic and hand scalers with 20% topical benzocaine and administered 1.0 carpule (1.7 cc) lidocaine HCL2% with 1:100,000 epinephrine via left mental block. Engine polished with medium prophy paste. Applied 5% fluoride varnish. Scheduled next periodontal maintenance care (3 months).
Reflection: After treating this patient, I developed a profound appreciation for the importance of obtaining a thorough medical history. It’s crucial to make specific inquiries and take necessary precautions when caring for individuals who are taking medications associated with xerostomia, which heightens the risk of tooth decay. Understanding the systemic impact of medications is critical due to their substantial role in treatment. Furthermore, patient education remains integral. I took measures to ensure that my patient fully grasped the significance of preserving optimal oral health.
