2 Patient information53 years old African American male Plays in a band Works as a billboard installer Single, no children Has medical but no dental insurance
3 Diagnosed with benign prostate hyperplasia in 2012 Medical historyGeneral health is goodNon-smokerDiagnosed with benign prostate hyperplasia in 2012Takes Terazosin every dayNo hospitalization history within the last 5 years and no major surgeriesLast medical exam was January 2014 for regular check-up. No significant findings.Vitals: Pulse: 90 Resp: 18 BP: 132/79 Pre-hypertensive
4 Dental historyGoes to the dentist irregularly. Had a “deep cleaning” before. Had an extensive amalgam fillings. FMX taken on 3/2013 Learning ladder: Unaware- did not know that plaque causes cavities.
5 Oral hygiene practices Brushes 1x per day using Colgate Total using a manual toothbrush Does not floss because said he’s lazy. Uses Listerine mouthwash 1x per day.
7 Physiologic pigmentation of the gingiva E/I examPhysiologic pigmentation of the gingivaBilateral linea alba adjacent to the molars onlyGeographic tonguePossible sleep apnea due to enlarged tongue, very difficult to see oropharynx
8 Contour– rounded margins on lower anteriors Gingival descriptionColor—pigmentedConsistency—boggyContour– rounded margins on lower anteriorsTexture– smooth and stippledPapilla— flat between 3 and 6, blunted between #23-27, bulbous on buccal and lingual of mandibular anteriors.Heavy plaque on IP of posteriorsModerate inflammationCalculus class 5 and AAP 2
9 High caries risk due to current decay BANA test: positive Saliva pH: 7 Other testsPlaque index: 1.67 (Fair)DMFT: 22 (D=3, M=0, F=19)High caries risk due to current decayBANA test: positiveSaliva pH: 7Low salivary flow at 5ml
10 Heavy mouth breather = fogged mirror 6mm anterior open bite OcclusionSevere open bite resulting in difficulty in chewing. Patient stated he has to cut most foods and push it inside his mouth or he has to bite large chunks of food in order to be able to chew it.Only 3rd and 2nd molars occlude (1 and 32, 2 and 31, 15 and 18 and 16 and 17).Heavy mouth breather = fogged mirror6mm anterior open bite4mm posterior open bite
14 Treatment Plan Periodontal risk: high PD range 2-6 mm Assessment FindingsGoals(Pt./client centered)Expected outcomes(evaluation methods, time frame)Periodontal risk: highPD range 2-6 mmModerate inflammation on lower anteriorsModerate supra calculus on lingual of lower anteriorsHeavy subgingival calculusmoderate plaque on posterior teethBOPRecessionPt. will learn Bass TB technique.Pt. will learn C-shape flossing.Patient will understand the link btw plaque and periodontal disease.Pt. will understand the benefits of antimicrobial rinses.Patient will learn how to use gum stimulator.Pt. demonstrates Bass TB techniquePt. demonstrates C-shape flossing.Pt. explains the link btw plaque and periodontal disease.Pt. reports using antimicrobial rinses dailyPatient reports using gum stimulator at least 1x per day.Caries risk: highSuspicious caries #1-O, 8M, 9M, 13DPt. will understand the link btw plaque and caries formation.Pt. will understand the benefits of topical fluoridePt. explains the link btw plaque and caries formation.Pt. explains the benefits of topical fluoride
15 Treatment plan by appointments Appt. #Plan for education, OHI, counselingAreaPlan for treatment & services1OHI: Bass techniqueEducate on plaque biofilm and periodontal diseaseFMComplete Assessments, disclose, OHI2Review Bass techniqueCheck-in assessments, photos, complete perio competency assessments, OHI318-24Update assessments, Topical, Administered Lidocaine 2% with epinephrine, Chlorhexidine pre-procedural rise, scaled for Mock Board using hand instruments and USS.4OHI: C-shape flossing25-31Update assessments, OHI, Topical, Administered Lidocaine 2% with epinephrine, Chlorhexidine pre-procedural rise, scaled for Test Case using hand instruments and USS.5Review C-shape flossingEducate on benefits of frequent topical fluoride application32, 31, 27, 26, 22, 20, 18, 1-5Update assessments, OHI, chlorhexidine pre-procedural rinse, Topical, Lidocaine 2% with epinephrine, scaled residual calculus from Test case and Mock Board, scaled 32 and 1-5 using hand instruments and USS.6OHI: Gum stimulator6-16Update assessments, OHI, chlorhexidine pre-procedural rinse, Topical, Lidocaine 2% with epinephrine, scale using hand instruments and USS.
