Case study #2 (allergy and smoking)

Profile and health condition:

  • This 23-year-old Asian female presents for a dental examination and cleaning due to her gum bleeding and inflamed. She indicated having smoking 1 cigarette per day and allergy to alcohol.
  • She reports brushing his teeth twice a day with an electronic toothbrush and Marvis toothpaste. Beginning to use Listerine antiseptic mouthrinse3-4 times/ day about 2 weeks due to gum bleeding. She does not floss and clean the tongue.
  • Vital sign: BP is 86/62, pulse 53. It is corresponding to Normal BP.
  • ASA 2 due to alcohol allergy and smoking.
  • Patient indicates neither take any medications nor alcohol.
  • Her Last dental exam and cleaning 3 years ago in her home country (China). No X ray history.

Summary of clinical findings:

  • Extraoral examination: No significant findings
  • Intraoral examination: bilateral linea alba. Scalloped tongue and redness tonsil area.
  • Dental charting: bilateral occlusion I. 2mm overjet. 10% overbite.
    • Localized attrition on posterior teeth.
    • Missing teeth: #1, 16, 17, 32
    • Suspicious caries: #3-OL
    • Fracture on#14-DO and #19-BO
  • Gingival description and periodontal status: Generalized bright red, flaccid thickened gingival margin with bulbous interdental papillae, tissue shiny in appearance. Generalized 4-5mm PD with localized 6mm PD on the posterior teeth. Generalized heavy bleeding.
  • Calculus statement: Generalized heavy subgingival rough/grainy calculus with clickable calculus in the posterior teeth and moderate supragingival visible calculus. Localized brown stain on the posterior teeth.
  • Radiographic statement: exposed BWS and Pano on 3/2024. Radiographs show generalized 10% HBL and generalized heavy subgingival calculus. No suspicious caries. Impacted teeth #16. Pano states filling on #8-ML and #9-M
  • PI: 1.2 ( poor)

Dental hygiene diagnosis:

Through completing all the assessments, patient is at a high risk for caries due to smoking. Patient was active generalized heavy periodontitis stage 1 grade B due to 4-5mm pocket depths, heavy BOP. Radiographic evidence of 10% HBL and patient smokes 1 cigarette per day.

Dental hygiene care plan and Treatment:

  • Referral form was given to a patient for evaluation suspicious caries and impacted teeth. Recommended to see dentists for evaluation of night guard due to bruxism on the posterior teeth.
  • After the CAMBRA assessment, patient was instructed to smoking cessation.
  • The patient was taught to use floss holder more easily than dental floss due to patient ‘s long fingernails.
  • 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.
  • Local anesthesia administration: 1.7ml 2% Lidocaine with 100,000epinhrine due to patient’s extremely sensitivity.
  • 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
  • Hand scalers: posterior Sickle , Nevi 4 posterior scaler
  • Horizontal, vertical and oblique debridement strokes were used for calculus removal.

Evaluation and reflection

The patient’s increased interest in oral hygiene care is a positive development, especially with her commitment to smoking cessation and adopting a desensitizing toothpaste. These changes reflect a proactive approach towards improving her oral health. Through regular follow-ups and evaluations of her oral home care routine, noticeable improvements were observed during each visit, indicating her dedication and efforts in maintaining better oral hygiene despite initial resistance. During her scaling procedure, I felt confident in performing the treatment with local anesthesia, and the patient tolerated it well. To aid in the recovery process post-scaling, I recommended rinsing with warm saltwater about one week after the procedure. This simple home remedy can help soothe the gums and promote healing. Overall, the patient’s progress demonstrates the effectiveness of  patient education in achieving positive outcomes in oral health.