Patient Assessment:

Patient has no history of medical conditions is a nonsmoker. During the dental history he complaint of having frequent bleeding after toothbrushing. Not on any medications. vital signs: BP:122/88 P:111.

During dental charting patient had generalized composite, amalgam restorations and PFM on tooth # 17. missing first mandibular molars. Abfraction on tooth # 12.

Oral Cancer Screening: No significant findings.

Periodontal Screening:

Patient had generalized 5mm-6mm pocket depths with localized 7mm. localized recession on mandibular facial incisors. Severe bleeding upon probing with severe inflammation. No furcation involvement or mobility patient was recommended to take a FMS to evaluate the severity of boneless. After exposure patient had generalized moderate boneless, no inter proximal caries or pathology.

Calculus:

Patient had generalized subgingival and supra gingival calculus mainly on inter proximal surfaces and mandibular lingual incisors. Decided to use the blue insert cavitron and universal curet as well as the sickle scaler.

Patient education:

Based on the gathered information and his severe periodontal case I demonstrated him a waterpik flosser which sprays water and deplaques inter proximal surfaces. I also suggested him to use antiseptic listernine to reduce bleeding and inflammation. Instead of using a manual toothbrush I suggested him to use a power toothbrush, so he would not cause any more abfractions or recessions due to severe pressure against the tooth surfaces. Patient was understanding his bleeding issue and was really motivated to make a change on his oral hygiene he was glad to finally understand what was actually going on in his mouth.

Treatment Planning:

After gathering all information he was classified as a heavy/type III due to his recession, localized 7mm pocket and boneloss. I discussed with patient a 2 visit cleaning just because his severe pocketing and tenacious calculus. I decided to use apply oraquix 2.5% lidocaine/ prilocaine just to desensitize the areas I was to scale. Visit one: An FMS 20 films was exposed I scaled the UR and quadrant only, there was severe bleeding I mainly used the universal curet to be able to reach deep down underneath the deposit. Visit two: I scaled the remaining three quadrants using the cavitron. I hand scaled the areas where recession was present just to make the patient feel more comfortable I still applied oraquix. during scaling there was severe bleeding which limited me access to the deposit. Gave patient a referral to a dentist to evaluate clinically seen caries. Recall 4months.