Case Study I- Arestin Patient

Recare/M/II- 63 year old African American Male. No systemic conditions. Currently taking Vitamin C and Vitamin D. Patient is a non-smoker. No allergies. ASA I. BP: 125/73 P: 70. Patient presents with bilateral melanin pigmentation on the buccal mucosa, mandibular tori and raised circumvallate papillae . Amalgam and composite restorations fully intact. Gingiva is marginally inflamed, has melanin pigmentation, flat interdental papillae and firm. Generalized 1-2mm recession with localized 5-6mm pocketing and generalized 2-4mm. Patient is periodontal type II with moderate BUP. Active localized periodontal disease maxillary molars remainder of mouth stabilized.

Visit I: Completed all assessments. OHI, taught patient modified bass method of brushing and introduced the use of a proxabrush. Full mouth scaling with hand instruments and ultrasonic use followed by fine paste polishing and fluoride varnish 5% was applied. Evaluated need for Arestin and placed on #2-DL, #15-DB, #16-DB, #18-MB, #19-DB. Post operative instructions were given.

Visit II: Re-evaluation of Arestin placement, tissue response was positive and bleeding was reduced.  #2- DL improved( was 5mm no w 3mm) , #15- DB improved ( was 6mm now 5mm), #16-DB improved (was 6mm now 4mm), #18-MB improved (was 5mm now 3mm) and #19-DB improved( was 5mm now 4mm). Overall the Arestin was effective on this patient and his probing depths were all reduced along with his bleeding. The patient is on a 6 month recare and  improved homecare will allow  pocket depths to continue to decrease.


Case Study II-  Congestive Heart Failure Patient

Recare/Medium/II- 73 year old Caucasian male. Currently taking Metoprolol Succinate 100mg 1x daily and Enalapril 10 mg 1x daily to treat heart failure and high blood pressure. BP: 135/90 P:93. Patient reports being hospitalized for pneumonia . Upon reviewing chart patient history reveals he has had pneumonia 4 times in the past 5 years.Patient is a non-smoker. No allergies. ASA III. The patient presented with no significant intra or extra oral findings. Patient was missing several teeth and had few restorations. Gingival tissue was pink, marginally inflamed, flat interdental papillae and firm, resilient tissue with presence of stippling. Generalized 1mm recession. Probing depths ranged from 2-4mm with localized 5mm and no BUP. Medium calculus deposits were present and were removed by hand instrumentation. Due to chronic pneumonia ultrasonic use was contraindicated for this patient.

Visit I: Completed all assessments. OHI advised patient to use electronic toothbrush and demonstrated with Oral- B spin brush. Patient reports brushing 2x daily but presented with heavy biofilm and material alba, this toothbrush would be the most beneficial removal tool at home. Exposed digital FMS which revealed moderate bone loss making the patient type II. Radiographs also revealed PAP #21. Hand scaled full mouth with Graceys and Nevi instruments. Polished with fine grit paste and placed fluoride varnish 5% to help seal dentinal tubules.

Overall the patient was satisfied with the end result and due to his poor homecare I have placed him on a 4 month recare to interfere with the calculus buildup. Due to his current high blood pressure I have requested that he get a medical clearance prior to coming in for the next recare appointment. I also gave the patient a referral to DDS for evaluation of PAP #21 and treatment. If treatment not completed and medical clearance not given patient was made aware that he can not be seen in NYCCT clinic.