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Dental Hygiene Clinical Practice II Kaite Manganaro

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Patient Profile 51 year old Caucasian female Health history reveals : No medications Vitals WNL Environmental allergies- Hay Fever, dust, trees Food allergy- Strawberries (carries EpiPen) Job related stress Previous depression (2002) ASA Class II Dental history reveals: Brushes 1x daily with manual soft toothbrush Flosses 1x monthly Slight dental anxiety #30 extracted approx. 25 years ago Sensitivity to pressure #13 Cold sores/canker sores approx. 2-3x per year Bruxism mostly at night, sometimes during the daytime Very strong gag reflex Last hygiene visit was 6 months ago

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Extraoral and Intraoral Examination Findings Lips: Slight dryness, fordyce granules Bilateral slight linea alba Small bilateral 1mm bite trauma and on apex of tongue Low maxillary frena attachment, causing diastema Generalized slight attrition Localized abrasion on #21 Slight decalcification on molars Slight recession on mandibular anteriors Slight clefting on buccal #21 Angles Class I Occlusion (Right molar N/A) #2 and #14 in torsoversion Overbite 60% Overjet 1mm

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(Cleft on buccal of #21)

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Furcation Involvement on #3 and #14 No mobility Mucogingival involvement #20 BOP #s 3, 4, 5 7, 10 and 24 Generalized slight spicules of supra and subgingival calculus Generalized slight interproximal biofilm Plaque Control Record was 23% (Last appointment) Generalized slight yellow stain Hypersensitivity to pressure on the distal of #13

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Generalized pale pink with localized marginal redness #6 #7, slightly enlarged tissue on the maxillary URQ, slight recession on mandible, rounded tissue with localized clefting on the buccal #20, stippling and edematous tissue type

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Contributory Factors: Calculus Food impaction Position of teeth/malocclusion Un-replaced teeth Periodontal Risk Factors: Hormonal involvement Stress Nutritional deficiencies

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Radiographs

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Generalized slight bone loss with slight to moderate bone loss on the mandible Amalgam restoration present on buccal of #19 Overlapping on the maxillary canine shot, the maxillary lateral incisor shot, slight distomesial overlap on #20 #21 Furcation involvement #3, #14, #19 Grade 1 No calculus present radiographically AAP II

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Generalized slight inactive chronic periodontitis with generalized moderate inactive chronic periodotitis on the mandible, localized slight active periodontitis URQ #3, #4, #5, #7, and #10

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APPOINTMENT ONE MEDICAL HISTORY: Reviewed, no contraindications to treatment PATIENT ASSESSMENT: EOE, IOE, dental charting, started GMs on periodontal assessment APPOINTMENT TWO MEDICAL HISTORY: Reviewed, no contraindications PATIENT ASSESSMENT: Cursory EOE & IOE, completed periodontal assessment & gingival description APPOINTMENT THREE MEDICAL HISTORY: Reviewed, no contraindications PATIENT ASSESSMENT: Cursory EOE, IOE, deposit assessment

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APPOINTMENT FOUR MEDICAL HISTORY: Reviewed, no contraindications PATIENT ASSESSMENT: Cursory EOE, IOE BIOFILM INDEX: 34% RADIOGRAPHS: Intra-oral photos DEBRIDEMENT: Power driven ULQ OTHER INSTRUCTION: Gave patient home care instructions to brush 2x daily, floss 1x daily before brushing, continue using ACT mouth rinse 1x daily. Recommended & demonstrated Modified Stillman & proper flossing technique. Went over treatment plan, Pt. responded well APPOINMENT FIVE MEDICAL HISTORY: Reviewed, no contraindications PATIENT ASSESSMENT: Cursory EOE, IOE, Re-assessed ULQ BIOFILM INDEX: 20% DEBRIDEMENT: Completed URQ with Catvitron and hand scaling

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APPOINTMENT SIX MEDICAL HISTORY: Reviewed- no contraindications PATIENT ASSESSMENT: Cursory IOE, EOE, Re-assessed previous quadrants BIOFILM INDEX: 40% DEBRIDEMENT: Power driven on LRQ, started LLQ FINAL APPOINTMENT MEDICAL HISTORY: Reviewed, no contraindications PATIENT ASSESSMENT: Cursory IOE, EOE BIOFILM INDEX: 23% DEBRIDEMENT: Power driven LLQ OTHER DENTAL HYGIENE SERVICES: Motor polished full mouth- Fine pumice FLUORIDE: "Gelato" foam fluoride w. xylitol tray for 4min, Pt. was given instructions to not eat/drink/brush for a half hour afterward RECARE: 4-6 weeks re-eval and 3 MTH recare

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This was such a rewarding case. I gained a better understanding of process of care, patient management, and worked on refining my skill. After looking at the patients radiographs, I realized my GM recordings were off & do not reflect the perio status of the patient. I believe this is due to my inexperience at the time. The 6 week re-evaluation was wonderful. The patient gained some attachment and I was unable to accesses the previously found furcations. The was also noticeable improvement to the color and contour of the gingiva. The patient also had a lowered plaque index score and was continuing recommended home care. It was such a great feeling seeing how my treatment and instruction, can make a difference.