Case I: Patient who presented with a medical condition:
Case II: Arestin Patient:
Recare visit. Mr. R. 80 year old Caucasian male presented for a recare visit. He is in good health.
Medical History: WNL – last physical exam in October 2018 (regular checkup). Patient is under the care of a specialist after cataract surgery done on his right eye in February 2016. Mr. R. was diagnosed with hypothyroidism 5 years ago. He takes Synthroid 0.5 mg 1xday. Patient also takes Aspirin 81 mg 1xday for more than 10 years, and OTC multivitamin supplements. Mr.R. is allergic to seasonal allergens, he has a slight ragweed allergy with symptoms like stuffy and runny nose. Pt smokes tobacco but very occasionally and is not interested in any cessation program. The patient has history of Hep B in 1978. His last dental visit was in December 2018, at that time a partial removable denture was made. Pt doesn’t use it, as it hurts during mastication. As per the patient he feels discomfort in the area close to #19 – pain when chewing and sensitivity to heat. His oral homecare includes brushing twice a day with soft manual toothbrush (modified Bass technique) and Colgate total toothpaste. Mr. R. rinses his mouth once a day with alcohol free mouthwash, and as an interdental aid he uses the thread floss and interdental brush.
Objective findings: Vitals: BP 112/65, pulse 53. ASA II. Extraoral exam was WNL, intraoral exam revealed an amalgam tattoo distal to the #30, generalized Fordyce granules on buccal mucosa, scar tissue approximately 1.5 cm by 2 cm on the alveolar crest ridge at the junction of the movable mucosa and at the ridge distal to #13. The scar was evaluated by an oral surgeon, biopsy didn’t show any malignancy. Fissured and geographic tongue. Slightly red and inflamed palatine tonsils. Dental chart was updated and reviewed. The patient has Class I canine occlusion bilaterally, overjet 3 mm, overbite 40%, generalized attrition.
Gingiva is generally pale pink, interdental papilla is generally blunted, slightly rolled gingival margin on #18-22, 27-30, non-resilient consistency, some stippling present, minimal BOP, exudate coming out of the buccal pocket of #19. Generalized PD 3-4mm, with localized 5-9mm, the patient has Grade I furcation involvement on #19 and #30.
The patient was light/II, localized type III based on radiographic evidence of bone loss, PD up to 9 mm.
Moderate caries risk due to exposed roots, visible plaque, and multiple interproximal restorations.
The patient appeared to be a good candidate for Arestin placement with PD 5-6 mm localized in premolar and canine areas. Radiographic evidence of bone loss on FMS exposed in 04/2018.
Treatment plan: Treatment was completed in one visit. Patient had to come back for Arestin placement a week later, and for reevaluation of treated areas 5 weeks after placement.
V1: OHI – reviewed flossing with superfloss for biofilm management around implants, scaled the whole mouth with the use of hand and ultrasonic instruments, used special instruments for implants. Engine polishing with fine paste. Exposed PA #6 and #18, both teeth have extensive bone loss up to 40%. The patient was advised to see his dentist in regards this matter and also for denture adjustment. Mr. R. is on three months recare.
V2 (a week after V1): The patient is present for Arestin placement. As per the patient he didn’t feel any discomfort in the previously scaled areas, he is in good health. No changes in Medical and Dental History. Brief EO/IO – WNL. He didn’t visit a dentist, but there was no pus on the buccal of #18.
Sites recommended for Aresin placement – #11(DF), #11(ML), #12(MF), #12(ML), #21(ML), #22(DL), #28(DL), #29(DL). Arestin Minocycline Hydrochloride was placed in 8 sites. The patient receved post procedural instructions. The patient is to come back for reevaluation in 4-5 weeks.
V3: Arestin Evaluation. Pt is present in good health. He was compliant with post procedural instructions. Brief EO/IO – pus reappeared in the buccal pocket of #18, the patient was strongly advised to see a dentist. The changes in PD of all 8 sites as follows: