Author: Medina Ferozedin

This case study is about a 47 vear old Asian Female patient , who was my first ever patient. She is here for her usual 3 month recare appointment. She is a non smoker, and she falls into a ASA 2 category due to controlled systemic conditions that will be mentioned. After taking her vitals, her blood pressure did correspond with (BP: 124/89 P : 79) to Hypertension stage 1, a referral was given to the patient. This patient presents with Type II diabetes since 2018 and takes Metformin QD for it. The patient claimed she does not check her HbA1c levels on a daily basis, rather 2-3 times a week. Thus she was informed to begin taking record on a daily basis. Her doctor was also called and disclosed her recent level which was a 6.5. Her most recent medical checkup was in September of 2023 for a physical and a TLC drug screening which resulted negative. The patient was asked if she has eaten breakfast and took her medications prior to this dental hygiene appointment and confirmed. This patient did report with a diagnosed dental infection in the posterior mandible, on October of 2023 she reported pain on Maxillary left posterior region beginning a week prior and she does not know where this pain is deriving from. Her last dental visit was before Covid-19 and has not received X-rays in more than 10 years. When asked about her dental habits she claimed to Brushing twice a day with Oral B electric toothbrush using Sensodyne toothpaste , Listerine cool mint twice a day as well as Flossing. Lastly, the Patient reported that she does grind her teeth on a nightly basis and utilizes a nightguard on a nightly basis to prevent bruxism.

Summary of Clinical Findings

Extraoral/Intraoral Findings: After completing an extra oral cancer screening She presented with a Horizontal bulging or protuberance of herniated disk on posterior neck, due to a car crash several years ago. When asking the patient to open and close her jaw, she did present with bilateral crepitus that was asymptomatic. During the time of the appointment , there was a mild scratch on left upper lip near midline- red 1×1 mm, which the patient was aware of. After completing assessments intra- orally everything objective was within normal limits along with having a palatal Torus which the patient was also aware of after educating her that it is only a growth of bone that appears and is not malignant.

Dental charting:

After taking a look at her gingival status , this patient was presented with Generalized mild inflammation, Localized rolled, dark pink shiny gingiva on left mandibular posterior gingival margins and mandibular anterior linguals (#22-27). One of her molars (#3) was recently extracted as well due to sharp pain from caries. The incisal edges were also flattened due to Generalized attrition. She also presented with bilateral Class 3 occlusion and an anterior underbite which resulted In Overjet Omm Overbite 0%.

Calculus: Generalized Heavy sub gingival and supragingival calculus with brown staining in the posterior region.

Periodontal charting/ Diagnosis:  After completing a periodontal assessment on this patient, she presented with Generalized Inflammation and bleeding on probing. She also presented with pockets ranging from 2-4mm with localized 5mm reading in the posterior region. There was also Class I mobility noted on #2, #26, #30. Due to these factors this patient was diagnosed as a Periodontal disease Stage I Grade B due to her radiographic evidence and also because of her Blood glucose reading. This patients CAMBRA status was also a high due to frequent snacking and taking medications that reduce salivary flow. This patient was advised to utilize the food sequencing method and to substitute high carb and sugary salty foods with more healthier options.

Dental Hygiene Care plan

OHI/PI: This patient reported to use the Horizontal brushing method with a Electric toothbrush so I introduced the Modified Bass brushing method and made it clear to angulate the bristles at a 45 degree angle so that the bristles can disturb any calculus or plaque bacteria formation that is occurring underneath the gums which is causing her gingival inflammation. I demonstrated it in her mouth first In order for her to have a gingival muscle memory so when she goes home to do it herself – he will remember how it feels. Then this patient tried it on her own while I was holding the handheld mirror to her and she immediately felt the difference and observed the disappearance of the disclosing solution that I had previously used on her. She was pleased with the new way of brushing. I also recommended my patient to use a non alcohol Listerine due to her slightly dry mouth and recommended her Crest Pro Health alcohol free mouthwash instead. After completing all assessments, I decided that it would be best for my patient to take 4VBW to better capture her bone levels and to have radiographic evaluation of her condition, also to take a look at why she is experiencing pain in her upper left region. After taking her radiographs it was seen that she had a overcontoured crown on #18, 30, so she was given a referral for that. She also radiographically presented with Generalized horizontal bone loss is about 15-33% which indicates a Stage 1. To complete treatment required only one visit. it would consist of SRP with ultrasonic scaler and hand scaling the whole mouth followed by engine polishing with fine prophy paste, concluding the visit with 5% sodium fluoride varnish. A referral was also given for her HTN and dental evaluation of several overhang crowns, along with evaluating the upper right quadrant for her pain.

