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
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.