‘Treatment Plan C: e Study #31- Kaitlyn, Kyann, Whitney Assessment- Preliminary Phase of Tx Patient Interview ‘New Patient hasn’t seen a dentist for Tyrs Chief Complaint- “My teeth hurt and my gums bleed when I brush them.” Patient is overweight and out of breath Stressed about the cost of treatment Medical History Has not seen a physician in over 10yrs Family history of diabetes, hyperthyroidism, cardiovascular disease, Excessive thirst and frequent urination at night, constant indigestion Dizzy spells at work Medications: Omeprazole (OTC) and Magnesium 400mg Dental History No Oral care for the last 7yrs Brushes with hard bristle brush when he remembers, doesn’t floss Occasionally uses OTC mouth rinse Has lost several teeth to gum disease Consumes soft drink and energy drinks Reports never using cigars or cigarettesSocial History ‘* Recently divorced and has two children © Occupation-Assistant manager at a paint store Vital Signs ‘© BP: 138/98; Pulse: 110bmp; Respirations: 20 breaths per minute ‘* The patient's BP is considered stage 1 hypertension and needs to be monitored during the appointment. EO/O Examination * EO-Palpable submandibular lymph nodes were found on the right side * See if movable, ask if painful and if he has noticed it ¢ IO- Small rounded vesicle located on labial mucosa adjacent to #12 duration 2 days and patient indicated that it hurts ‘© Gingiva tissue-pink generalized, stripped in maxillary anterior ‘© Gingival inflammation in mandibular and posterior ‘© Moderate to heavy calculus especially in the mandibular anterior © Plaque score 65% ‘© Generalized moderate to heavy bleeding ‘+ Heavy bleeding localized to mandibular anterior and mandibular molars ‘* Bleeding index:75% Periodontal Examination: © Generalized moderate to heavy bleeding‘* Localized heavy bleeding mandibular anterior and posterior molars ‘© Probing depths generalized 6-9mm Radiographs: © Pan and 4 horizontal BW’s Diagnosis © This patient presents with periodontal disease Patient has either Stage III or Stage IV as he reports that he’s lost ‘a few’ teeth due to gum disease. © Patient has generalized probing depths of 6-9mm © Generalized moderate to heavy bleeding upon probing was present © Localized heavy bleeding on mandibular anterior and posteriors Plan Consultations Necessary ‘© Primary care provider- overall health, palpable submandibular lymph node ‘© Periodontist- advanced periodontal disease (Phase II) ‘© Dentist- Look over radiographs, vesicle, chart caries (Preliminary phase) ‘+ Prosthodontist and Oral Surgeon- if needed, to remove teeth and for implants/partials, (Phase II) Treatment Goals‘+ Stabilize/Improve stage 4 advanced periodontitis of teeth that can be saved- remove etiology and complete extreme scaling and root planing/possible regeneration with, periodontal surgery (Phase 11) * Remove unsavable teeth before it causes more pain- create implants/partials with prosthodontist (Phase IT) * Control pain/diagnose vesicle on labial mucosa (Preliminary phase/ Phase II) © Restore Caries (Phase III) ‘* Create better home care routine reduce plaque index, educate patient (Phase IV) ‘+ Reduce BOP, biofilm, gingivitis- OHI (Phase IV) Implementation ‘© Appointment 1: Assessing/Creating Plan (Preliminary Phase) ‘© Assess patient- needs, home care, knowledge, diet- educate © Make other needed radiographs- PA's, chart caries © Evaluate patients! willingness to change behavior and vesicle ‘© Appointment 2: Primary care provider © Determine any underlying conditions/see if any precautions are needed for extensive dental treatment, determine medications needed Find cause and severity of palpable submandibular lymph node © Appointment 3: Periodontist (Phase II) o Evaluate bone levels © Determine which teeth can be saved and ways to keep them ‘* Appointment 4: Oral Surgeon and prosthodontist if needed (Phase II) © Make plans for implants/partials if beneficial© Remove teeth that have lost too much bone structure and can’t be saved ‘© Appointment 6: Dental Hygienist (Phase 1) ‘© Scaling and root planing right side of mouth with anesthetic © Ultrasonic- Perio probe tip and ball point tip for furcation involvement © Follow that with hand scaling © Give POV/pain control ‘© Appointment 7: Dental Hygienist (Phase 1) © Scaling and root planing left side of mouth with anesthetic © Ultrasonic. Perio probe tip and ball point tip for furcation involvement ©. Follow with hand scaling © Give POW/pain control ‘© Appointment 8; Dentist (Phase IIT) © Once stable- restore caries and evaluate vesicle ‘© Appointment 9: Dental Hygienist/Dentist- Educating/Maintaining/Evaluating (Phase lv) © Recall- 3-month, update health history, go over home care, update xrays © Educate patient- importance of a better home routine and changing diet © Polish- remove biofilm, fine prophy paste due to root exposure © Recheck perio status- getting worse/stabilized improving © Fluoride- varnish to get in hard-to-reach areas and so it will stick longer Evaluation © Record a plaque score at each appointment to compare previous recording with the patient© Take new radiographs (vertical BWs) to monitor bone support and see if there is a progression ‘+ Evaluate the improvement of pocket depths by probing and note improvements in tissue quality, bleeding on probing ‘* Follow up charting note any progression or regression and provide supplemental care for patient who does not respond to initial therapy ‘© Have the patient demonstrate OHI and make any modifications in technique if necessary ‘© Consult with patient over energy drinks and soft drinks to see if they changed their behavior in overly consuming these products References: Wilkins, E. M., Wyche, C. J., & Boyd, L. D. (2017). Clinical practice of the dental hygienist. Wolters Kluwer. Wynn, R. L., Meiller, T. F., & Crossley, H. L. (2021). Drug information handbook for dentistry Including oral medicine for medically compromised patients & specific oral conditions. Lexicomp/Wolters Kluwer.