Focused Case Study

Leslie Bebber
Summer 2009
Clinic Practice
 Background Information

19 yr old Caucasian female

Lower middle socioeconomic status

No medications

ACL surgery: numbness of upper calf
 Past Dental Treatment

Prophy 5+ yrs ago

Ortho 5+ yrs ago

No fillings

No extractions

Sealants as a young teenager

Note: lingual bar came off and the lower anterios
shifted back

question abount dental charting
 Chief Complaint

Patient states that she is extremely embarrased of the
way her mouth smells.

Patient also states she wants to get her teeth straight
and white.
 Gingival Description

Red, edematous, bulbous,soft, smooth and shiny in
the lower anterior region
 Anxiety and Dental Conerns
Assessment

Moderate anxiety with a score of 10

Dental concerns: cost, being put down or lectured to
and embarrassed about the condition of her mouth

Note: discuss what we talked about
 24hr Dietary Recall

Sips on Dr. Peppers all day

Does not consume many sweets

Not a big snacker
 Oral Risk Assessment

Caries visible on xrays

Crowding in lower anteriors

Brushes 1x daily

Rarley flosses

Occasionally uses Listerine mouthwash
Note: Patient states she does not like to brush often because it
makes her gums bleed.
 Recommendations

Brush 2x daily, especially before bed with her Sonic
Care

Crest Pro-Health

Waxed floss

GUM soft pics after lunch

Listerine for 30sec 2x daily prior to brushing

Note: Patient has good dexterity
 Findings

Several 4mm pockets

No furcations or moblity

Attachment at the CEJ (above CEJ in lower anterior
except for # 25 Stillman's Cleft)

Mouth breather

Tongue thrust

question*
 Mouth Breathers

According to Wilkins mouth breathing causes
dehydration of oral tissues in the anterior region
which leads to changes in size, shape, surface,
texture and consistency.
 Etiologic Factors of Malodor

Intrinsic or Extrinsic

Extrinsic: absorbed into the circulatory system and
released through the respiratory system and saliva

Intrinsic: 10% systemic, 90% directly related to
intraoral sources

Daniel and Harfst
 O'Leary

93, 87 and 56

Generalized marginal and facial of lower anteriors
 Patient Education

Continual process

Discussed the bleeding gums and her source of bad
breath

Taught BASS method and proper flossing techniques

Gave patient a sample of GUM soft pics

Increasing brushing frequency

Discussed the link of oral health to her overall health
 Diagnosis

Gingivitis

Moderate BOP

4mm pockets on the distal and mesials of third
molars
 Pain Management

Anxiety was moderate on paper with of score of 10

Patient's mother expressed concern that patient did
not handle discomfort/pain well

Extremely sensitive to probing: used Benzocaine 20%

Oraqix for scaling

Iatrosedation
 Anticipated Outcomes

O'Leary of 20%

No BOP

Gingiva: pale pink, firm, knife-edged with papillae
that fill the interproximal space

Most importantly: no halitosis following treatment
with continued proper home care
 Instrumentation

Hand instrumentation, slim tip to deplaque

Most improvement needed with universal curette in
the premolar region

Patient's sensitivity, crowding and inflammed tissues
in the lower anterior created the most challenge

question*
Evaluation
 Self Assessment

Good communication with the patient

Patient was eagar to learn and asked good questions