Patient Assessment

Patient presents with a history of bulimia (2 years). Patient also complains of severe sensitivity to cold. Patient not taking any medications other than the Nuvaring contraceptive (3 years) and vitamin C supplements daily. BP 121/85 pulse=85.

Patient presents with multiple fractures of maxillary incisors due to severe erosion. Enamel appears translucent not only on the lingual of the maxillary insisors, but also from the facial aspect. Patient is also a coffee drinker and is a professional swimmer. The dentist and I came to the conclusion that the patient was suffering from erosion from a combination of bulimia, coffee, and chronic chlorine exposure.

Oral Cancer Screening: Within Normal Limits

Periodontal Screening: Patient presents with localized pocket depths of 4mm and 5mm on the mandibular molars. Patient has slight bleeding on probing. Generalized slight marginal inflammation. No furcation involvement and no tooth mobility.

Calculus: Patient presents with generalized moderate subgingival calculus.

Assessment of Oral Health Knowledge

Patient Education: Both the dentist and I both explained to the patient that there were some changes that she would have to make in order to arrest the current effects of the erosion. The patient was extremely interested in making an effort to turn her oral health around. I advised the patient to seek a support group to manage her bulimia, which she said she had stopped for 3 months. I also gave the patient a list of therapeutic recommendations to help her control the erosion and sensitivity. Among these, I chose to use Colgate Sensitive Pro Release paste before scaling, to ensure patient comfort. After scaling, I applied 5% NaFl varnish to help remineralize the enamel and to aid in desensitizing the teeth. The patient was advised not to brush her teeth right after consuming coffee, and to wait at least an hour before brushing.

I recommended Sensodyne pronamel, although I think she would really benefit from a prescription fluoride toothpaste such as Prevident 5000. I also recommended she use Act fluoride rinse for 1 minute once a day. I taught this patient how to brush properly using the modified bass method, and I also taught her how to floss. I introduced her to an oral B powerbrush as well, which she took a strong liking to.

Treatment Planning: Based on the assessment the patient was classified as a Medium type 1 case value. In collaboration with my faculty member, we decided it was best to give the patient a referral to take care of her erosion. We mentioned different options such as veneers, implants, and crowns, and we gave her a list of hospitals and clinics where she could find appropriate care.

My treatment plan consisted of:

Visit #1: OHI (brushing and flossing), Colgate Sensitive Pro Relief prophy paste, hand scale LR, UR and expose FMS (20)

Visit #2: OHI (review), hand scale LL, UL, 5% Nafl varnish.

Patient Management: For patient comfort I used Colgate Sensitive Pro Relief prohy paste. I also hand scaled instead of using the cavitron due to severe sensitivity to water and the vibration of the tip.

Implementation of treatment

Incisal edges appear radiolucent especially on maxillary incisors.

Radiographs confirm the severity and extent of the erosion. The incisal edges of the teeth are radiolucent on the radiographs. It is very hard to tell if caries are present or not due to the varying densities of enamel.