In my two years at the city tech clinic I have most certainly encountered many patients. In ranges they range from about 4 year olds to people well past their 80s. I have seen various tooth abnormalities and heavily involved cases, yet none have moved me as much as one I had 2 weeks ago.

In April of 2013 a young lady sits in my chair. Her medical history checks out very well, she has no complaints in her mouth or any systemic disease. She has been to her physician in the past month and everything had checked out fine. She managed to tell me that she wanted to get her teeth checked before she started law school in the fall and was interested in a whitening. I explained to her that before we could even think of the whitening we had to make sure her oral health was healthy. I then went on with my intra and extra oral cancer screening and everything was within normal limits, I had no significant findings.

As soon as she smiled I knew I had a lot on my plate. Along the buccal surface of her maxillary anteriors she had a bridge of calculus. We quickly reviewed her oral hygiene habits and she claimed to floss occasionally and brush twice a day. I explained to her the importance of being thorough and brushing for enough time. Since I noticed that she was not bring effective in her brushing I recommended an electric toothbrush and we went over the different functions the electric toothbrush had to offer. She finally agreed to it and I moved on to the rest of the evaluations. As I feared this young lady had supra and sub gingiva deposit on literally every surface of every tooth. At age 22 she was a perio type II localized III with severe inflammation, 4 molars with furcations and bleeding. I had never seen a person so young compromised with such advanced disease.

Immediately an FMS was taken which only confirmed the severity of the disease. She was very compliant and I was able to proceed to her place score which was poor. We went along and reviewed flossing and the efficiency of an electric toothbrush. Finally I proceeded with treatment, which was certainly not easy. Even when she was touched with the probe her gums would just gush blood. Using hand instruments was not easy but her deposits were soo deep and tenacious that they were essential. Managing the bleeding was the most challenging aspect in this case. The blood covered the entire surface as soon as it was touched making sub gingival insertion very challenging.

On the first visit her radiographs were taken and two quadrants were completed. The bleeding was unbearable and the patient was quite uncomfortable with the blood. She claimed she had never bleed while she brushed or at any other dentists office. Then I saw her two weeks later and was happy to document that her plaque score had dramatically deceased by 50%. She followed up on her home care and the side scaled in the previous appointment had healed very nicely. I finished debriefing her and gave her a referral to a periodontist. After all her cal was a generalized 6-7mm with generalized 2-3 mm recession.

This case was certainly complex in terms of the amount of work necessary to complete her. Yet most of all her young age and lack of care was what surprised me. Hedge was a very young obviously intelligent and very educated young lady who was negligent towards her own oral health. Yet I feel like I made a difference and she wholeheartedly has taken the steps onto becoming more consciencious of her health.