1. Periodontal Case Study Project
Dental Hygiene Clinical Practice II
Kaite Manganaro

2. 51 year old Caucasian female
Patient Profile
51 year old Caucasian female
Health history reveals:
No medications
Vitals WNL
Environmental allergies- Hay Fever, dust, trees
Food allergy- Strawberries (carries EpiPen)
Job related stress
Previous depression (2002)
ASA Class II
Dental history reveals:
Brushes 1x daily with manual soft toothbrush
Flosses 1x monthly
Slight dental anxiety
#30 extracted approx. 25 years ago
Sensitivity to pressure #13
Cold sores/canker sores approx. 2-3x per year
Bruxism mostly at night, sometimes during the daytime
Very strong gag reflex
Last hygiene visit was 6 months ago

3. Extraoral and Intraoral Examination Findings
Lips: Slight dryness, fordyce granules
Bilateral slight linea alba
Small bilateral 1mm bite trauma and on apex of tongue
Low maxillary frena attachment, causing diastema
Generalized slight attrition
Localized abrasion on #21
Slight decalcification on molars
Slight recession on mandibular anteriors
Slight clefting on buccal #21
Angle’s Class I Occlusion (Right molar N/A)
#2 and #14 in torsoversion
Overbite 60%
Overjet 1mm

4. Intraoral Photos

6. (Cleft on buccal of #21)

9. Dental Chart

10. Periodontal Charting

11. Periodontal Evaluation

12. Assessment Findings Furcation Involvement on #3 and #14 No mobility
Mucogingival involvement #20
BOP #’s 3, 4, 5 7, 10 and 24
Generalized slight spicules of supra and subgingival calculus
Generalized slight interproximal biofilm
Plaque Control Record was 23% (Last appointment)
Generalized slight yellow stain
Hypersensitivity to pressure on the distal of #13

13. Gingival Description
→ Generalized pale pink with localized marginal redness #6 #7, slightly enlarged tissue on the maxillary URQ, slight recession on mandible, rounded tissue with localized clefting on the buccal #20, stippling and edematous tissue type

14. Contributory Factors:
Calculus
Food impaction
Position of teeth/malocclusion
Un-replaced teeth
Periodontal Risk Factors:
Hormonal involvement
Stress
Nutritional deficiencies

15. Radiographs

16. Radiograph Interpretation
Generalized slight bone loss with slight to moderate bone loss on the mandible
Amalgam restoration present on buccal of #19
Overlapping on the maxillary canine shot, the maxillary lateral incisor shot, slight distomesial overlap on #20 #21
Furcation involvement #3, #14, #19 Grade 1
No calculus present radiographically
AAP II

17. Periodontal Diagnosis:
Generalized slight inactive chronic periodontitis with generalized moderate inactive chronic periodotitis on the mandible, localized slight active periodontitis URQ #3, #4, #5, #7, and #10

18. TREATMENT PLAN

19. Procedures APPOINTMENT ONE
MEDICAL HISTORY: Reviewed, no contraindications to treatment
PATIENT ASSESSMENT: EOE, IOE, dental charting, started GM’s on periodontal assessment
APPOINTMENT TWO
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE & IOE, completed periodontal assessment & gingival description
APPOINTMENT THREE
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE, IOE, deposit assessment

20. Procedures Cont’d APPOINTMENT FOUR
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE, IOE
BIOFILM INDEX: 34%
RADIOGRAPHS: Intra-oral photos
DEBRIDEMENT: Power driven ULQ
OTHER INSTRUCTION: Gave patient home care instructions to brush 2x daily, floss 1x daily before brushing, continue using ACT mouth rinse 1x daily. Recommended & demonstrated Modified Stillman & proper flossing technique. Went over treatment plan, Pt. responded well
APPOINMENT FIVE
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE, IOE, Re-assessed ULQ
BIOFILM INDEX: 20%
DEBRIDEMENT: Completed URQ with Catvitron and hand scaling

21. Procedures Cont’d APPOINTMENT SIX
MEDICAL HISTORY: Reviewed- no contraindications
PATIENT ASSESSMENT: Cursory IOE, EOE, Re-assessed previous quadrants
BIOFILM INDEX: 40%
DEBRIDEMENT: Power driven on LRQ, started LLQ
FINAL APPOINTMENT
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory IOE, EOE
BIOFILM INDEX: 23%
DEBRIDEMENT: Power driven LLQ
OTHER DENTAL HYGIENE SERVICES: Motor polished full mouth- Fine pumice
FLUORIDE: "Gelato" foam fluoride w. xylitol tray for 4min, Pt. was given instructions to not eat/drink/brush for a half hour afterward
RECARE: 4-6 weeks re-eval and 3 MTH recare

22. Summary
This was such a rewarding case. I gained a better understanding of process of care, patient management, and worked on refining my skill. After looking at the patient’s radiographs, I realized my GM recordings were off & do not reflect the perio status of the patient. I believe this is due to my inexperience at the time.
The 6 week re-evaluation was wonderful. The patient gained some attachment and I was unable to accesses the previously found furcations. The was also noticeable improvement to the color and contour of the gingiva. The patient also had a lowered plaque index score and was continuing recommended home care. It was such a great feeling seeing how my treatment and instruction, can make a difference.