- 35 yr old white female
- Patient reports not having an oral hygiene appointment in 10 years.
- Patient smokes 1/2 a pack of cigarettes per day for the last 20 years and has ~4 alcoholic drinks per week.
- No medical problems. No medications. Bp 99/68 p74
Oral cancer screening
- Thorough EOIO done with no significant finding.
- Patient presents with exostosis and mandibular bilateral tori all within normal limits.
- Patient presents with generalized fibrotic tissue and blunted papilla (type III embrasure)
- Generalized recession present.
- Perio case type III with moderate BUP.
- Class III furcation present on #30.
- Moderate mobility present on tooth #16.
(Clinical attachment loss) #3B-756 #4B-545 #5B-768 #6F-434
#7F-656 #8F-545 #8L-656 #9F-657 #9L-777 #10F-657 #10L-656
#11F-525 #12B-759 #13B-546 #14B-768 #15B-537 #20B-644 #21B-646
#22F-544 #23F-544 #23L-424 #24F-667 #24L-444 #25F-767 #25L-444
#26F-656 #26L-544 #27F-445 #28B-647 #29B-846
*Probing depths on posterior teeth are between 4-7mm and 2-4mm on anterior.
- Generalized supra/subgingival heavy calculus deposits present.
Assessment of oral health knowledge:
- Patient currently using medium type manual toothbrush, not using any type of interdental aid and rinsing daily with antiseptic Listerine.
- Recommended the use of a power assisted toothbrush, daily use of floss, a proxy brush for embrasure spaces, and continued use of Listerine.
- These recommendations are to reduce overall plaque accumulation and decrease the bacterial count.
- One on one exchange about oral health concerns included smoking cessation, periodontal disease, and overall oral hygiene. Patient was informed about the severity of smoking and its effects on the oral cavity. Patient was also informed about the severity of her periodontal case and the need for an overall evaluation with a periodontist.
- Periodontal case type III
- Recommended exposure of FMS
- Scaling and root planing of all four quadrants
- referral for periodontal and caries evaluation on teeth #3, 13, 14, 30, and 31
The use of local anaesthesia.
Implementation of treatment:
Patient did not respond well to local infiltration. The use of ultrasonics was almost impossible with this patient because she reported the feeling of shocks to her teeth. A block was then given by the dentist to give the patient a deeper level of anesthesia. After given a block, the patient still did not respond well with ultrasonics. Hand scaling was the only option in this case for patient comfort. Because the case was strictly hand scaled it took a total of 3 visits to complete this patient. The calculus deposit was very tenacious and hard to remove especially in areas with type III embrasure spaces. The patient was recommended Arestin in areas that had probing depths of 5-7mm and they were placed on a 3 month recall.