Periodontitis Project Dental Hygiene Clinical Practice II KELLY OLSEN

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.

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

INTRA ORAL PHOTOS

MAXILLA

MANDIBLE

DENTAL CHART

DENTAL CHART FINDINGS

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

PERIODONTAL CHART

PERIODONTAL EVALUATION

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

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

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

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

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)

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)

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

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)

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)

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

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

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

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.

PERIODONTAL DIAGNOSIS 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