Download Periodontitis Project

PERIODONTITIS PROJECT
KELLY OLSEN
Dental Hygiene Clinical Practice II
PATIENT PROFILE
42 year old Caucasian female
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Health History
considerations:
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Vitals WNL
ASA II
No Medications
Cigarette smoker, 10x daily (since
1990)
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Dental History
considerations:
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4 wisdom teeth removed (1990)
Gums bleed when brush/floss
Sensitive teeth
Clench/grinds teeth
No nightguard
Gags easily
Medium toothbrush
Brushes 2x daily
Flosses 1x daily
The patient did not disclose dental
anxiety, but I suspected her to have
dental anxiety.
EXTRA ORAL AND INTRA ORAL
FINDINGS
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TMJ
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Clicking on left side of jaw
Molar right: class I
Molar left: class I
Canine right: class I
Canine left: class I
30% overbite
3.5mm overjet
Attrition
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OCCLUSION
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Decalcification
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#23, #26
Labioversion
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#31 (lingual and buccal)
Lingualversion
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#7 -#11
#22-#27
#24, #25
Enlarged papillae
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between #8 and #9
INTRA ORAL PHOTOS
MAXILLA
MANDIBLE
DENTAL CHART
DENTAL CHART FINDINGS
DENTAL CHART FINDINGS
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Extracted
 #1,
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#16, #17, #32
Suspicious caries
 #19,
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#21, #31
Sealants
 #20,
#21
Amalgum
 “OD”

#19
Composites
 “O”
#31
 “OB” #18
 “L” #10
PERIODONTAL CHART
PERIODONTAL EVALUATION
PERIODONTAL ASSESSMENT
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No furcations
No mobility
No MGI
No BOP
No Exudate
GINGIVAL DESCRIPTION
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Generalized pink shiny, smooth, spongy tissue with
localized stippling on the maxillary anterior teeth,
marginal redness, slight enlarged tissue, bulbous
margins with localized blunted papillae between
#7 -#10, #12-#13, #23 - #26
TISSUE TYPE: Edemadous tissue
FACTORS
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CONTRIBUTORY FACTORS
 Calculus
 Position

of teeth/malocclusion
PERIODONTAL RISK FACOTS
 Smoking
RADIOGRAPHS
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Tooth #2-3
#2 –slight vertical bone loss
#3 –slight horizontal bone loss
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Tooth #3-5
#4 –slight horizontal bone loss
#5 –slight vertical bone loss (distal)
slight horizontal bone loss (mesial)
with a ledge of calculus
RADIOGRAPHS
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Tooth #6-7
Tooth #6 –slight horizontal bone loss
Tooth #7 –slight horizontal bone loss
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Tooth #8-9
Tooth #8 –slight horizontal bone loss
Tooth #9 –slight vertical bone loss (mesial)
slight horizontal bone loss (distal)
RADIOGRAPHS
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Tooth #10-11
Tooth #11 – slight horizontal bone loss
Tooth # 12 – slight horizontal bone loss
(distal)
Tooth #13 – No bone loss
Tooth #14 – No bone loss
Spicule of calculus (mesial)
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Tooth #12-14
RADIOGRAPHS
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Tooth #15
Tooth #15 – slight vertical bone loss
(distal)
spicule of calculus on
mesial
Tooth #18 – slight vertical bone loss
(distal)
Spicule of calculus on
both mesial and distal
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Tooth # 18-19
Tooth #19 – slight vertical bone
loss
RADIOGRAPHS
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Tooth #20-21
Tooth #20 – No bone loss
Tooth #21 – Slight horizontal bone loss
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Tooth #22-23
Tooth #22 – Slight horizontal bone loss
(distal)
Moderate vertical bone
loss (mesial)
Tooth #23 – Slight horizontal bone loss
(distal)
Moderate horizontal bone
loss (meisal)
Spicule of calculus (mesial)
RADIOGRAPHS
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Tooth #24-25
Tooth #24 – moderate vertical bone loss
spicule of calculus (mesial and
distal)
Tooth #25 – moderate vertical bone loss
(mesial)
slight horizontal bone loss (distal)
spicule of calculus (mesial and
distal)
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Tooth #26-28
Tooth #26 – slight horizontal bone loss
spicule of calculus (mesial and
distal)
Tooth #27 – No bone loss
Tooth #28 – slight horizontal bone loss (mesial)
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Tooth #29
Tooth #29 – slight horizontal bone
loss
Tooth #30 – slight vertical bone loss
calculus on distal
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Tooth #30-31
Tooth #31 – slight horizontal bone
loss (mesial)
calculus on mesial and
distal
RADIOGRAPHS
BITEWINGS
Tooth #1-30
Tooth #3-28
Tooth #12-19
Tooth #14-17
RADIOGRAPH INTERPRETATION
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#1: Extracted
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#18: No bone loss (mesial), slight vertical bone loss (distal)
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#2: slight vertical bone loss
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#19: Slight vertical bone loss
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#3: slight horizontal bone loss
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#20: No bone loss
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#4: slight horizontal bone loss
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#21: Slight horizontal bone loss
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#5: Slight horizontal bone loss (mesial), Slight vertical bone
loss (distal)
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#6: Slight horizontal bone loss
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#7: Slight horizontal bone loss
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#8: Slight horizontal bone loss
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#9: Slight vertical bone loss (mesial), slight horizontal bone
loss (distal)
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#10: slight horizontal bone loss
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#11: Slight horizontal bone loss
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#12: No bone loss (mesial) Slight horizontal bone loss
(distal)
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#13: No bone loss
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#14: No bone loss, spicule of calculus on the mesial
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#15: Slight vertical bone loss (distal), spicule of calculus on
the mesial
#16 and #17: Extracted
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#22: Moderate vertical bone loss (mesial), slight horizontal
bone loss (distal)
#23: Moderate horizontal bone loss (mesial), slight
horizontal bone loss (distal), spicule of calculus on the mesial
#24: Moderate vertical bone loss, spicule of calculus mesial
and distal
#25: Moderate vertical bone loss (mesial), slight horizontal
bone loss, spicule of calculus on mesial and distal
#26: Slight horizontal bone loss, spicule of calculus on mesial
and distal
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#27: no bone loss
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#28: slight horizontal bone loss (mesial)
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#29: Slight horizontal bone loss
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#30: Slight vertical bone loss (mesial), slight horizontal bone
loss (distal), calculus on the distal
#31: Slight horizontal bone loss (mesial), no bone loss
(distal), calculus on the mesial and distal
PROCEDURES
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Appointment 1: Medical History, Vital signs, EOE,
IOE, Dental Charting, Began perio assessment.
Appointment 2: Finished perio assessment.
Appointment 3: Re-did Perio assessment. I was
hitting ledges of subgingival calculus and the pocket
depth were actually larger than I had thought.
Appointment 4: Completed perio assessment,
completed hard deposit assessment, completed
treatment plan.
PERIODONTAL DIAGNOSIS
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PERIODONTAL DIAGNOSIS: generalized slight
inactive chronic periodontitis
AAP CASE TYPE: II
SUMMARY
This patient was definitely my most challenging patient
this semester. My patient presented with tenacious ledges
on almost every tooth. She did not disclose that she had
dental anxiety, but I suspected that she did and used
stress reduction protocol to make it a more pleasant
experience. My patient was unaware what periodontitis
was, which was very disappointing. She has a history of
smoking about 10 cigarettes daily since 2000 which was
a big periodontitis risk factor. This patient was definitely a
good learning experience for me since all my other
patients had gingivitis. This semester I learned that
radiographs are very helpful when looking for disease
and bone loss.
CLINIC NOTES