Profile:

• This 37-year old African-American male presents for a dental examination and cleaning. He reports he suffered a beaten a year ago due to fight accident and his anterior teeth got loosen and some teeth got infection without dental treatment
• He reports brushing his teeth twice a day with a manual soft toothbrush and Colgate fluoridated toothpaste. He uses antiseptic mouth rinse twice a day. He does not floss and clean tongue. He reports having sensitivity to cold around #7.

Health history overview:

• Vital sign: First reading of Blood pressure: 132/94, pulse 64. After 5 minutes, the second reading of BP is 138/99, pulse 67. It is corresponding to Hypertension stage II. ASA 2.
• Patient indicates his physician made note of this last year, but he didn’t recommend any treatment. He indicates he does not take any mediations, no allergy, neither smokes nor drinks. His dental exam and cleaning was done on 6/2023 with X ray for checking tooth mobility.

Summary of clinical findings:

• Extraoral examination: 4x2mm brown scar on the middle of nose
• Intraoral examination: bilateral linea alba. High and narrow hard palate. 2x2mm red with white center regular border round pustule between apical of #24 and #25.
• Dental charting: bilateral occlusion I . 9mm overjet. 100% deep bite.
  • Localized attrition on mandibular anterior.
  • 8 missing teeth: #1,10,16,23,26,27 &32
  • Composite: #31-O , #8 and 9-L
  • Amalgam: #2-O and #15-BO
  • Flaring and chip on #8 incisor.
  • Diastema from #6-10 and #24 and 25.
  • #24 and #25 had mobility class II
• Gingival description and periodontal status: Generalized pigment, spongy, shiny rolled gingival margin with bulbous interdental papillae. Localized margin 2mm apical to CEJ in #8. Generalized 3-4mm PD with localized 5-6mm PD on the posterior teeth. Generalized Moderate Bleeding.
• Calculus statement: Generalized heavy subgingival rough/grainy calculus with clickable calculus in the posterior teeth and moderate supragingival visible calculus. Generalized moderate stain.
• Radiographic statement: exposed FMS on 2/2024. Radiographs show generalized 15% HBL and subgingival calculus. #17 impacted teeth. #8 and 9 RCT. Periapical RL #24 and 25. Widened PDL on #7,11, 27. No suspicious caries.
• PI: 1.5 ( poor)

Dental hygiene diagnosis:

Through completing all the assessment, patient is at a high risk for caries due to multiple risk factors. Patient was active generalized heavy periodontitis stage 3 grade B due to mobility teeth #8 and #9, 5-6mm pocket depths, moderate BOP. Radiographic evidence of 15% HBL and missing teeth.

Dental hygiene care plan and Treatment:

• Referral form was given to patient for evaluation of high blood pressure and impacted teeth. Recommended to see his physician how to control his blood pressure.
• After the CAMBRA assessment, the patient was instructed to change a diet ( less sugar taking)
• The patient was taught the using effective ‘C’ shape dental floss technique on the posterior teeth twice a day, also patient exhibited type 2 embrasure which indicated a proxy brush was the best choice of interdental aid. Educated Bass and Modified Bass Methods toothbrush techniques.
• The patient was instructed to use Sensodyne sensitivity and gum sensitive toothpaste in replacement of his current toothpaste 2X daily and to incorporate using tongue cleaner into his routine hygiene.
• Performed engine polish with a medium prophy paste to remove hard tissue stain and applied 5% NaF Varnish with patient instruction to remineralize any areas that have been demineralized at the end of his treatment.
  Preventative service—periodontal maintenance : 3months recalls.

Debridement:

• Ultrasonic: used powerline 1000 and slimline 1000 — instrument allowed removal of supragingival and subgingival calculus in areas the patient had 4+ mm pocket depths as well as on the areas with moderate to heavy calculus.
• Hand scalers: Gracey 1/2, 11/12, 13/14. Barnhardt 5/6, Nevi 4 posterior scaler
• Horizontal, vertical and oblique debridement strokes were used for calculus removal.
• Performed Local anesthesia to relieve pain
• The goals of treatment was to remove all the calculus with ultrasonic and hand scaler.

Evaluation:

The patient is not interested in oral hygiene care because on the second visit, his teeth built up a lot of plaque/biofilm in quadrant 1 where it was previously scaled. I kept encouraging him and reviewing the brushing and flossing techniques at each visit. I also informed him that unhealthy or bleeding teeth may cause inflammation and tooth mobility. Additionally, I evaluated his high blood pressure at each visit. I introduced the connection between high blood pressure (hypertension) and oral health, emphasizing its importance in comprehensive healthcare. It influences gum disease and can affect other parts of the body, potentially impacting cardiovascular health. Furthermore, I recommended that the patient promote healthy lifestyle choices such as a balanced diet low in sugar and processed foods, and regular exercise. These lifestyle changes can benefit both oral health and blood pressure management. He was very happy to hear and accept my advice. Hopefully, his oral care will make a significant difference.

Reflection:

The presence of tenacious calculus on the deep pocket posed challenges in complete removal, requiring careful and thorough scaling. I utilized specialized instruments  with Ultrasonic scaler to effectively remove the tenacious calculus. Local anesthesia was administered to ensure the patient’s comfort throughout the procedure. The scaling procedure yielded positive results, significantly improving the patient’s oral hygiene and overall dental health. This experience reinforced the importance of thorough scaling techniques and effective patient communication in delivering quality dental care.