Comprehensive

Care Project
Tang Blanton
Jose Mendez
 Patient Profile

32 year old Hispanic Male

BP: 124/84 mmHg Pulse: 66 Respiration: 18

Chief Complaint:
I have cavities and one front tooth fell off. Theyre
also yellow and dont feel smooth.
Medical Assessment
Medications:
Acetaminophen - Analgesic (As needed)
Aspirin - Salicylate, antiplatelet agent (As needed)
Prolongs bleeding for 7-10 days
Fish Oil - Omega-3 Fatty Acids (Daily)
Prolongs bleeding in doses above 1000 mg
Marijuana (Once per week)
Multivitamin (Daily)
Medical Assessment

Most recent physical exam was 10 years ago

History of prehypertension

No history of other systemic diseases

ASA II
Periodontal Assessment
AAP: Generalized Severe Chronic Periodontitis
Calculus: Maxillary arch 5-Medium-Heavy
Mandibular arch 6-Heavy
Probing depths
Generalized 4-6 mm pockets
Recession:
2mm recession: #4L, 6F, 8F, 9F, 13L, 15L, 17F, 17L, 21L, 22F, 26F, 27F, 28F,
31F, 31L, 32F
3mm recession on: #13F, 16F, 19F, 20F, 23F, 24F, 25F, 29F, 31F
4mm recession on #20L, 21F, 21L, 24L, 25L, 26L, 29L
5 mm recession on #12F
Clinical Attachment Loss (CAL):
Generalized 5-7 mm attachment loss
Periodontal Assessment
Furcation Involvement
Class I: 15B, 19B, 19L
Class II: #2B, 31B
Class III: #30 B and L
Mobility:
Physiological mobility: #1, 2, 4, 10, 11, 12, 16, 17, 20, 21, 27, 28, 30, 31, 32
Class I mobility: #5, 8, 9, 13, 19, 22, 23, 24, 25, 26, 29
MGI: None
Bleeding on Probing: 100%
Plaque Index: 97%
Radiographs
Preventative Dental Hygiene

Caries Assessment - CAMBRA

High Caries Risk
Multiple active carious
lesions
#1-0, 9-ML, 15-O,
19-OB, 20-O, 21-O,
29-MO, 31-B
DMFS = 32%
3 or more between meal
snacks per day
Frequent soda, consumed
over 1 hour or more
Preventative Dental Hygiene

Recommendations:
5% NaF varnish at each periodontal maintenance
Twice daily 1000 ppm fluoride dentifrice
Once daily 0.05% NaF mouthrinse
Once daily 5000 ppm fluoride gel

Educate patient about sugar and caries process

Motivate improved oral hygiene
Patient Education
Current Status:
Limited oral hygiene knowledge and low motivation
Brushes once per day with large scrubbing motions, misses areas
Does not floss
Chronic sleep deprivation - often falls asleep without oral hygiene
Oral Hygiene Instruction
Increase brushing and flossing frequency
Modified Bass toothbrushing
C-shape flossing
Patient Education
Nutritional Counseling
Deficient in vitamins A, C, D, E, and K
Kale, broccoli, green leafy vegetables, avocado,
spinach, sweet potato
Deficient in magnesium and potassium
Green leafy vegetables, sweet potato, beans,
avocado, spinach
Smoking Cessation
Smokes marijuana weekly
Not interested in quitting
Treatment Plan
Quadrant SRP with Anesthesia
9-1-16 LLQ - abscess on #24-L, Heavy calculus
9-8-16 ULQ
9-15-16 LRQ - Heavy calculus
9-29-16 URQ
Re-evaluation
10-25-16 & 11-20-16
Scale residual calculus, selective polish, 5% NaF varnish
Desensitization, locally delivered antimicrobials
Referrals
Refer to DDS for restorative care post-hygiene therapy
Refer to oral surgeon for extraction of root tips
Refer to periodontist for severe periodontitis
Treatment Progress
Tissue Resolution
Gingiva pre-treatment: reddish-blue, bulbous, spongy, hemorrhagic
BOP pre-treatment: 100%
Gingiva post-treatment: pink with interproximal inflammation
BOP post-treatment: 4%
Patient Compliance:
Plaque score pre-treatment: 97%
Plaque score post-treatment: 31%
Oral hygiene has improved, but is still poor
Additional Therapy
3 month periodontal maintenance
Intraoral Photos
Before After
Treatment Progress
Prognosis: Poor-to-questionable
Poor compliance with oral hygiene
25-50% attachment loss
Class II and III furcation involvement
Probing depths improved, but still 5-6 mm on molars
Good compliance with scheduled appointments
Interesting Experience
Managing a chronically sleep deprived patient
Fell asleep at each treatment appointment
Mouth prop
Difficult to motivate
Falls asleep without performing oral hygiene
Power toothbrush
Incorporate oral hygiene into existing daily habits
Chronic sleep deprivation promotes inflammation and
disrupts immunity
Works Cited
1. Beck, J., Youngblood, M., Atkinson, J., Mauriello, S., Kaste, L., & Badner, V. et al.
(2014). The prevalence of caries and tooth loss among participants in the Hispanic
Community Health Study/Study of Latinos. The Journal of The American Dental
Association, 145(6), 531-540. http://dx.doi.org/10.14219/jada.2014.25
2. Grover, V., Malhotra, R., & Kaur, H. (2015). Exploring association between sleep
deprivation and chronic periodontitis: A pilot study. Journal of Indian Society of
Periodontology, 19(3), 304. http://dx.doi.org/10.4103/0972-124x.154173
3. Los Angeles Department of Water & Power, (2013). L.A.'s Drinking Water Quality
Report (pp. 10, 12). Los Angeles Department of Water & Power. Retrieved from
http://terrabellawater.com/wp-content/uploads/2014/08/LADWP-2013-Drinking
Water-Quality-Report.pdf
4. Rawal, S., Tatakis, D., & Tipton, D. (2012). Periodontal and oral manifestations of
marijuana use. The Journal of The Tennessee Dental Association, 92(2). Retrieved
from
https://www.researchgate.net/publication/235667400_Periodontal_and_oral_manifestat
ions_of_marijuana_use
5. Sheiham, A., & James, W. (2014). A new understanding of the relationship between
sugars, dental caries and fluoride use: implications for limits on sugars consumption.
Public Health Nutrition, 17(10), 2176-2184.
http://dx.doi.org/10.1017/s136898001400113x