Periodontal+Case+5+-+Aggressive+Periodontitis

__ Aggressive Periodontitis __ __**Patient Information:**__  Rose Smith is a 19 year old female, ethnicity- African American, DOB: 7/ 7/1992. Reason for Visit: She is a patient today for dental hygiene care and she complains that she has two loose teeth. __**Dental History:**__ Yes: Loose teeth. Patient noticed since 2007- mandibular first molars and mandibular incisors. Last dental exam: October of 2010. Previous Dentist: Pure Gold Professionals. Last x-rays: October 2010. 18 FMX Last cleaning: In April of 2010- regular cleaning. __**Medial History:**__ Cardiovascular System: No past or present history of any diseases. Head/neck problems: the patient marked yes to visual impairment-she wears glasses since she was 7years old; she is nearsighted. Social life- no past or present history of social life problems. Neuromuscular System/CNS: No past or present history of any diseases. Hemo/Endo/Immune Disorders: frequent canker sore on lower lip and apthous ulcers since 2009 last breakout 5/2010. Psychological and behavioral problems: No past or present history of any problems. Childhood vaccinations and Hepatitis B vaccination series were completed in 2001. Family History- no family history of any conditions Hospitalizations: none  __**Medications**:__   Medication Name: Abreva (Docosanol)   Dose: apply 5x a day to infected area   Period of time taken: as needed   Last taken: 5/2010   Taken for: cold sores/ herpes simplex of the lips (type1)   Dental Implications: No significant effects or complications reported to require special precautions   Dental contraindicatons: no information avalible to require special precautions __**Assessments**__ :

Maximum opening: 42mm. Salivary flow is adequate. Gingival description: Free gingiva is generalized pink, firm fills the embrasure with localized erythema b/w 23-26, and around 31; the interdental papilla is bulbous; and shiny. Attached gingiva is generalized pink with melanin pigmentations, firmly attached to the bone and stippled w/ localized erythema, loss of stippling and glossy b/w 23 and 26 and around 31. Angels class: Bilateral Class I normal occlusion. Facial profile: Mesognathic. MBI 11%. BOP 19%. Generalized probing depths of 3-4mm and localized 5-6mm. Restorative findings: Occlusal Amalgam #3, 14, 19, 30, & 31. Recession: 22-2mm, 23-2mm, 24-4mm, 25-4mm, 26-2mm, 27-2mm. Furcations: Class II #14 & 19, Class III on #3 & 30. Mobility: (+) #7-9, Class II# 3, 19, 23, 26, & 30. Class III on #24-25. Fremitus: +7-10. Mucogingival defects on 24, 25, and 26. Calculus code: light/med PI 22%.



__**DDS exam:**__ Missing teeth: 1 never developed, 16, 17, and 32 impacted. Restorations- no open margins, overhangs. Possible areas of decay: none No radiolucency at apices No intrinsic absorption noted No extrinsic absorption noted No dilaceration of roots noted Root resoption-#3, 14, and 19. No atypical findings such as attrition, erosion, enamel pear, super numary tooth. General osseous: no radiolucent/radiopaque lesions or foreign objects __**Referral**__ DDS: Extraction #24-25 Periodontist: Evaluate #3, 14, 19, and 30.

__**2nd check-in**__ Periodontal Interpretation: Quality of radiographs- incorrect vertical angulation Trabecular pattern- consistent throughout Lamina dura- not present Alveolar crest is generalized 1-2mm from the CEJ with localized 5-6mm. Vertical bone loss M-2, D-3,D-14, D-19, M-23, M & D- 24-25, M-26, and M & D-31. PDL inconsistent Interadicular radiolucency- furcations on 3 and 30. Calculus noted on the M/D of #31 ADA case type II with localized IV. AAP: Genralized slight chronic periodontitis with localized severe periodontitis due to plaque and calculus. MVC calculus Code: Light/Med

__**Critical Thinking:**__

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Influencing cultural and social factors: Pt. is young and dose not quite grasp the concept of the importance of proper oral health ======

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Oral Health Belief model: Transtheoretical Modle and stages of change: Pre-contimplation stage: pt. has little or no intrest and no intention of changing behavior ======

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Recommended OHI: Soft bristle toothbrush using Bass method 2x a day, Floss 1x a day and demonstrate "C" shape flossing technique. ======

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Anesthesia /rational: yes, 2 % lidocaine with vasopressor to maintain patient comfort due to pocket depths. Maxilla= PSA & GP (Concerned w/ probing depths M-#2 & D-#3, D-#14 & M-#15) Mandible= Gow Gates (Concerned w/ probing depths D-#19. #23-26, #30, M-#31) ======

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Anticipated outcomes: maintain bone level, reduce PI by 5% and BOP by 5% also reduce 4mm -3mm, 5mm-4mm and 6mm-5mm pocket depths. ======

