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Periodontal Project
Dental Hygiene Practice II
By: Brittanymarie Horrigan
Medical History
• Date of Last Physical Exam 3/2013
• Currently under the care of a Physician for
- Endometriosis
-Chronic Migraines
-ADD
*All conditions are well controlled with Medication
• Has been hospitalized for
-Endometriosis:
Surgery- Feb. 2011, Jul. 2013
- Concussion:
Car accident- Oct. 2013
-Migraines:
Jan. 2009
• Occasional Drinker & Smoker
• Father has a history of type II Diabetes
Medical History Continued
Current Medications
Name/ Dose
Time to be taken
Purpose
Drug Class
Adverse Effects
Gabapentin 600 mg
Night
Migraine
Prevention
Anticonvulsant
Fatigue, Rhinitis, Xeristomia,
Hypersensitivity, Dizziness
Aygestin 5mg
Night
Endometriosis
Progestin Contraceptive
Headache, Dizziness, Nausea,
Insomnia
Miratazapine 7.5 mg
Night
Sleep
Antidepressant, tetracyclic Xeristomia, Dizziness, Drowsiness,
Flu like symptoms
Femara 2.5 mg
Night
Endometriosis
Anti-estrogen
Hot flashes, joint pains, fatigue,
insomnia, dizziness, hair loss
Topamax 50 mg
Night
Migraine
Prevention
Anticonvulsant
Fatigue, Loss of coordination,
Altered taste
Ibuprophen 600 mg
As needed
Pain
Management
Non-steroidal antiinflammatory
Dizziness, Vomit, Nausea, Rash
Adderall RX 25 mg
Morning
ADD/ADHD
Amphetamine
Xeristomia, insomnia, Fever,
Anxiety, Loss of Appetite
Hormone
Therapy
Progestin Contraceptive
Pain, Migraine, Hypersensitivity,
Anxiety, Depression
Increase Vit.
Intake
Vit. And Mineral Combo
Dizziness, Upset Stomach,
Headache, Allergic Reaction
Mirena 20 mg
Multi Vit. 1 Tab
Morning
Medical His. Continued
Allergies
• Bactrim
• Erythromycin eye ointment
Vitals
• Blood Pressure:110/60 RAS
• Pulse:
64
• Respiration:
17
ASA II
Dental History
• Last Dental Appt. 8-30-2013
• Last Hygiene Appt. 8-30-2013
***Completed in clinic 03/2014
• Last X-Ray. 8-30-2013
-Panoramic
-Bite Wings
• History of Ortho treatment
-Palate expander: 2003
-Ortho: 2003-2007
• Currently uses a Maintenance Retainer
- Wears while sleeping
***Invisalign
• All 4 wisdom teeth Extracted in 2004
Dental History Continued
• Currently has Sensitivity
• Clenches
-Induced by stress
-Hot
-Cold
-Sweet
***Mandibular Anteriors
• Grinds
-Nocturnal
***Generalized slight attrition on
posteriors
• Gums Bleed when flossing
-4x weekly
***Improper flossing technique
• TB
-2x daily -Manual
-Angled Bristles
-Soft
*** Patient would like to discuss the
usage of an electric TB
• Generalized Food entrapment
-Posteriors
*** Slightly open contacts
Patients Left side
Occlusion:
• Molar Right- Class I
• Canine Right- Class I
• Molar Left- Class I
• Canine Left- Class I
Patients right side
Facial View
Frenum:
- Slight
involvement
Facial View
Malocclusion:
- Open bite
Maxillary View
Palate:
- Median
palatine tori
Mucosa:
- Bilateral linea
alba
- Keratinized
tissue from
cheek biting
habit
Tongue:
- scalloped,
slightly coated
Mandibular View
Floor of the mouth:
- Tight frenum
- Slight mandibular
tori
Tongue:
- moderate-severe
vascularity
Gingival Description
Color: Gen. pale pink with loc. sl. marginal and papillary redness on ant.
Contour: Gen. rolled margins on post. with rounded margins on anteriors and localized sl. bulbous
papillae on mand. ant.
Consistency: Gen. sl. spongy
Size: Gen. sl. enlarged
Texture: Gen. sl. stippled
Exudate: Gen. BOP on the facials of # 2, 14, 18, 19, 20, 21, 22 and linguals of #15, 13, 8, 9, 18, 19
Tissue Type: Gen. sl. edematous
GINGIVAL DESCRIPTION: Generalized, pink, rolled, stippled, spongy, enlarged edematous tissue
with bleeding upon probing and localized slight marginal redness with bulbous papillae on the
mandibular anteriors.
Dental Chart
• Defective Sealants:
#3, 15,18,19
• Sealants:
#14, 30
• Caries:
Buccal of #19,30
• Amalgam:
#2-OL
• Composite:
#31- O
#18-O
Perio Chart
Average PD:
3mm
Average GM:
1mm coronal to CEJ
Periodontal Chart
Bleeding on Probing
Facials: # 2, 14, 18, 19,
20, 21, 22
Linguals: #8, 9, 13, 15,
18, 19
Periodontal
Diagnosis
AAP Class type II
Generalized Slight Active
Chronic Periodontal Disease
Hard and Soft Deposit
> Generalized small spicules of subgingival and
supragingival calculus.