Discussion/ Evaluation

Managing a patient with both diabetes and periodontal disease requires a enhanced approach that addresses the bidirectional relationship between these conditions. Emphasizing meticulous oral hygiene, controlling blood sugar levels, and implementing periodontal treatments are key components of management. Patient education plays a crucial role in empowering individuals to prioritize oral hygiene and diabetes management. Regular monitoring and follow-up appointments ensure treatment progress and overall well-being. Collaboration between dental and medical professionals is essential for optimal outcomes in patients with diabetes and periodontal disease.

Here are some of the certificates that I have achieved in the past years!

State of New York Local Anesthesia and Nitrous Oxide Certification

JFEW Scholarship

Countless Nominations to the Honors Scholars Program and the National Society of Collegiate Scholars

Throughout my years in dental school, I was able to learn not only the technical skills required for clinical practice but also the importance of empathy and communication in patient care. From mastering intricate dental care to understanding the underlying biological principles of oral health, each experience shaped my development as a future hygienist. Additionally, clinical rotations and community outreach programs provided amazing opportunities to apply clinic knowledge in real-world settings, fostering appreciation for the diverse needs of patients and the broader implications of oral health on overall well-being. Collaborating with peers and faculty members in research projects further expanded my understanding of emerging trends and innovations in the field. Moreover, encountering challenging cases and diverse patient populations strengthened my problem-solving abilities and cultural competence. Overall, my journey through dental school has been a transformative and enriching experience, equipping me with the skills, knowledge, and compassion needed to make a meaningful difference in the lives of others through dentistry.

• Scaling and Root Planing Expertise 
• Ultrasonic Instrumentation 
• Local Anesthesia Administration
• Nitrous Oxide Sedation
• Oral Cancer Screening
• Head and Neck Cancer Screening 
• Fluoride Treatments     
• Sealant Application
• Digital Radiographs (ability to interpret)
• Suture Removal 
• Engine Polishing 
• Time Management
• Infection Control 
• Periodontal Probing 
• Dental Charting
• Whitening Tray Fabrication 
• Oral Hygiene Instruction
• Medical History Review
• Arestin Placement 
• Alginate and Digital Impressions
• Pouring and Trimming Stone Models From Alginate Impressions

JFEW Scholarship Based Internship– National Dental Oakland Gardens, NY (June 2023)

As part of the JFEW scholarship community since Fall 2022, I was granted the opportunity to complete a work based internship in any office of my choice and to my convenience during the summer months of 2023. My internship experience in the dental field was truly invaluable, providing me with hands-on exposure to various aspects of dental practice and patient care. Working alongside experienced dentists and dental professionals, I gained practical skills in dental treatment, patient interaction, and office management. From assisting with dental exams and procedures to managing patients and scheduling appointments, every task contributed to my growth and understanding of the dental profession. Moreover, the mentorship I received during the internship was exceptional, offering guidance, feedback, and insights that enhanced my learning experience. This internship not only solidified my passion for dentistry but also equipped me with the knowledge and confidence to pursue further education and a career in the dental field. Overall, it was a transformative experience that reaffirmed my commitment to providing compassionate and quality dental care to patients in the future. This experience was very eye opening and gave me a realistic overview of the life of a hygienist through a students perspective. I must say I really do look forward to starting my career soon !

Service Learning Project – Omar Mosque/Sunday school (Brooklyn, NY March 2024)

This project predominately focused on a specific group of our choice – children. My classmates and I decided to visit the Omar Mosque in Brooklyn to educate their children about dental health ! Educating children about dental hygiene is crucial for instilling lifelong habits that promote oral health. Through interactive and age-appropriate methods, such as Tell-Show-Do, storytelling and hands-on activities, we engaged these children in learning about the importance of brushing, flossing, and visiting the dentist regularly. By incorporating fun elements like colorful visuals, games, and songs, we made dental education enjoyable and memorable for these children. Teaching them about the effects of sugary foods and drinks on their teeth, as well as the role of fluoride in cavity prevention, will empower them to make healthier choices to avoid the SUGARBUGS!

Give Kids a Smile! – February 2024 at NYCCT

Colgate supported the fantastic Give Kids a Smile event for pediatric children, which took place on February 2024 at our City Tech campus clinic. The GKAS event was fantastic since we received more pediatric experience and exhibited our abilities. We provide EO/IO examinations, dental charting for primary and mixed dentition, scaling (as required), engine polishing, and flossing. Additional procedures, such as pit and fissure sealant placements and 5% fluoride varnish coatings, can be provided as needed with parental agreement.

This was one of my favorite events because Colgate generously provided us with toys and handheld visuals for the kids to have fun while connecting and bonding with the student clinicians. It was also a very heartwarming experience working with those cute children; seeing them happily smiling after treatment felt incredible.