Case Study II

53 year old Asian male BP: 118/83 P: 70.
Pt. has never had a dental cleaning.
Med Hx: Positive for Hepatitis B and is currently taking Entecavir 0.5MG daily.
Pt. states that he smokes 1 pack of cigarette daily.
EOIO: Within normal limits. Dental Charting: Missing #19 and #30. Fracture on #7.
Perio: Generalized 2-3 mm on anterior teeth and 3-5 mm on posterior teeth with moderate bleeding upon probing.
Furcation: Grade I. No tooth mobility.
Patient’s gingiva was white and pale with bulbous interdental papilla.
Calculus: Generalized heavy subgingival calculus, supragingival calculus on mandibular anterior- lingual aspect.
Patient also had generalized heavy staining.
Patient is H/II because there was slight bone loss as evidenced by FMS. FMS revealed calculus deposits, slight bone loss, and no carious lesions.
Treatment: V1: Pt. was taught the proper brushing method using an electronic toothbrush. Pt. was also educated on the
detrimental effects smoking can have on the oral cavity. Recommended pt. to rinse 2x/day with Listerine.
V2: Pt. was taught to floss using the proper technique.
Patient was scaled using hand instruments and ultra sonic inserts. Pt. was not air-polished to prevent aerosols due to medical condition.
When patient came back for a second visit, staining on previous scaled areas had reappeared and there were no changed in the gingival tissue.
Although pt. was educated on the effects smoking can have on the oral cavity, pt. refused to quit.
Pt. was placed on a 3 month recare appointment.