1. Periodontal case study project
Dental Hygiene Clinical Practice II
Shannon Kelleher

2. Patient profile Health history reveals: Dental history reveals:
59 year old Caucasian male
Health history reveals:
Job related stress
High blood pressure controlled with medication
Vitals WNL
ASA Class II
Dental history reveals:
Brushes with electric toothbrush 1x daily
Flosses occasionally
Clenches
3 month recall

3. Extra oral & Intra oral findings
Bilateral linea alba
Sl pronounced rugae
Sl scalloped & coated tongue
Sl maxillary right resorption of
alveolar ridge
Moderate generalized attrition
20% overbite
4mm over jet
Torso version #8,9,10,21,23,28 & 29
Linguoversion version #4,5 & 12
Labioversion #6,10,11,21,23 & 25
Angles Class I molar & canine left
Angles Class I tend to II canine right
Maxillary frena tag
Amalgam stain #12 & 27
Abfraction #4,6,11,27,27 & 28

4. Intra oral photos

9. Dental chart

10. Periodontal charting

11. Periodontal evaluation

12. Assessment findings
Class I furcations on the buccal aspect of #18 & 31
Class I furcations on the lingual aspect of #2,17,18 & 30
Class II furcations on the buccal aspect of #2,14,15 & 17
No mobility
Mucogingival involvement #17
Sl BOP #13,14,15,17 & 23
Generalized spicules of subgingival calculus
Sl localized spicules of supragingival calculus on mandibular anteriors
Generalized moderate interproximal biofilm
Biofilm index 52%

13. Gingival description
Generalized slight cyanotic, recessed, rounded, firm stippled tissue
with localized bleeding on probing.

14. Contributory factors Calculus Faulty restorations Root morphology
Root resorption
Mouth breathing
Food impaction
Malocclusion
Occlusal discrepancies
Un-replaced teeth
Clenching

15. Periodontal risk factors
Stress
Nutritional deficiencies
Obesity

16. radiographs
See hard copy (scanner not working)

17. Periodontal diagnosis
Generalized moderate inactive chronic periodontitis with localized
severe inactive chronic periodontitis on teeth #2,5,18,21,29 & 31
with localized severe active chronic periodontitis on teeth #14,15,
& 17
AAP IV

18. Treatment plan

19. Procedures First & second visit completed assessments Third visit
Medical history, EOE, IOE, vital signs
Biofilm index & homecare
Review electric TB technique, floss technique & how to use proxi-brush
Debridement on UR with cavitron slim insert & hand instrumentation
Fourth visit
Biofilm index
Reinforce good job done at home & improved biofilm index
Re-assess UR
Debridement of LR with cavitron slim insert & hand instrumentation

20. procedures Fifth visit Medical history, IOE, EOE, vital signs
Biofilm index
Still doing a great job with homecare
Re-assess UR & LR
Debridement of UL with cavitron slim insert & hand instrumentation
Sixth visit
slightly more interproximal biofilm reinforced importance of flossing & technique
Re-assess UR, LR & UL
Debridement of LL with cavitron slim insert & hand instrumentation
Selective motor polishing of mandibular anteriors
Fluoride treatment with NaFl gel trays

21. summary
Although this case had many challenges I learned a lot from it. There were many things from text books and class that I got to see first hand with this patient. He had furcations, mucogingival involvement and extensive restorations among other issues. I was proud of myself for doing as well as I did with this case with the little experience that I had. There were a few areas around furcations that I had left some tenacious calculus but I don’t feel as though I had the experience level to remove it and in the future I expect to learn techniques to deal with that type of situation.
I would love to have this patient in for a follow up to see how his condition progresses now that I have a base line. Being able to see if removing calculus or the homecare education made a difference in the patient would be a valuable experience. I look forward to implementing the things I learned with this patient in the future.