This is a case of a 65 years old male with a long history of tobacco smoking, poor oral hygiene and early periodontitis.

ASSESSMENT

 Patient health history and vital signs

 Vital signs were slightly above normal limits 126/84.Patient had penicillin allergy. Patient had radiation therapy for prostate cancer in 2007. Patient did not take any medications

Oral Pathology

Patient had 2 small, 2X2 mm , flat,round, white lesions present on right retromolar pad area. Appeared as hyperkeratosis. No referral needed.

Dentition

Patient presented abrasion on teeth #20, 21,27,28 and attrition on #23,24,25  . Several posterior and anterior restorations including PFM crowns, porcelain veneers and 2 implants( #8,11). Patient did not have active caries.

Periodontal

Generalized moderate marginal inflammation with pale pink and very fibrotic tissue. Probing depths 3-5 mm with localized recession. Moderate BUP  .Patient was classified as generalized  periodontal Type II. Based upon the assessment, Arestin was appropriate for this patient because of several 5 mm pockets located on maxillary anterior teeth and mandibular molars.

Oral Hygiene

 Generalized  heavy sub and supragingival calculus deposit. Heavy tobacco stains on maxillary and mandibular lingual anteriors. Plaque score was poor. Patient had large amounts of visible plaque and food debris. Tongue was coated and fissured.

Patient stated that he cleans his teeth with manual soft brush and flosses occasionally. I discussed  the importance of the proper oral hygiene and I showed him the amount of plaque on his teeth. For home care I recommended power toothbrush, Listerine rinse and tongue cleaner. I taught him the correct way of flossing and he responded that he would try to floss every day.

 Radiographs

Last radiographs taken in 9/2012. They were not available for the assessment.

Other findings:

Patient was a heavy smoker. He has been smoking 15 pipes a day for the last 40 years. Even though he was not interested in quitting, I discussed smoking cessation and relationship to oral cancer and periodontal disease.

TREATMENT MANAGEMENT

I established the treatment plan for this patient as follows:

V1- scale UR and LR, review OHI                                                                                                                            V2-  scale UL and LL, air polishing

During the treatment  I discussed with the patient oral home care. Based on the patient’s oral health status, I suggested the anti-microbial rinse Listerine, soft pick for posterior teeth and tongue cleaner. When scaling I removed large amounts of food debris from in between the posterior teeth. I effectively removed  supragingival calculus and tenacious subgingival deposit. I used different ultrasonic inserts (FSI 100 and 1ooo), universal curette and scalers. I finished my treatment with air polishing and was able to remove all the stains.