1. Periodontitis Project
Dental Hygiene Clinical Practice II
KELLY OLSEN

2. PATIENT PROFILE 42 year old Caucasian female
Health History considerations:
Dental History considerations:
Vitals WNL
4 wisdom teeth removed (1990)
ASA II
Gums bleed when brush/floss
No Medications
Sensitive teeth
Cigarette smoker, 10x daily (since 1990)
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.

3. EXTRA ORAL AND INTRA ORAL FINDINGS
TMJ
Attrition
Clicking on left side of jaw
#7 -#11
OCCLUSION
#22-#27
Molar right: class I
Decalcification
Molar left: class I
#31 (lingual and buccal)
Canine right: class I
Lingualversion
Canine left: class I
#23, #26
30% overbite
Labioversion
3.5mm overjet
#24, #25
Enlarged papillae
between #8 and #9

4. INTRA ORAL PHOTOS

5. MAXILLA

6. MANDIBLE

7. DENTAL CHART

8. DENTAL CHART FINDINGS

9. DENTAL CHART FINDINGS Extracted Amalgum Suspicious caries Composites
#1, #16, #17, #32
“OD” #19
Suspicious caries
Composites
#19, #21, #31
“O” #31
Sealants
“OB” #18
#20, #21
“L” #10

10. PERIODONTAL CHART

11. PERIODONTAL EVALUATION

12. PERIODONTAL ASSESSMENT
No furcations
No mobility
No MGI
No BOP
No Exudate

13. GINGIVAL DESCRIPTION
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

14. FACTORS CONTRIBUTORY FACTORS PERIODONTAL RISK FACOTS Calculus
Position of teeth/malocclusion
PERIODONTAL RISK FACOTS
Smoking

15. RADIOGRAPHS Tooth #2-3 Tooth #3-5 #2 –slight vertical bone loss
#3 –slight horizontal bone loss
#4 –slight horizontal bone loss
#5 –slight vertical bone loss (distal)
slight horizontal bone loss (mesial)
with a ledge of calculus

16. RADIOGRAPHS Tooth #6-7 Tooth #8-9
Tooth #6 –slight horizontal bone loss
Tooth #7 –slight horizontal bone loss
Tooth #8 –slight horizontal bone loss
Tooth #9 –slight vertical bone loss (mesial)
slight horizontal bone loss (distal)

17. RADIOGRAPHS Tooth #10-11 Tooth #12-14
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)

18. RADIOGRAPHS Tooth #15 Tooth # 18-19
Tooth #15 – slight vertical bone loss
(distal)
spicule of calculus on
mesial
Tooth #18 – slight vertical bone loss
Spicule of calculus on
both mesial and distal
Tooth #19 – slight vertical bone
loss

19. RADIOGRAPHS Tooth #20-21 Tooth #22-23 Tooth #20 – No bone loss
Tooth #21 – Slight horizontal bone loss
Tooth #22 – Slight horizontal bone loss
(distal)
Moderate vertical bone
loss (mesial)
Tooth #23 – Slight horizontal bone loss
Moderate horizontal bone
loss (meisal)
Spicule of calculus (mesial)

20. RADIOGRAPHS Tooth #24-25 Tooth #26-28
Tooth #24 – moderate vertical bone loss
spicule of calculus (mesial and
distal)
Tooth #25 – moderate vertical bone loss
(mesial)
slight horizontal bone loss (distal)
Tooth #26 – slight horizontal bone loss
Tooth #27 – No bone loss
Tooth #28 – slight horizontal bone loss (mesial)

21. Tooth #29 Tooth #30-31 Tooth #29 – slight horizontal bone loss
Tooth #30 – slight vertical bone loss
calculus on distal
Tooth #31 – slight horizontal bone
loss (mesial)
calculus on mesial and
distal

22. RADIOGRAPHS BITEWINGS Tooth #1-30 Tooth #3-28 Tooth #12-19

23. RADIOGRAPH INTERPRETATION
#1: Extracted
#18: No bone loss (mesial), slight vertical bone loss (distal)
#2: slight vertical bone loss
#19: Slight vertical bone loss
#3: slight horizontal bone loss
#20: No bone loss
#4: slight horizontal bone loss
#21: Slight horizontal bone loss
#5: Slight horizontal bone loss (mesial), Slight vertical bone loss (distal)
#22: Moderate vertical bone loss (mesial), slight horizontal bone loss (distal)
#6: Slight horizontal bone loss
#23: Moderate horizontal bone loss (mesial), slight horizontal bone loss (distal), spicule of calculus on the mesial
#7: Slight horizontal bone loss
#24: Moderate vertical bone loss, spicule of calculus mesial and distal
#8: Slight horizontal bone loss
#9: Slight vertical bone loss (mesial), slight horizontal bone loss (distal)
#25: Moderate vertical bone loss (mesial), slight horizontal bone loss, spicule of calculus on mesial and distal
#10: slight horizontal bone loss
#26: Slight horizontal bone loss, spicule of calculus on mesial and distal
#11: Slight horizontal bone loss
#12: No bone loss (mesial) Slight horizontal bone loss (distal)
#27: no bone loss
#28: slight horizontal bone loss (mesial)
#13: No bone loss
#29: Slight horizontal bone loss
#14: No bone loss, spicule of calculus on the mesial
#30: Slight vertical bone loss (mesial), slight horizontal bone loss (distal), calculus on the distal
#15: Slight vertical bone loss (distal), spicule of calculus on the mesial
#31: Slight horizontal bone loss (mesial), no bone loss (distal), calculus on the mesial and distal
#16 and #17: Extracted

24. PROCEDURES
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.

25. PERIODONTAL DIAGNOSIS
PERIODONTAL DIAGNOSIS: generalized slight inactive chronic periodontitis
AAP CASE TYPE: II

26. 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.

27. CLINIC NOTES