1. Periodontal Project Dental Hygiene Practice II By: Brittanymarie Horrigan

2. Medical History Date of Last Physical Exam 3/2013 Currently under the care of a Physician for - Endometriosis-Chronic Migraines -ADD *All conditions are well controlled with Medication Has been hospitalized for -Endometriosis:Surgery- Feb. 2011, Jul. 2013 - Concussion:Car accident- Oct. 2013 -Migraines:Jan. 2009 Occasional Drinker & Smoker Father has a history of type II Diabetes

3. Medical History Continued Current Medications Name/ Dose Gabapentin 600 mg Aygestin 5mg Miratazapine 7.5 mg Femara 2.5 mg Topamax 50 mg Ibuprophen 600 mg Adderall RX 25 mg Mirena 20 mg Multi Vit. 1 Tab Purpose Migraine Prevention Endometriosis Sleep Endometriosis Migraine Prevention Pain Management ADD/ADHD Hormone Therapy Increase Vit. Intake Time to be taken Night As needed Morning Drug Class Anticonvulsant Progestin Contraceptive Antidepressant, tetracyclic Anti-estrogen Anticonvulsant Non-steroidal anti- inflammatory Amphetamine Progestin Contraceptive Vit. And Mineral Combo Adverse Effects Fatigue, Rhinitis, Xeristomia, Hypersensitivity, Dizziness Headache, Dizziness, Nausea, Insomnia Xeristomia, Dizziness, Drowsiness, Flu like symptoms Hot flashes, joint pains, fatigue, insomnia, dizziness, hair loss Fatigue, Loss of coordination, Altered taste Dizziness, Vomit, Nausea, Rash Xeristomia, insomnia, Fever, Anxiety, Loss of Appetite Pain, Migraine, Hypersensitivity, Anxiety, Depression Dizziness, Upset Stomach, Headache, Allergic Reaction

4. Medical His. Continued Allergies Bactrim Erythromycin eye ointment Vitals Blood Pressure:110/60 RAS Pulse:64 Respiration:17 ASA II

5. Dental History Last Dental Appt. 8-30-2013 Last Hygiene Appt. 8-30-2013 ***Completed in clinic 03/2014 Last X-Ray. 8-30-2013 -Panoramic-Bite Wings History of Ortho treatment -Palate expander: 2003 -Ortho: 2003-2007 Currently uses a Maintenance Retainer - Wears while sleeping ***Invisalign All 4 wisdom teeth Extracted in 2004

6. Dental History Continued Currently has Sensitivity -Hot-Cold-Sweet ***Mandibular Anteriors Gums Bleed when flossing -4x weekly ***Improper flossing technique Generalized Food entrapment -Posteriors *** Slightly open contacts Clenches -Induced by stress Grinds -Nocturnal ***Generalized slight attrition on posteriors TB -2x daily -Manual -Soft -Angled Bristles *** Patient would like to discuss the usage of an electric TB

7. Patients right side Occlusion: Molar Right- Class I Canine Right- Class I Molar Left- Class I Canine Left- Class I Patients Left side

8. Facial View Frenum: - Slight involvement

9. Facial View Malocclusion: - Open bite

10. Maxillary View Palate: -Median palatine tori Mucosa: -Bilateral linea alba -Keratinized tissue from cheek biting habit Tongue: - scalloped, slightly coated

11. Mandibular View Floor of the mouth: -Tight frenum -Slight mandibular tori Tongue: - moderate-severe vascularity

12. Gingival Description Color: Gen. pale pink with loc. sl. marginal and papillary redness on ant. Contour: Gen. rolled margins on post. with rounded margins on anteriors and localized sl. bulbous papillae on mand. ant. Consistency: Gen. sl. spongy Size: Gen. sl. enlarged Texture: Gen. sl. stippled Exudate: Gen. BOP on the facials of # 2, 14, 18, 19, 20, 21, 22 and linguals of #15, 13, 8, 9, 18, 19 Tissue Type: Gen. sl. edematous GINGIVAL DESCRIPTION: Generalized, pink, rolled, stippled, spongy, enlarged edematous tissue with bleeding upon probing and localized slight marginal redness with bulbous papillae on the mandibular anteriors.

13. Dental Chart Defective Sealants: #3, 15,18,19 Sealants: #14, 30 Caries: Buccal of #19,30 Amalgam: #2-OL Composite: #31- O #18-O

14. Perio Chart Average PD: 3mm Average GM: 1mm coronal to CEJ

15. Periodontal Chart Bleeding on Probing Facials: # 2, 14, 18, 19, 20, 21, 22 Linguals: #8, 9, 13, 15, 18, 19 AAP Class type II Generalized Slight Active Chronic Periodontal Disease Periodontal Diagnosis

16. Hard and Soft Deposit > Generalized small spicules of subgingival and supragingival calculus. > Generalized slight biofilm located around the cervical 1/3 > Localized slight tobacco stain on lingual surfaces of mandibular anteriors

