Allergic to nuts and fruits
A 32 year-old Asian male patient presented for a dental cleaning and patient reported allergic to nuts and fruits. Patient informed the specific nuts and fruits that he was allergic to such as walnut and pine nut. As well as green kiwi, cherries, peaches, apricot. ASA 2.
Patient reported noticing gum bleeds when he brushes, once in a while. Patient informed that he has sensitivity to sour food, and a weird sensation feeling on his molar region. Patient last radiographs was taken in 2021 in the dental office that he visited. Patient’s reported oral regimen was once a day usually in the morning for 5 minutes with an Oral B toothbrush and changes the toothbrush head every 3 months, and does not floss but uses Listerine alcohol mouth rinse 2-3x a week.
After the assessments in patient’s dental charting I have found localized attrition on the anterior region, and mandibular crowding on the anterior region, also localized BOP. Based on the probing depth with generalized 2-4mm and localized 5mm on the posterior. I have discussed with the faculty that I would like to expose a 4VBWs with informed consent from the patient.
For treatment, since findings of heavy supra gingival and subgingival calculus, patient’s case value was classified as Heavy. Patient was scheduled for 3 visits, the first visit completed assessments and exposed radiographs. During second visit scaled Q1 & Q4 with ultrasonic and hand scaled. For pain management I provided Oraqix because of patient’s sensitivity and for patients comfort, patient responded well. Third visit evaluated Q1 & Q4, and scaled Q2 &. Q3, engine polished and applied fluoride, because patient is allergic to pine nut I did not apply 5% NaF fluoride varnish but applied 1.23% fluoride gel.
After exposure, I noticed furcation on #30 and a radiolucency on the mesial portion. Therefore after discussion with the faculty, I took a PA on tooth #30, and saw the radiolucency throughout #30 mesial. I informed patient of the findings and written a referral on the finding, and provided the patient with a copy of the radiographs on a USB flashdrive. OHI demonstrated were modified Bass brushing technique and C shape flossing technique, emphasized the importance of the interdental aids and the frequency of brushing and flossing.