19 Periodontal Assessment High periodontal risk:PD range 2-6 mmModerate inflammation on lower anteriorsModerate supra on lingual of lower anteriorslight subgingival calculusLight to moderate plaque on posterior teethBOPNOTE: Patient stated that he was brushing and flossing more when I was seeing him consistently almost every Tuesday.
25 The success of any dental treatments depend heavily on home care. ReflectionThe success of any dental treatments depend heavily on home care.Changing behavior is hard but having continued discussion with patients do make an impact.Time management- always be prepared.In clinic, setting the right expectations is critical.
26 MALOCCUSION AND PERIODONTAL DISEASE ResearchMALOCCUSION AND PERIODONTAL DISEASEMalocclusion is any deviation from the normal relationship of the maxillary arch to the mandibular arch.Anterior open bite is a type of malocclusion characterized by a deviation in vertical relationship between maxillary and mandibular dental arches resulting in the absence of contact between the incisal edges of both dental arches.
27 Anterior open bite may be caused by: Prolonged thumb sucking EtiologyAnterior open bite may be caused by:Prolonged thumb suckingTongue thrustingPoor teeth positionSkeletal deformitiesClassification of anterior open bite: dental or skeletalCorrect diagnosis is critical since each classifications have different treatment modalities ranging from orthodontics alone or in combination with orthognathic surgery.
28 Dental MalocclusionClassified similar to Angle’s method of malocclusion classification. This is malocclusion involving poor teeth position. POSSIBLE CAUSES: Posterior teeth erupt too far or if anterior teeth erupt too little Prolonged thumb sucking Tongue thrusting This type of malocclusion are generally fixed by orthodontics.
29 Skeletal Malocclusion This exists when the problem is caused by the position of the jaws relative to one another. Multifactorial etiology Classifications: horizontal, transverse and vertical planes. Horizontal malocclusions are classified as Class II or Class III malocclusions similar to Angle’s classification. Vertical malocclusions include open bites and severe overbites Transverse malocclusions include crossbites. Treatment includes both orthodontics or orthognathic surgery.
30 Effects of malocclusion to quality of life A study done in Wonkwang University dental hospital and six private clinics in Korea aimed to evaluate the effect of malocclusion on oral health quality of life in adults.860 participants were divided into four groups: normal occlusion, malocclusion, fixed treatment and retention.Normal occlusion and malocclusion classification were decided clinically for adults visiting the hospital and clinics who had not received previous orthodontic treatment. The classification was based on the alignment of the anterior teeth and the degree of lip protrusion.The participants were asked to complete a questionnaire assessing how frequently they experience functional limitation, physical pain, psychological and social disability and handicap.
31 ResultsThe malocclusion group perceived the strongest psychosocial impact related to esthetics.
32 Darby M, Walsh M. Dental hygiene theory and practice ReferencesDarby M, Walsh M. Dental hygiene theory and practiceChoi, S., Kim, B., Cha, J., & Hwang, C. Impact of malocclusion and common oral diseases on oral health–related quality of life in young adults. Am Journal Of Orthodontics & Dentofacial Orthopedics [Internet] Apr [cited 2015 May 1]; 147(5). Available from: e-17f2-43b3-be25-cdb08bcbf493%40sessionmgr111&vid=32&hid=119Geron, S., Wasserstein, A., & Geron, Z. Stability of anterior open bite correction of adults treated with lingual appliances. European Journal Of Orthodontics [Internet] Oct[cited 2015 May 1]; 35(5), Available from: e-17f2-43b3-be25-cdb08bcbf493%40sessionmgr111&vid=32&hid=119