Treatment Plan Jessica Heberlie, Caitlin Jamison, Allie Erickson, Rebecca MulletASSESSMENT A. Patient Interview 1. Chief Complaint: “I am way overdue for my dental check-up.” 2. Complains of a burning, dry mouth 3. Brushes twice a day with a medium bristles toothbrush 4. Pt. does not floss unless food is trapped 5. Mouthwash Pt. is using gives him a burning sensation B. Medical/Dental History 1. Medical History: Pt. reports a history of cigar smoking, hypothyroidism, Parkinson's disease, frequent bronchitis, GERD. and occasional angina. Five years ago he had a basal cell carcinoma removed from under his right eye, 2. Medications: a) (Simvastatin) Zocor® Clholesteyal + Covaid Jena Tx: hyper ersio___ py (Metoprolol succinate) Toprol® no, Hyper tenscortM\ | OradycharSio ©) (Levothyroxine) Synthroid@ T nyrors d) (Lisinopril) Zestril® Lypertension ,1\ e) (Levodopa) Shomet® Peuvansons TK f) 81 mg aspirin 3. Dental History: In previous years Pt. received regular dental care and was on a 6 mo. recare appointment interval. C. Social History 1. Smoked cigars weekly for 20 years and now smokes 1 pack of cigarettes weekly 2. Retired life insurance salesman D. Vital Signs 1. BP 138/88 - \ei\\ monitor Buying TX E, Extra Oral Exam 1. Pthad clicking and popping noted in bilateral TMJ 2, Mild and inconsistent facial tremors occurred 3. Areas of tenderness were noted in the submental, submandibular and deep cervical chain nodes F. Intra Oral Exam 1. Stain: med-heavy with calc deposits 2. Generalized plaque and BOP 3. 55% bleeding index 4, Overjet 5, Generalized pale, bulbous, rolled, spongy, edematous, inflamed gingiva WI \ocoSeed Tolunting in irrerpraximoJ Berd \Oell 2nsesWith locatized Trm dapths G. Periodontal Exam 1. Generalized 4-6mm probing depths, bleeding upon probing, class | mobility on tooth #9 H. Radiographs (if available) 1, Congult Periodontics to look at 7mm. pockets on #30, #25, #9 2. Consult Prosthodontics for a possible implant or bridge for #19 3. Vertical bone loss present , Witty Horitentad im posterior Il. DH DIAGNOS!: A. Level of Health B. Diagnosis (select one: Gingivitis, Perio, Caries) 1. Generalized Moderate Chronic Periodontitis 2. Localized advanced chronic periodontitis - #9 (Class | mobility) 3. Generalized Gingivitis MW PLAN A. Consultations Necessary 1. Restorative work on #3 and #31 with DDS 2, Perio consult a) #9 mobility b) Generalized moderate chronic periodontitis, localized advanced chronic periodontitis, 3. Potential pros consult for missing #19 a) Bridge or implant 4. Potential ortho consult for overjet of maxillary arch 5. TMJ specialist for popping and clicking of both sides B. Treatment Goals 1. Plaque control a) Increase the plaque-free score 2. Gingiva a) Reduce redness - move toward pink and healthy, More firm and less spongy, Less bulbous and rolled 3. Establish a habit of flossing once/day with C shape 4. Establish a habit of using the BASS method with soft toothbrush ,m ONO al C. Phases of Treatment (Wilkins pg. 409) on UF anquot 1. Preliminary a) Gather pt data (1) Medical and dental historyb) Appears there is no immediate need for emergency care 2. Phase | a) Preform plaque score and utilize this teaching tool for OHI on the pt a, b) Hand scale to remove cale, with Possible WitraASoNc 1) ©) Set pt up for appointment with DDS for restorative work on tals #3 and #31 oyrtentort 3. Outcomes of Phase | ca a) Probe full mouth deep pecs b) Chart the description of the gingiva from first and second appointment ©) Redisclose at second appointment and perform plaque score (1) Use this as teaching moment for OHI 4. Phase Il a) Set pt up with perio consult (1) #9 mobility (2) Generalized moderate chronic and localized advanced chronic pt b) Set pt up with pros consult (1) Potential implant #19 5. Phase lll \ Pug in twice? a) Set up pt with pros consult (1) Potential bridge for #19 6. Evaluation of Overall Outcomes a) Check and chart the gum tissue around the restorations on #3 and #31, #9 if perio was done, #19 if pros was done (1) Probe depths 7. Phase IV maintenance a) Perio pt should be on a 3 month recall b) Keep teaching OHI to pt Vv. IMPLEMENTATION .. Scaling Type: Hand scale 4 quadrants . Plaque removal: Tooth brush, floss and a prophy angle (cup/brush) - Fluoride: Varnish . Auxiliary Procedures: Local anesthesia may need to be administered if there is too much sensitivity when scaling with deep probing depths OHI: Teach and demonstrate the BASS brushing technique, being sure to use small rotating motions with the tooth brush at at a 45 degree angle to pomp msame ne S nin A ae will you or hod did you evaluate care command «Ui the gumline and turning the tooth brush vertical when brushing “behind his front teeth.” Demonstrate the c-wrap method of flossing to ensure that the floss is going under the gingiva along the tooth surface, and recommend that he gets into a routine of flossing at least once a day.-Moyoe Sto of Wee F. Homecare: Bux wel + 1. Soft manual toothbrush using BASS technique twice per day UR Sire! 2. Floss using c-wrap technique at least once per day 3. Use a water irtigator to ensure the debridement of materials from the deep pockets 4, Use a non-alcoholic mouth rinse that contains fluoride to help eliminate the burning that he is having with his current rinse 5. Incorporate Biotene products into his daily routine to help with the discomfort of his dry mouth G. Teuing, & Wash vog to plate offer Smolci Se 1. Hand scale and check with an explorer when finished oe help 2. Follow up with pt to see when they have scheduled the consults own a) Restorative work on #3 and #31, Perio for mobility #9, Potential pros for missing #19, Ortho for overjet, TMJ ‘specialist for popping and clicking B. Follow up charting 1. Disclose and perform another plaque score 2. Probe full mouth 3. Redo bleeding index 4, Redo extraoral exam a) check for lymphadenopathy in submental, submandibular, and deep cervical chain b) Ask if seen PCP for this 5. Redo intraoral exam . Radiographs 1. Take radiographs as prescribed by DDS a) Check bone loss levels D. Patient OH behavior changes 1. Sawa decrease in redness within 6 weeks 2. Staining is lessened but still present after 6 weeks 3. Want to see the patient develop a habit of flossing with C shape once a day. 4. Expect the patient to be using a soft toothbrush and the BASS method . K \D where Wwe should put Ht, but 1) Bet ive we Shad note Possible oydthosiahc p ton! Thoughts? iLevedopa (inemed) - Panes +x mMetooolic precursor of dopamine. A pen bleeding,