Case 20

Archie McCoy Tang Blanton

Alejandro Garcia
The Patient
50-year old White Caucasian male in good health.

Chief Complaint: "I am very concerned about the

stain on my front teeth."
He is very energetic, smokes one pack of cigarettes
daily and has 2-3 alcoholic drinks weekly.
Patient has dry mouth frequently.
NO VITAL SIGNS RECORDED
has a slipped disc in his neck
4 year old X-rays
Not taking any medications
No allergies, recent
Brushes twice daily with fluoridated dentifrice. surgeries, recent
Uses a phenol mouthrinse daily. hospitalization, or
Does not floss regularly. visits to a doctor.
The patient is a smoker, has a slipped disc in
his neck, and has 2-3 alcoholic drinks per
week. These combined factors make him...
a. ASA II
b. ASA III
c. ASA IV
d. Carne ASAda
ANSWER:
a. ASA II

Tobacco use or a slipped disc would

categorize him as ASA II, but
moderate alcohol use would not.
Combining factors does not increase
a persons ASA classification.
Dental
Assessment
4 year old
Radiographs -
needs new ones
No active caries
Poor Amalgam
restorations on
MD#30, DOL#19 Restoration on
potentially #3 is
etiologic. questionable
Recommend to due to lack of
use a threader for tooth structure
flossing those and restorative
areas margins at
Refer to DDS for biologic width
evaluation.
Missing Information
Vital signs not recorded
Record patient vitals before any procedure
Intraoral images: Incomplete
Missing photograph of right side
Radiographs: Incomplete and 4 years old
Missing maxillary right canine
Lack of open contacts
Needs updated FMX
Occlusion
Right Canine: Class I Left Canine: Class I
Occlusion
Right Molar: Unclassifiable Left Molar: Unclassifiable
Missing maxillary 1st molar Missing intraoral image
AAP Classification
Generalized 2-3 mm recession & 1-3 mm
pockets
Generalized moderate chronic
periodontitis

Severe bone loss in posterior teeth

Class I and Class II furcations in all molars
Localized severe chronic periodontitis
Periodontal Condition
Severe horizontal bone loss
But gingiva appear healthy
1-3 mm pockets
May be related to smoking
Past moderate to severe periodontitis
Controlled with successful periodontal
therapy
 8 Human Needs
1. Upright patient position,
Protecti minimize duration that
on from patient is reclined.
health
risks

2. No fear. Use anesthesia.

Freedo
m from
Fear
and
Stress

3. Selective polishing,
Wholes inform about in-office and
ome at-home tooth whitening
Facial options.
Image

4. Refer to DDS to evaluate

Biologi overhanging amalgam
 8 Human Needs
5. Skin Recommend alcohol-free
and 0.05% fluoride
Mucou mouthrinse and sodium
s lauryl sulfate-free
Membr dentifrice. Recommend
ane saliva substitutes, sugar
Integrit free gum, and other non-
y of cariogenic solutions for
Head xerostomia. Advise on
and effect of smoking on
Neck xerostomia and
periodontal disease.

6. Sit patient upright during

Freedo procedure. Minimize
m from duration that patient is
Head reclined.
and
Neck
Pain
Modifications to Treatment
Medical History: Missing Vital Signs
Before any treatment:
Heart rate
Respiration
Blood pressure
Make sure he is safe to treat
People with high blood pressure
can feel fine
Modifications to Treatment
Medical History: Missing Vital Signs
Before any treatment:
Heart rate
Respiration
Blood pressure
Make sure he is safe to treat
People with high blood pressure
can feel fine
Shoulder pain when reclined for
extended periods:
Upright patient position
Treatment Plan
Ap Dat Procedures:
po e/In
int terv
m al
en
t

1 12/ E&I, FMX, Evaluate full

9/2 mouth periodontal and
015 dental condition (general
assessment, periodontal
assessment, restoration
assessment), treatment plan,
selective polishing

2 12/ E&I, Plaque index, SRP ULQ

16/ with anesthesia
201 (radiographically evident
5 calculus #15M), selective
polish, OHI and smoking
cessation

3 12/ E&I, plaque index, SRP LLQ

Specialist Referral
Refer to prosthodontist
Evaluation of restoration on
tooth #3.

Refer to a DDS
Overhanging amalgam
restorations
MD#30, DOL#19
Oral Health Instruction
Xerostomia
Sugar-free gum
Alcohol-free mouth rinse
Avoid sodium lauryl sulfate dentifrice

Does not floss regularly

Explain connection between flossing,
interproximal plaque, and periodontal
disease.
Interdental brush; Floss threader for
overhanging restorations

Tobacco Cessation
Assess readiness to quit
Tobacco Cessation
The 5 As
ASK patients smoking history and habits
ASSESS readiness to quit
ADVISE patient on the benefits of quitting
ASSIST patient to quit smoking
ARRANGE follow up visits

Only if he wants to quit

inform, dont force
 The bone loss in the patients radiographs
indicates moderate-to-severe periodontitis.
The patient currently has healthy gingiva with
shallow pockets, so his condition has
improved to slight periodontitis.

a. Both statements are true.

b. Both statements are false.
c. The first statement is true, the second
statement is false.
d. The first statement is false, the second
statement is true.
ANSWER:
c. The first statement is true, the
second statement is false.

The patient is still classified as having

moderate or severe periodontitis. His
gingiva may have recovered, but the
bone loss is irreversible.