Demographics:

– 64 year old

–Caucasian

-Female

Assessment:

-Blood Pressure: 106/68, Pulse 72.

-ASA II: Patient takes Claritin – 10 mg as needed for management of seasonal allergies.  Patient has no known drug allergies, no recent hospitalizations, and doesn’t report any other systemic conditions.

-EO/IO: Maxillary torus, Bilateral mandibular tori.

-Occlusion: Bilateral Class I occlusion with 40% overbite and 3mm overjet.

-Home care: Patient reports brushing twice a day in the morning and at bed time, doesn’t floss, and doesn’t use an antiseptic mouth rinse.

-Deposits: Generalized moderate subgingival calculus. Localized moderate supragingival deposits on lower anteriors. Little to no staining observed.

-Plaque: Patient had a plaque score of 1.0 (Fair).

– Generalized pink, firm, gingiva. Stippling observed in anterior regions.

– Type II – Localized Type III Periodontitis, with radiographic evidence, due to generalized 3-6mm probe depths, slight bleeding upon probing, and recession on lower anterior teeth.  No furcation activity or mobility present.

Planning

I was able to formulate the treatment plan and obtain informed consent in the first visit. The tx plan was to scale two quadrants per visit.

Treatment plan was as follows:

V1: Expose radiographs. Plaque index. OHI: Introduce the use of proxy brushes. Scale UR quadrant to completion using the ultrasonic and hand scalers.

V2: Plaque index: OHI:  Introduce the use of an electric toothbrush. Re-evaluate UR quadrant. Scale LR/UL/LL quadrants to completion using the ultrasonic and hand scalers.

V3: Re-evaluate entire dentition for residual calculus. Place Arestin in required sites.

V4: Evaluate Arestin 4-6 weeks after Arestin placement.

Implementation:

V1: Patient was able to bring a copy of FMS radioraphs exposed within the last year (November 2018).

Plaque index was performed. This patient’s plaque score was 1.0 fair. Majority of plaque build up was observed on the cervical third of the lingual surfaces of all teeth.

OHI: Patient was taught the proper use of an electric toothbrush. Patient was able to correctly re-demonstrate what she was taught. Patient seemed motivated to purchase an electric toothbrush.

Scaled UR quadrant to completion using the ultrasonic and hand scalers. 20% Benzocaine topical anesthetic was used for patient comfort. Patient tolerated procedure well.

V2: New plaque index was performed. This patient’s plaque score decreased to 0.6 (Good). A decrease in plaque/biofilm build up was noted. This was most likely due to patients incorporation of an electric toothbrush into her daily regimen.

OHI: Patient was taught the use of proxy brushes. Patient did not seem motivated to continue this method, so I introduced the Waterpik an alternative. Patient stated that she would rather stay “old school” and floss. Thus, patient was taught the proper flossing method.

Re-evaluated UR for residual calculus. No residual calculus was observed.

I scaled the UR/UL/LL quadrants to completion using the ultrasonic and hand scalers. Polished entire dentition with fine paste. 5% Fl varnish treatment was applied.

V3: After a week, patient came in for evaluation and Arestin placement. Arestin was placed in  5 sites with 5-6mm pockets on the UR region. Patient was given post operative instructions for Arestin. These instructions include;

• No eating or drinking for 30 minutes after this appointment.
• Wait 12 hours after treatment before brushing.
• Wait 10 days after treatment to begin interdental care.
• Avoid chewing gum or eating sticky foods for 1 week.

V4:  Patient came in for a short appointment to evaluate Arestin.  Probe depths were assessed. Findings from this evaluation are listed below.

Evaluation:

Patient was very responsive to Arestin treatment. All probe depths decreased by 1-2mm. Patient was pleased with the results and scheduled to return for Arestin placement on the UL, LL,LR quadrants.

-The patient was compliant with OHI recommendations. Gingival tissue of areas scaled appeared pink, resilient, and pointy.