Patient with generalized severe attrition and erosion.
Demographics: Patient is a 34 year old Caucasian male.
Assessment: Vital signs: blood pressure 138/94 – hypertension stage I, pulse 71 beats per minute. Patient is allergic to dust. ASA II due to dust allergy, hyperthyroidism and possible hypertension. Patient suffers from Dermographism – sensitivity to touch (red spots appear on the skin surface after touch sensations). Patient takes Vitamin D once a week. Ortho treatment – Invisalign since October 2020. CC: “small teeth”, patient is not satisfied with his smile. Patient reports that recently has been coughing with blood coming out.
Social Hx: non-smoker, non-drinker.
Patient had physical examination in January 2020 and had a chest X-ray exposure done, patient states the readings of the Xray were WNL. Patient states he was working in the construction site recently without wearing a proper mask and was exposed to a lot of dust there. Patient is under the care of a physician for hyperthyroidism – patient does not take any medications for the condition.
Last dental visit was performed in July 2020, a few restoration were done, FMS was taken the same day. August 2020 PAN was exposed for the ortho treatment.
Oral home care: Patient brushes teeth about 5 times a day (due to Invisalign treatment) using electric toothbrushes. Does not floss. Does not use mouthwash.
- Extraoral findings: Multiple papules on the right upper neck ; enlarged thyroid ; red spots appear on the skin after touch sensations.
- Intraoral findings: Petechiae on the buccal mucosa left side.
Dental Assessment: Crowding anterior teeth. Small clinical crowns due to generalized severe attrition and erosion. Patient reports that from a young age to the age of 14 he had significant GERD and received medication for that condition. Invisalign attachments teeth 37-11, 21,22, 27, 28. Composite margins on maxillary and mandibular molars are worn out.
Class of occlusion II bilaterally; Overjet 5mm; Overbite 50%.
Gingival Statement: Generalized pink scalloped gingiva. Stippling present. Minimal localized gingival inflammation on mandibular anterior teeth – gingiva is red in color with rolled gingival margin; Localized BOP on maxillary molars.
Perio charting: Max PD is 4 mm on tooth #2. Generalized PD 1-3 mm.
Diagnosis of oral condition: Gingivitis. Light calculus/ Erosive tooth wear and severe attrition.
Planning and Implementation: Oral Hygiene Instructions: PI 0.3 – Good. Plaque is visible on mandibular anterior teeth lingual along the gingival margin. Full mouth scaling and root planing performed using hand instruments. Sodium Fluoride varnish 5% applied. Electric toothbrush technique is reviewed. Flossing demonstrated. Flossing technique demonstrated, patient understood, agreed and performed back. The patient was advised to start using Fluoride products to stabilize erosive tooth wear. Colgate Total SF was recommended and Listerine with Fluoride for the mouthwash.
Evaluation:
Treatment was performed within two visits. Revisit every 6 months recommended.
My reflection: As for a future hygienist, this case was a very valuable case to me. It was very important to think critically taking into consideration a patient’s medical conditions and make a fair decision about the treatment. The patient suffers from hyperthyroidism. Hyperthyroid patients are often anxious, with warm and sweaty hands. They also may have increased blood pressure and heart rate. It was important to evaluate my patient’s level of anxiety and blood pressure and make sure it is under control. Referral to the physician regarding hypertension was given. It was very important to consider his medical condition in case local anesthesia was needed. Epinephrine as a vasoconstrictor in local anesthetic drugs causes cardiovascular stimulation, and hyperthyroid patients can develop dysrhythmias or tachycardia. However, if local anesthesia is required, minimal cardiac doses of epinephrine should be administered. Patient presented with small clinical crowns due to severe generalized attrition and erosion. It was important to understand the underlying cause and if it is under control now. After interviewing the patient about his diet choices and any problems with acid reflux in the past, I found out that the patient had significant GERD as a teenager and received medication for that condition. It was important to make sure that this medical condition is being taken care of. The treatment went very well, and the patient had a positive attitude towards OHI.
