Case Study 2

Patient Overview

The patient is a 74-year-old Argentinian female who presented to the clinic seeking a dental cleaning. She was cooperative, pleasant, and motivated to improve her oral health. The patient had not received regular preventive dental care and reported her last dental cleaning was completed in March 2024. She had previously visited a dental office for an extraction in preparation for implants; however, implant treatment was not completed due to the need for bone grafting.

Medical History

The patient reported a physical examination in April 2025. She has a history of high blood pressure, but stated her physician advised that medication was not necessary at this time and that blood pressure should be managed through diet and lifestyle modifications. Two blood pressure readings were obtained with an initial reading of 137/90, Pulse 107 and 132/90, Pulse 94, corresponding to Hypertension stage II. The patient reported no known drug allergies and no current medications. At the recall visit, blood pressure was re-evaluated giving 137/85, Pulse 93, corresponding to Hypertension Stage I. She denied tobacco use, vaping, and recreational drug use. The patient reported drinking approximately two glasses of wine daily.

ASA classification: II due to history of hypertension requiring observation and continued medical monitoring.

Extraoral Findings:

  • Beauty mark/mole located on the superior right cranial area above the eye

Intraoral Findings

  • Fissured tongue
  • 3mm red lesion on the gingiva close to the apex of tooth #9

Periodontal and Hard tissue Findings

Initial periodontal charting revealed generalized 3–4 mm probing depths with localized 4-6mm, 6-8mm on upper posteriors. Little to no bleeding present. Generalized gingival recession of 1–2 mm was noted.

Calculus Detection

Generalized medium supragingival calculus was present facially and lingually at the initial visit.

Gingival Assessment

Gingival tissues appeared pink but enlarged, with rounded and thickened margins and flat papillae that did not completely fill embrasure spaces. Mild mobility was noted on teeth #4, #5, and #7. At reassessment, inflammation had decreased in previously treated areas. Gingival tissues appeared healthier with reduced marginal inflammation and no bleeding upon exploration.

Dentition & Occlusion

  • Class I occlusion bilaterally
  • Overjet: 4 mm
  • Overbite: 50%

Localized mild abfraction of 1-2mm present on tooth #4, 5, 21 and 22. Generalized attrition in molar areas. recession is present, most pronounced on the facial and lingual surfaces of the mandibular anterior teeth.

Staining

Generalized heavy yellow staining present.

  • Case Type: Moderate
  • Periodontal Diagnosis: Generalized Stage III, Grade A Periodontitis
  • Caries Risk: High

Treatment Provided

Visit #1 (Sept 2025):
Medical and dental histories were reviewed and vital signs obtained. Extraoral, intraoral, periodontal, and gingival assessments were completed. Oral hygiene instruction was provided, and the Stillman brushing technique was introduced to improve plaque removal while minimizing trauma to the gingival tissues. This technique was specifically recommended due to the patient’s gingival recession and exposed root surfaces, as it allows effective cleansing at the cervical areas of the teeth while gently stimulating the gingiva. The technique was demonstrated to the patient, who then performed it to ensure proper understanding and ability to replicate it at home.

Initial debridement was completed on Quadrant 1 using hand instrumentation and ultrasonic scaling. A referral for blood pressure follow-up was provided due to elevated blood pressure readings. Treatment plan was discussed with the patient, with approval of vertical bitewing radiographs to be taken on next visit.

Visit #2 (Sept 2025):

The patient returned for completion of care. Medical history was reviewed with no significant changes reported. The patient stated she had begun implementing the Stillman brushing technique taught previously. The patient also reported mild sensitivity when drinking cold water, but no significant discomfort.

Radiographs of four vertical bitewings wrecked exposed. Findings included:

  • Horizontal bone loss up to approximately 33-50%
  • Notable subgingival calculus on teeth #12, #13 and #15
  • Suspicious carious lesions noted on #30-D and #31-M

Scaling of Quadrants 2, 3, and 4 was completed using ultrasonic and hand instrumentation. Engine polishing and 5% fluoride varnish treatment were completed. Patient responded positively in every step of the treatment.

A referral was again provided for comprehensive periodontal and caries evaluation.

Evaluation of Care

The prognosis of this patient will depend on several factors:

  1. Maintaining consistent oral hygiene at home
  2. Attending regular periodontal maintenance appointments every three months
  3. Following up with medical care regarding elevated blood pressure
  4. Seeking comprehensive dental evaluation for restorative and periodontal needs

Because the patient was motivated and receptive to instruction, the prognosis may be considered fair to good if recommendations are followed consistently. Continued professional maintenance and home care will be essential in preventing further periodontal breakdown and caries progression.

Reflection

As a clinician, this case was especially meaningful to me because the patient expressed that she urgently needed dental cleaning treatment but had been unable to find care within her budget. Hearing that made me realize how many patients truly want treatment but face financial barriers that delay necessary care. Being able to provide care and contribute to improving her oral health through the school clinic was very rewarding and reminded me of the importance of accessible dental services.

It was also rewarding to see the patient respond positively to treatment and oral hygiene instruction. Within a short period of time, there was visible improvement in gingival health, reduced inflammation, and less stain accumulation. Seeing these changes reinforced how effective preventive care and patient education can be when patients are motivated and given the opportunity to receive treatment.

This case also taught me the importance of compassion and patience when treating an older adult patient. I needed to make sure the patient remained comfortable throughout treatment, especially during radiographs, scaling, and longer appointments. Taking time to explain procedures clearly, checking in often, and working at the patient’s pace helped create a more positive and trusting clinical experience.

Another important takeaway was understanding how oral health is often connected to larger life circumstances such as finances, access to care, and systemic health concerns. The patient’s elevated blood pressure readings and delayed dental treatment showed how multiple factors can impact overall wellness. It reminded me that dental hygienists do more than provide cleanings—we also advocate for patients, educate them, and help connect them to needed care.

This experience strengthened my appreciation for patient-centered care and the value of community clinic settings. It reinforced that providing treatment is not only about technical skill, but also about empathy, communication, and helping patients receive care they may not otherwise have access to.