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PERIODONTITIS PROJECT Dental Hygiene Clinical Practice II KELLY OLSEN

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PATIENT PROFILE 42 year old Caucasian female Health History considerations: Vitals WNL ASA II No Medications Cigarette smoker, 10x daily (since 1990) Dental History considerations: 4 wisdom teeth removed (1990) Gums bleed when brush/floss Sensitive teeth 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.

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EXTRA ORAL AND INTRA ORAL FINDINGS TMJ Clicking on left side of jaw OCCLUSION Molar right: class I Molar left: class I Canine right: class I Canine left: class I 30% overbite 3.5mm overjet Attrition #7 -#11 #22-#27 Decalcification #31 (lingual and buccal) Lingualversion #23, #26 Labioversion #24, #25 Enlarged papillae between #8 and #9

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INTRA ORAL PHOTOS

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MAXILLA

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MANDIBLE

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DENTAL CHART

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DENTAL CHART FINDINGS

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Extracted #1, #16, #17, #32 Suspicious caries #19, #21, #31 Sealants #20, #21 Amalgum OD #19 Composites O #31 OB #18 L #10

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PERIODONTAL CHART

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PERIODONTAL EVALUATION

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

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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

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

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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

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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)

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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)

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RADIOGRAPHS Tooth #15 Tooth # 18-19 Tooth #15 slight vertical bone loss (distal) spicule of calculus on mesial Tooth #18 slight vertical bone loss (distal) Spicule of calculus on both mesial and distal Tooth #19 slight vertical bone loss

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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 (distal) Moderate horizontal bone loss (meisal) Spicule of calculus (mesial)

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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) spicule of calculus (mesial and distal) Tooth #26 slight horizontal bone loss spicule of calculus (mesial and distal) Tooth #27 No bone loss Tooth #28 slight horizontal bone loss (mesial)

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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

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RADIOGRAPHS BITEWINGS Tooth #1-30 Tooth #12-19 Tooth #14-17 Tooth #3-28

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RADIOGRAPH INTERPRETATION #1: Extracted #2: slight vertical bone loss #3: slight horizontal bone loss #4: slight horizontal bone loss #5: Slight horizontal bone loss (mesial), Slight vertical bone loss (distal) #6: Slight horizontal bone loss #7: Slight horizontal bone loss #8: Slight horizontal bone loss #9: Slight vertical bone loss (mesial), slight horizontal bone loss (distal) #10: slight horizontal bone loss #11: Slight horizontal bone loss #12: No bone loss (mesial) Slight horizontal bone loss (distal) #13: No bone loss #14: No bone loss, spicule of calculus on the mesial #15: Slight vertical bone loss (distal), spicule of calculus on the mesial #16 and #17: Extracted #18: No bone loss (mesial), slight vertical bone loss (distal) #19: Slight vertical bone loss #20: No bone loss #21: Slight horizontal bone loss #22: Moderate vertical bone loss (mesial), slight horizontal bone loss (distal) #23: Moderate horizontal bone loss (mesial), slight horizontal bone loss (distal), spicule of calculus on the mesial #24: Moderate vertical bone loss, spicule of calculus mesial and distal #25: Moderate vertical bone loss (mesial), slight horizontal bone loss, spicule of calculus on mesial and distal #26: Slight horizontal bone loss, spicule of calculus on mesial and distal #27: no bone loss #28: slight horizontal bone loss (mesial) #29: Slight horizontal bone loss #30: Slight vertical bone loss (mesial), slight horizontal bone loss (distal), calculus on the distal #31: Slight horizontal bone loss (mesial), no bone loss (distal), calculus on the mesial and distal

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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.

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PERIODONTAL DIAGNOSIS PERIODONTAL DIAGNOSIS: generalized slight inactive chronic periodontitis AAP CASE TYPE: II

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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.

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CLINIC NOTES