17. Contributory Factors Calculus – Generalized sub(spicules), Localized areas of supra Mouth breathing- Open bite, Nocturnal Food impaction - Gen. Sl. Post, Lo. Mod. #3-4, 29-30 Position of teeth/malocclusion - Open bite 2mm Appliances- retainer top & bottom, only worn at night( invisalign) Toothbrush Trauma- 1mm recession on #4-6, #11-13, #20-22, #27-22 Parafunctional habits- Grinding Orthodontics- 2003-2007

18. Bite Wings Radiolucency around the amalgam on #2 Radiolucency under the contact point of #2 and 3 Slight vertical loss on the mesials of #3, 4 and 14 Overall there is a normal pattern of generalized slight horizontal bone loss

19. Full Mouth Series

20. Full Mouth Series (Patients Right side) > Radiolucency on #4 apical to the CEJ, mesial aspect > There is a combination of slight bone horizontal and vertical bone loss around the maxillary premolar > There is noticeable widening of the PDL on the mandibular 1 st premolar and canine

21. Full Mouth Series (anteriors) > Slight horizontal bone loss present on the mandibular anteriors > Vertical bone loss present between the maxillary central and lateral incisors > Patient has close root proximity, which could be decreasing the available blood flow to tissues > Widening of the PDL is visible on the right premolar and canine film > Areas of radiolucency are present on the mesial aspects of the maxillary lateral incisors

22. Full Mouth Series (Patients Left side) > First molar root morphology > Vertical bone loss on the distal aspect of the mandibular second molar > Radiolucent area apical to the contact point of tooth # 18 and 19 > Spicule of calculus on the distal aspect of #15, located at the CEJ

23. Treatment/ Care Plan Dental Hygiene Diagnosis: High caries risk related to high sucrose diet, occasional tobacco usage, and medications used to control systemic disease

24. Clinic Procedure Notes 03/04/2014 Medical History: Reviewed MHX, vitals, no contra. ASA II Patient Assessment: Cursory EOE and IOE Biofilm Index: 43 % Debridement: Maxillae Next Visit: Debride Mandible 02/06/2014 MEDICAL HISTORY: Reviewed MHX, Vitals, No contra., ASA II PATIENT ASSESSMENT: Cursory EOE & IOE, Perio, Hard and Soft deposit. Detection RADIOGRAPHS: X-Ray auth. Procured NEXT VISIT: Biofilm index, Treatment plan 02/18/2014 MEDICAL HISTORY: Reviewed MHX, Vitals, no contra. ASA II PATIENT ASSESSMENT: Cursory EOE, IOE, Hard and soft deposit BIOFILM INDEX: 59% NEXT VISIT: TX plan, Debridement 02/04/2014 MEDICAL HISTORY: Comp. MHX, No contra., ASA II, Vitals PATIENT ASSESSMENT: EOE, IOE, Occlusion, Dental charting 02/04/2014 MEDICAL HISTORY: Reviewed MHX, Vitals, no contra. PATIENT ASSESSMENT: Cursory EOE, IOE, Perio NEXT VISIT: perio assess. 03/04/2014 MEDICAL HISTORY: Reviewed MHX, vitals, no contraindications, ASA II PATIENT ASSESSMENT: Cursory EOE and IOE BIOFILM REMOVAL: TB and Flossing DEBRIDEMENT: Mandible REFERRALS: General dentist for continuing comprehensive care RECARE: 6 months

25. Risk Factors Smoking- occasional, social Systemic disease- Endometriosis- hormone imbalance High biofilm index- 59% Hormonal Involvement- Endometriosis, Mirena Medication- Gabapentin, Femara, Topamax, Miratazapine, Adderall RX Alcohol use- occasional Genetics- All systemic diseases are genetically linked Stress- Moderate, school related Nutritional deficiencies- Balanced out by multi vitamin, working on better nutritional habits

26. Summary Initially: Upon completion of assessing this patient I had diagnosed them to be a AAP II directly based upon my clinical findings. Following completion of the dental hygiene treatment the patient was then brought in for a full mouth series. Currently: After completing a full mouth series and a comprehensive interpretation of the series I have come to the conclusion that my original diagnosis is incorrect and is not supported by the radiographic images. The alveolar bone height is generalized healthy with localized areas of slight horizontal or vertical bone loss- these localized areas are in relation to where the patient occludes(edge to edge on the premolars) because of their anterior open bite Recommended Referalls: General dentist ***Continue comprehensive care *** Possible restorative needs Orthodontist: *** Malocclusion- anterior open bite ***Occlusal trauma due to edge to edge position of teeth. (premolar region) TB -Electric, oral B *** one that monitors the patients pressure on teeth Nutritional -Avoid sticky/ adherent substances - Variety = Daily recommended values for food groups Tooth Paste -Flouridex, Sensodyne, Pronamel ***Toothpaste focusing on sensitivity Floss -Tufted *** Open contacts posteriors -Waxed ***Tight contacts anteriors Advice for Patient