__**Treatment Planning:**__ Appt. 1 X-ray check 4 BWX Assessments DDS exam Second check in

Appt. 2 PI/OHI URQ w/ anes. (PSA & GP) LRQ w/ anes. (Gow Gates) Chlorhexidine # M-2, D-3, M & D-25, M-26, and M & D-31. Fluoride varnish treatment

Appt. 3 ULQ w/ anes. (PSA & GP) LLQ w/ anes. (Gow Gates) Chlorhexidine #D-14, D-19, M-23, and M & D- 24. Fluoride varnish treatment

Appt. 4 4 month recare

__**SOAP Notes:**__

S: Patient states she “is concerned with two loose teeth”. O: RMH, B/P: 116/76, P: 74, R: 16. Extra oral findings: None, Intra oral findings: None. Maximum opening: 42mm. Salivary flow is adequate. Gingival description: Free gingiva is generalized pink, firm fills the embrasure with localized erythema b/w 23-26, and around 31; the interdental papilla is bulbous; and shiny. Attached gingiva is generalized pink with melanin pigmentations, firmly attached to the bone and stippled w/ localized erythema, loss of stippling and glossy b/w 23 and 26 and around 31. Angels class: bilateral Class I normal occlusion. Facial profile: Mesognathic. MBI :11%. BOP: 19%. Generalized probing depths of 1-2mm and localized 5-6mm. Restorative findings: Occlusal Amalgam #3, 14, 19, 30, & 31. Recession: 22-2mm, 23-2mm, 24-4mm, 25-4mm, 26-2mm, 27-2mm.Furcations: Class II #14 & 19, Class III on #3 & 30. Mobility: (+) #7-9, Class II# 3, 19, 23, 26, & 30. Class III on #24-25. Fremitus: +7-10. Mucogingival defects on 24, 25, and 26. A: ASA I, ADA case type II with localized IV. AAP: Generalized slight chronic periodontitis with localized severe periodontitis due to plaque and calculus. MVC calculus Code: Light. P: X-ray check, completed BWX (4 films), completed assessments, DDS exam and 2nd check-in. N.V: PI, OHI, Scale URQ and LRQ with anesthesia, Chlorhexidine treatment and Fluoride varnish.
 * __Appointment 1: __**

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">--AdamsBaezaBobovaCadena #2012- <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">**__Appointment 2:__** <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">S: Patient states she “is concerned with two loose teeth”. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">O: RMH-no changes, B/P: 116/74, P: 72, R: 16. E & I exam: no findings. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">A: ASA I, <span style="font-family: 'Arial','sans-serif'; font-size: 13px;">ADA case type II with localized IV. AAP: Generalized slight chronic periodontitis with localized severe periodontitis due to plaque and calculus. MVC calculus Code: Light. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">P: PI-22%, OHI-demonstrated Bass method and “C” shape flossing technique, Scaled URQ & LRQ with anesthesia, <span style="font-family: 'Arial','sans-serif'; font-size: 13px;">Chlorhexidine treatment # 2-3, 25-26, and 31, and <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">Fluoride varnish. Administered PSA, GP, and gow gates on the patient’s right side, used 2% lidocaine with vasopressor at a total amount of 3.15 ml. Applied 5% sodium fluoride varnish. Advised patient to not eat or drink for 30 minutes, avoid gum, hard or sticky food & candy for 4 hours.Patient tolerated the procedure well and was dismissed from clinic in good condition. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">N.V: Scale ULQ & LLQ, Chlorhexidine treatment, and fluoride varnish. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">--AdamsBaezaBobovaCadena #2012-

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">**__Appointment 3:__** <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">S: Patient states she “is concerned with two loose teeth”. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">O: RMH-no changes, B/P: 114/74, P: 80, R: 17. E & I exam: no findings. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">A: ASA I, <span style="font-family: 'Arial','sans-serif'; font-size: 13px;">ADA case type II with localized IV. AAP: Generalized slight chronic periodontitis with localized severe periodontitis due to plaque and calculus. MVC calculus Code: Light. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">P: Scaled ULQ & LLQ with anesthesia, <span style="font-family: 'Arial','sans-serif'; font-size: 13px;">Chlorhexidine treatment # 14, 19, & 23-24, and <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">Fluoride varnish. Administered PSA, GP, and gow gates on the patient’s left side, used 2% lidocaine with vasopressor at a total amount of 3.15 ml. Applied 5% sodium fluoride varnish. Advised patient to not eat or drink for 30 minutes, avoid gum, hard or sticky food & candy for 4 hours.Patient tolerated the procedure well and was dismissed from clinic in good condition. <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">N.V: 3 month recare <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 13px;">--AdamsBaezaBobovaCadena #2012-

Reference Carranza, F., Klokkevold, P., Newman, M., & Takei, H. (2006). Carranza's clinical periodontology. (10 ed., pp. 506-511). St. Louis, MO: Saunders Elsevier.