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    Comprehensive Care Project

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    This document summarizes the dental treatment plan for a 32-year-old Hispanic male patient with severe chronic periodontitis, multiple cavities, and one missing front tooth. The plan involves non-surgical periodontal therapy including scaling and root planing over multiple appointments. Additional treatment includes restorative dental work, extractions, nutritional counseling, and periodontal maintenance. The prognosis is considered poor-to-questionable due to the patient's non-compliance with oral hygiene and history of chronic sleep deprivation.

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    Comprehensive Care Project

    Uploaded by

    api-312451539
    75 views17 pages
    This document summarizes the dental treatment plan for a 32-year-old Hispanic male patient with severe chronic periodontitis, multiple cavities, and one missing front tooth. The plan involves non-surgical periodontal therapy including scaling and root planing over multiple appointments. Additional treatment includes restorative dental work, extractions, nutritional counseling, and periodontal maintenance. The prognosis is considered poor-to-questionable due to the patient's non-compliance with oral hygiene and history of chronic sleep deprivation.

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    This document summarizes the dental treatment plan for a 32-year-old Hispanic male patient with severe chronic periodontitis, multiple cavities, and one missing front tooth. The plan involves non-surgical periodontal therapy including scaling and root planing over multiple appointments. Additional treatment includes restorative dental work, extractions, nutritional counseling, and periodontal maintenance. The prognosis is considered poor-to-questionable due to the patient's non-compliance with oral hygiene and history of chronic sleep deprivation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    75 views17 pages

    Comprehensive Care Project

    Uploaded by

    api-312451539
    This document summarizes the dental treatment plan for a 32-year-old Hispanic male patient with severe chronic periodontitis, multiple cavities, and one missing front tooth. The plan involves non-surgical periodontal therapy including scaling and root planing over multiple appointments. Additional treatment includes restorative dental work, extractions, nutritional counseling, and periodontal maintenance. The prognosis is considered poor-to-questionable due to the patient's non-compliance with oral hygiene and history of chronic sleep deprivation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 17

    Comprehensive

    Care Project
    Tang Blanton
    Jose Mendez
    Patient Profile

    32 year old Hispanic Male


    BP: 124/84 mmHg Pulse: 66 Respiration: 18

    Chief Complaint:
    I have cavities and one front tooth fell off. Theyre
    also yellow and dont feel smooth.
    Medical Assessment
    Medications:
    Acetaminophen - Analgesic (As needed)
    Aspirin - Salicylate, antiplatelet agent (As needed)
    Prolongs bleeding for 7-10 days
    Fish Oil - Omega-3 Fatty Acids (Daily)
    Prolongs bleeding in doses above 1000 mg
    Marijuana (Once per week)
    Multivitamin (Daily)
    Medical Assessment

    Most recent physical exam was 10 years ago

    History of prehypertension

    No history of other systemic diseases

    ASA II
    Periodontal Assessment
    AAP: Generalized Severe Chronic Periodontitis
    Calculus: Maxillary arch 5-Medium-Heavy
    Mandibular arch 6-Heavy
    Probing depths
    Generalized 4-6 mm pockets
    Recession:
    2mm recession: #4L, 6F, 8F, 9F, 13L, 15L, 17F, 17L, 21L, 22F, 26F, 27F, 28F,
    31F, 31L, 32F
    3mm recession on: #13F, 16F, 19F, 20F, 23F, 24F, 25F, 29F, 31F
    4mm recession on #20L, 21F, 21L, 24L, 25L, 26L, 29L
    5 mm recession on #12F
    Clinical Attachment Loss (CAL):
    Generalized 5-7 mm attachment loss
    Periodontal Assessment
    Furcation Involvement
    Class I: 15B, 19B, 19L
    Class II: #2B, 31B
    Class III: #30 B and L
    Mobility:
    Physiological mobility: #1, 2, 4, 10, 11, 12, 16, 17, 20, 21, 27, 28, 30, 31, 32
    Class I mobility: #5, 8, 9, 13, 19, 22, 23, 24, 25, 26, 29
    MGI: None
    Bleeding on Probing: 100%
    Plaque Index: 97%
    Radiographs
    Preventative Dental Hygiene

    Caries Assessment - CAMBRA


    High Caries Risk
    Multiple active carious
    lesions
    #1-0, 9-ML, 15-O,
    19-OB, 20-O, 21-O,
    29-MO, 31-B
    DMFS = 32%
    3 or more between meal
    snacks per day
    Frequent soda, consumed
    over 1 hour or more
    Preventative Dental Hygiene