> Generalized slight biofilm located around the
cervical 1/3
> Localized slight tobacco stain on lingual
surfaces of mandibular anteriors
Contributory Factors
• Calculus – Generalized sub(spicules), Localized areas of supra
• Mouth breathing- Open bite, Nocturnal
• Food impaction - Gen. Sl. Post, Lo. Mod. #3-4, 29-30
• Position of teeth/malocclusion - Open bite 2mm
• Appliances- retainer top & bottom, only worn at night( invisalign)
• Toothbrush Trauma- 1mm recession on #4-6, #11-13, #20-22, #27-22
• Parafunctional habits- Grinding
• Orthodontics- 2003-2007
Bite Wings
Radiolucency around the
amalgam on #2
Radiolucency under the
contact point of #2 and 3
Slight vertical loss on the
mesials of #3, 4 and 14
Overall there is a normal
pattern of generalized slight
horizontal bone loss
Full Mouth Series
Full Mouth Series
(Patients Right side)
> Radiolucency on #4 apical to the
CEJ, mesial aspect
> There is a combination of slight
bone horizontal and vertical bone
loss around the maxillary premolar
> There is noticeable widening of
the PDL on the mandibular 1st
premolar and canine
Full Mouth
Series
(anteriors)
> Slight horizontal bone loss
present on the mandibular
anteriors
> Vertical bone loss present
between the maxillary central and
lateral incisors
> Patient has close root
proximity, which could be
decreasing the available blood
flow to tissues
> Widening of the PDL is visible
on the right premolar and canine
film
> Areas of radiolucency are present on the mesial aspects of the maxillary
lateral incisors
Full Mouth Series
(Patients Left side)
> First molar root morphology
> Vertical bone loss on the distal aspect of
the mandibular second molar
> Radiolucent area apical to the contact
point of tooth # 18 and 19
> Spicule of calculus on the distal aspect of
#15, located at the CEJ
Treatment/ Care Plan
Dental Hygiene Diagnosis:
High caries risk related to
high sucrose diet, occasional
tobacco usage, and
medications used to control
systemic disease
Clinic Procedure Notes
02/04/2014
02/18/2014
MEDICAL HISTORY: Comp. MHX,
No contra., ASA II, Vitals
PATIENT ASSESSMENT: EOE, IOE,
Occlusion, Dental charting
03/04/2014
MEDICAL HISTORY: Reviewed
MHX, Vitals, no contra. ASA II
PATIENT ASSESSMENT: Cursory
EOE, IOE, Hard and soft deposit
BIOFILM INDEX: 59%
NEXT VISIT: TX plan,
Debridement
MEDICAL HISTORY: Reviewed
MHX, vitals, no
contraindications, ASA II
PATIENT ASSESSMENT: Cursory
EOE and IOE
BIOFILM REMOVAL: TB and
Flossing
DEBRIDEMENT: Mandible
REFERRALS: General dentist for
continuing comprehensive care
RECARE: 6 months
02/04/2014
MEDICAL HISTORY:
Reviewed MHX, Vitals, no
contra.
PATIENT ASSESSMENT:
Cursory EOE, IOE, Perio
NEXT VISIT: perio assess.
02/06/2014
MEDICAL HISTORY: Reviewed
MHX, Vitals, No contra., ASA II
PATIENT ASSESSMENT:
Cursory EOE & IOE, Perio,
Hard and Soft deposit.
Detection
RADIOGRAPHS: X-Ray auth.
Procured
NEXT VISIT: Biofilm index,
Treatment plan
03/04/2014
Medical History: Reviewed MHX,
vitals, no contra. ASA II
Patient Assessment: Cursory
EOE and IOE
Biofilm Index: 43 %
Debridement: Maxillae
Next Visit: Debride Mandible
•
•
Risk Factors
•
•
•
•
•
•
•
•
•
Smoking- occasional, social
Systemic disease- Endometriosis- hormone imbalance
High biofilm index- 59%
Hormonal Involvement- Endometriosis, Mirena
Medication- Gabapentin, Femara, Topamax, Miratazapine,
Adderall RX
Alcohol use- occasional
Genetics- All systemic diseases are genetically linked
Stress- Moderate, school related
Nutritional deficiencies- Balanced out by multi vitamin,
working on better nutritional habits
Initially:
Upon completion of assessing this
patient I had diagnosed them to be
a AAP II directly based upon my
clinical findings.
Following completion of the dental
hygiene treatment the patient was
then brought in for a full mouth
series.
Currently:
After completing a full mouth series and a
comprehensive interpretation of the series I
have come to the conclusion that my original
diagnosis is incorrect and is not supported by
the radiographic images.
The alveolar bone height is generalized healthy
with localized areas of slight horizontal or
vertical bone loss- these localized areas are in
relation to where the patient occludes(edge to
edge on the premolars) because of their
anterior open bite
Summary
Recommended Referalls:
General dentist
***Continue comprehensive care
*** Possible restorative needs
Orthodontist:
*** Malocclusion- anterior open bite
***Occlusal trauma due to edge to edge
position of teeth. (premolar region)
Advice for Patient
Floss
-Tufted
*** Open contacts posteriors
-Waxed
***Tight contacts anteriors
TB
Nutritional
-Avoid sticky/ adherent
substances
- Variety = Daily recommended
values for food groups
Tooth Paste
- Electric, oral B
*** one that monitors
the patients pressure on
teeth
-Flouridex,
Sensodyne, Pronamel
***Toothpaste
focusing on sensitivity