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P3 Project Gerardo Viadas, RDAEF. Personal History Personal: 62 year old Male Hispanic Single Retired Medical: Hypertension HIV Coarctation of the aorta.

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Presentation on theme: "P3 Project Gerardo Viadas, RDAEF. Personal History Personal: 62 year old Male Hispanic Single Retired Medical: Hypertension HIV Coarctation of the aorta."— Presentation transcript:

1 P3 Project Gerardo Viadas, RDAEF

2 Personal History Personal: 62 year old Male Hispanic Single Retired Medical: Hypertension HIV Coarctation of the aorta Periodontitis Seasonal Allergies Herpes Simplex II

3 Medical History Continued BP 144/56 P 54 R 18 BP 120/60 P 70 R 18 BP 150/60 P 86 R 20 ASAIII Premedication required for coarctation of the aorta. Epivir Antiviral HIV Drug Viramune Antiviral HIV Acyclovir Antiretroviral HSVII Hydrochlothorizide Diuretic Hypotension Proklor Potassium supplement uptake Clarinex Seasonal Allergies (Antihistamine)

4 Review of Symptoms Neurological: None Psychological: None Functional : None Respiratory: None Cardiovascular: Coarctation of the aorta Dermatological: None Gastrointestinal: None Hematological: None Endocrine: None Immunological: HIV Dental History BW’s: 6/2006 FMX: 6/2006 Latest exam: 7/2008 Latest dental prophylaxis: 6/08

5 Dental History Continued Patient presents w/ restorations on teeth #’s 2MO, 3O, 8RCT, 14PFG, 15MOD, 18OB, 19DO, 28O, 29O, 30O, 31MO Missing teeth: #1,12,13,16,17,23,24,25,26,& 32. Patient present w/ generalized 3 mm recessions on all teeth. Abrasions and abfractions are not present.

6 Clinical Examination: First Visit Extraoral exam: WNL (max. opening 45mm) Intraoral exam: Hard tissues WNL, soft tissue WNL except for generalized 2-3mm gingival recessions on existing teeth, salivary flow WNL. Patients presents with a lower partial denture replacing teeth #’s 23,24,25, &26 (lower anterior incisors), and an upper partial denture replacing teeth #’s 12 and 13.

7 Clinical Examination Continued Occlusal relationship: Class I Facial profile: mesognatic Overbite: 5mm Overjet: 3mm Mobility: WNL Furcation: WNL Generalized 2-3mm probings w/ localized 4-5mm probings. Gingival description: Maxillary attached gingiva: pink, firm, and stippled. Maxillary free gingiva: pink, firm and smooth. Mandibular attached gingiva: pink, firm, and stippled. Mandibular free gingiva: pink, smooth with localized rolled borders. Initial PI: 65% PFI:35% Initial BOP: 1% Calculus description: Light 2 supra and slight subgingival. 25% interproximally. Radiographic interpretation: Consistent horizontal bone loss. Periodontal classification: Generalized severe periodontitis.

8 Pre-operative Images

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10 Treatment Plan OHI: Modified Bass technique Flossing instructions: using the “C” method of wrapping the floss around each tooth. Interdental Aids: Proxybrush for open contacts. Tongue scraper: Coated tongue. Flouride tx: 2% sodium fluoride for 4 minutes. Full–mouth scale Re-Evaluation 3-4 weeks, to reassess the OH, to assess improvement, and new problems, and to evaluate the frequency of follow-up with dental hygiene appointment.

11 Nutritional Recommendations PT should exercise 30 minutes (suggestion). PT should drink more water instead of coffee and bottled coffee flavored beverages. Nutritional Counseling: Patient needs to consume more wholesome foods. Such as milk products, vegetables, fruits, whole grains, and low fat meats.

12 Re-evaluation Visit Gingiva: Generalized pink, firm, and stippled Probings: Generalized 2-3mm (localized 5mm decreased 1mm). PI: 39% PFI: 61% MBI: 0% WLAC Calculus Code: Light 1 OHI: Modified Bass technique, C-fold flossing technique, with interproximal cleaning aids (proxybrush). Nutritional recommendation: Based on patient’s data.

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14 Cambra The patient is considered a high risk patient because the patient has a history of restorations within a three year period. Cambra recommends high risk patients to brush twice a day with a toothpaste containing 1.1% NaF. Use a 0.2% NaF mouthrinse daily. 3-4 month recall to evaluate caries risk and apply flouride varnish. Saliva test and bacterial culture. Chlorhexidine gluconate 0.12% (10ml). Xylitol gum (6-10g daily). Two tabs a gum four times a day. Use MI paste twice a day.

15 What would I have done differently? Premedication is a must for patients with coarctation of the aorta according to the American Heart Association. Try to manage clinic time accordingly. My patient left on a two week vacation that prolonged the treatment plan. Overall time management needs improvement.

16 References Removable prosthetics: Clinical Indication and Treatment Principles (2008). Retrieved June 10, 2009 from Rx for the Durable Partial Denture: Proper Maintenance Plan (2006). Retrieved June 10, 2009 from Dentures: Frequently asked Questions (2009). Retrieved June 10, 2009 from


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