    Recommendations:
    5% NaF varnish at each periodontal maintenance
    Twice daily 1000 ppm fluoride dentifrice
    Once daily 0.05% NaF mouthrinse
    Once daily 5000 ppm fluoride gel

    Educate patient about sugar and caries process


    Motivate improved oral hygiene
    Patient Education
    Current Status:
    Limited oral hygiene knowledge and low motivation
    Brushes once per day with large scrubbing motions, misses areas
    Does not floss
    Chronic sleep deprivation - often falls asleep without oral hygiene
    Oral Hygiene Instruction
    Increase brushing and flossing frequency
    Modified Bass toothbrushing
    C-shape flossing
    Patient Education
    Nutritional Counseling
    Deficient in vitamins A, C, D, E, and K
    Kale, broccoli, green leafy vegetables, avocado,
    spinach, sweet potato
    Deficient in magnesium and potassium
    Green leafy vegetables, sweet potato, beans,
    avocado, spinach
    Smoking Cessation
    Smokes marijuana weekly
    Not interested in quitting
    Treatment Plan
    Quadrant SRP with Anesthesia
    9-1-16 LLQ - abscess on #24-L, Heavy calculus
    9-8-16 ULQ
    9-15-16 LRQ - Heavy calculus
    9-29-16 URQ
    Re-evaluation
    10-25-16 & 11-20-16
    Scale residual calculus, selective polish, 5% NaF varnish
    Desensitization, locally delivered antimicrobials
    Referrals
    Refer to DDS for restorative care post-hygiene therapy
    Refer to oral surgeon for extraction of root tips
    Refer to periodontist for severe periodontitis
    Treatment Progress
    Tissue Resolution
    Gingiva pre-treatment: reddish-blue, bulbous, spongy, hemorrhagic
    BOP pre-treatment: 100%
    Gingiva post-treatment: pink with interproximal inflammation
    BOP post-treatment: 4%
    Patient Compliance:
    Plaque score pre-treatment: 97%
    Plaque score post-treatment: 31%
    Oral hygiene has improved, but is still poor
    Additional Therapy
    3 month periodontal maintenance
    Intraoral Photos
    Before After
    Treatment Progress
    Prognosis: Poor-to-questionable
    Poor compliance with oral hygiene
    25-50% attachment loss
    Class II and III furcation involvement
    Probing depths improved, but still 5-6 mm on molars
    Good compliance with scheduled appointments
    Interesting Experience
    Managing a chronically sleep deprived patient
    Fell asleep at each treatment appointment
    Mouth prop
    Difficult to motivate
    Falls asleep without performing oral hygiene
    Power toothbrush
    Incorporate oral hygiene into existing daily habits
    Chronic sleep deprivation promotes inflammation and
    disrupts immunity
    Works Cited
    1. Beck, J., Youngblood, M., Atkinson, J., Mauriello, S., Kaste, L., & Badner, V. et al.
    (2014). The prevalence of caries and tooth loss among participants in the Hispanic
    Community Health Study/Study of Latinos. The Journal of The American Dental
    Association, 145(6), 531-540. http://dx.doi.org/10.14219/jada.2014.25
    2. Grover, V., Malhotra, R., & Kaur, H. (2015). Exploring association between sleep
    deprivation and chronic periodontitis: A pilot study. Journal of Indian Society of
    Periodontology, 19(3), 304. http://dx.doi.org/10.4103/0972-124x.154173
    3. Los Angeles Department of Water & Power, (2013). L.A.'s Drinking Water Quality
    Report (pp. 10, 12). Los Angeles Department of Water & Power. Retrieved from
    http://terrabellawater.com/wp-content/uploads/2014/08/LADWP-2013-Drinking
    Water-Quality-Report.pdf
    4. Rawal, S., Tatakis, D., & Tipton, D. (2012). Periodontal and oral manifestations of
    marijuana use. The Journal of The Tennessee Dental Association, 92(2). Retrieved
    from
    https://www.researchgate.net/publication/235667400_Periodontal_and_oral_manifestat
    ions_of_marijuana_use
    5. Sheiham, A., & James, W. (2014). A new understanding of the relationship between
    sugars, dental caries and fluoride use: implications for limits on sugars consumption.
    Public Health Nutrition, 17(10), 2176-2184.
    http://dx.doi.org/10.1017/s136898001400113x

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