Periodontal+Case+6+-+Down's+Syndrome

Case #6- Down's Syndrome
__Health History: __


 * =====Jenny Hopkins is an 18 year old caucasian female. She is currently unemployed. She is under the care of Dr. John Van and the number is (951)555-1234, and her emergency contact is her caretaker and mother, Marjory Hopkins. All contact information is current. Her major reason for coming to the Riverside Community College Dental Hygiene Clinic is to get her teeth cleaned. She experiences bleeding gums when brushing and her mother states that she "always complains that her teeth hurt." Her previous dentist Dr. Lee saw her for an DDS Exam on July 19, 2009.She had an FMX done on that day as well as a regular cleaning. The patient is nearsighted and wears glasses since 1999 and has slight hearing loss since 1998. The patient presents with mental retardation in the form of Down's syndrome since birth in 1993. The patient also presents with congenital hypothyroidism since 1993. She had her childhood vaccinations in 1997, a flu vaccination in 2011, and has a family history of Type 2 diabetes. The patient does not have any allergies. The patient's mother did share that Jenny has had celiac disease since 1997 and is on a gluten-free diet. The patient has never been hospitalized or visited the ER. =====

__Jenny's Medications:__
 Tylenol 500mg as needed for headache  Dental implications: No significant effect or complications reported.  Dental contraindications: Hypersensitivity to acetaminophen or any component of the formulation.

 Synthroid (Levothyroxine)0.125 __mcg__ times daily for management of hypothyroidism. Dental Implications: No significant effects or complications reported. Dental Contraindications:Hypersensitivity to levothyroxine sodium or any component of the formulation; acute MI; thyrotoxicosis of any etiology; uncorrected adrenal insufficiency.

__Periodontal Exam Findings: __ Extraoral exam: epicantheal folds, brushfield sopts in the iris. Intraoral exam: angular chelitis, enlarged fissured tongue, enlarged tonsils, inadequate salivary flow.

Free gingival description: Generalized erythematous, firm, blunted, and smooth with localized areas that are bulbous and buccal lower anterior gingiva is flaccid. Attached gingival description: Generalized erythematous, spongy, not stippled.

Max-opening: 43 mm Salivary flow: inadequate <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Angle’s Classification- Bilateral Class III, anterior open bite. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> Facial profile: Prognathic <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Restorative: Occl. amalgams on 2, 3, 4, 14, 18, 30.

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">MBI -54% <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Probing depths were generalized 3 to 4mm, with localized 5-6 mm areas. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">BOP %- 68% <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Recession: #6- 1mm, #27-2mm <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Mobility- + 22-27. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Fremitus- + 6-11 <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Mucogingival defects- #27 <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">MVC Calculus code-medium calculus on all four quads. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">ADA classification- III <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">AAP-generalized chronic moderate periodontitis due to plaque and calculus, modified by Down's syndrome

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Missing teeth: 1,16,17,32 never developed. Existing Restorations: #2 PFM, 3 MOD, 4 DO amalgam, MOD amalgam on14,18,30. Possible areas of decay: recurrent decay#3 and 4, decay on Distal of 13, mesial of 31. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Atypical Findings: altered cuspids on maxillary molars, crowding of anterior teeth on maxilla. Radiolucencies on apices (differential diagnosis):none noted. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Intrinsic/Extrinsic Resorption (state etiology):none noted <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Root resorption on 7and 10 caused by trauma. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Dilacerated Roots: 3 and 15 <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Other Atypical Anatomy Findings:none noted. ====<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 16px; text-decoration: none; vertical-align: baseline;">General osseous: any radiolucent/radiopaque lesions or foreign objects- none noted. ====

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 16px; text-decoration: none; vertical-align: baseline;">PDL space is widened D and M of 23-26
<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">__Critical Thinking Form__: <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Chief Complaint: Pt. states, “She is here to get her teeth cleaned.” <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Medical History/Systemic Health: Down Syndrome and Hypothyroid. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> Oral risk factors: increase risk of periodontal disease, poor oral hygiene, possible limited <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> dexterity, xerostomia <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Dental Health Diagnosis: Perio: uncontrolled <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> Caries:uncontrolled <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> Oral Hygiene: uncontrolled <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Influencing Cultural and Social Factors: Pt. relies on her mother as her caregiver but generally brushes her teeth on her own and doesn’t floss. She states she has a little difficulty sometimes but likes visiting the dentist. Also, the patient loves to eat gummy candies. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Oral health belief model: Precontemplation stage of Transtheoretical model- pt. needs knowledge of how important OH is and how to get rid of plaque effectively so that she can have a healthy mouth. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Recommend OHI: to caregiver and patient Bass brushing technique, C-shape flossing technique, Reach flosser, interdental brush, alcohol free fluoride rinse, nutritional counseling, tongue brushing/tongue scraper <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Instrument selection:Piezo, Catoni, anterior/posterior sickles, McCall’s and Younger-Good universals and graceys. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Anesthesia/ Rationale: Lidocaine 2% with epinephrine for pt. comfort and operator accessibility. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Reevaluations:n/a <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Anticipated Treatment Outcomes: Reduce pocket depths by 1mm and decrease MBI and BOP by 20% <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Referrals: GP- For caries. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Recall interval: 3 months <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;"> -Rationale: to re-evaulate patient’s pocket depths, decrease MBI and BOP.

__<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Treatment Plan __ <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 1 X-ray check 4 bwx, 2pas Gathered assessments <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 2 DDs exam 2nd check in, PI OHI- Introduce the c-shape flossing technique. Plaque Index -92% and nutrition counseling. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 3 OHI- Introduced the bass brushing technique. Scale Upper right quad with 2% lidocaine, 0.9ml PSA, 1.8ml AMSA, and 0.45ml GP. Fluoride varnish on quad scaled. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 4 OHI- Introduce Reach flosser. Scale lower right quad with Lidocanine 2%, 1.5ml IA, and 0.3ml Buccal nerve block. Fluoride varnish. Nutrition counseling. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 5 OHI-Introduced Interdental brush, evaluate how previous OHI are being implemented and ease of performance for pt. Scale upper left quad with 2% lidocaine, 0.9ml PSA, 1.8ml AMSA, and 0.45ml GP. Flouride varnish. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt.6 OHI- Recommend fluoride rinse. Scale lower left quad with Lidocanine 2%, 1.5ml IA, and 0.3ml Buccal nerve block. Fluoride varnish. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt.7 OHI-tongue brushing/tongue scraper. Re-eval 4-6 weeks. Nutrition counseling. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt. 8 Re-care 3 months.