P3 Project Gerardo Viadas, RDAEF
Personal History Personal: • 62 year old • Male • Hispanic • Single • Retired Medical: • Hypertension • HIV • Coarctation of the aorta • Periodontitis • Seasonal Allergies • Herpes Simplex II
Medical History Continued • BP 144/56 P 54 R 18 • BP 120/60 P 70 R 18 • BP 150/60 P 86 R 20 • ASAIII • Premedication required for coarctation of the aorta. • EpivirAntiviral HIV Drug • Viramune Antiviral HIV • Acyclovir Antiretroviral HSVII • Hydrochlothorizide Diuretic Hypotension • Proklor Potassium supplement uptake • Clarinex Seasonal Allergies (Antihistamine)
Review of Symptoms • Neurological: None • Psychological: None • Functional : None • Respiratory: None • Cardiovascular: Coarctation of the aorta • Dermatological: None • Gastrointestinal: None • Hematological: None • Endocrine: None • Immunological: HIV Dental History • BW’s: 6/2006 • FMX: 6/2006 • Latest exam: 7/2008 • Latest dental prophylaxis: 6/08
Dental History Continued Patient presents w/ restorations on teeth #’s 2MO, 3O, 8RCT, 14PFG, 15MOD, 18OB, 19DO, 28O, 29O, 30O, 31MO Missing teeth: #1,12,13,16,17,23,24,25,26,& 32. Patient present w/ generalized 3 mm recessions on all teeth. Abrasions and abfractions are not present.
Clinical Examination: First Visit • Extraoral exam: WNL (max. opening 45mm) • Intraoral exam: Hard tissues WNL, soft tissue WNL except for generalized 2-3mm gingival recessions on existing teeth, salivary flow WNL. • Patients presents with a lower partial denture replacing teeth #’s 23,24,25, &26 (lower anterior incisors), and an upper partial denture replacing teeth #’s 12 and 13.
Clinical Examination Continued • Occlusal relationship: Class I • Facial profile: mesognatic • Overbite: 5mm • Overjet: 3mm • Mobility: WNL • Furcation: WNL • Generalized 2-3mm probings w/ localized 4-5mm probings. • Gingival description: Maxillary attached gingiva: pink, firm, and stippled. • Maxillary free gingiva: pink, firm and smooth. • Mandibular attached gingiva: pink, firm, and stippled. • Mandibular free gingiva: pink, smooth with localized rolled borders. • Initial PI: 65% PFI:35% • Initial BOP: 1% • Calculus description: Light 2 supra and slight subgingival. 25% interproximally. • Radiographic interpretation: Consistent horizontal bone loss. • Periodontal classification:Generalized severe periodontitis.
Treatment Plan • OHI: Modified Bass technique • Flossing instructions: using the “C” method of wrapping the floss around each tooth. • Interdental Aids: Proxybrush for open contacts. • Tongue scraper: Coated tongue. • Flouridetx: 2% sodium fluoride for 4 minutes. • Full–mouth scale • Re-Evaluation 3-4 weeks, to reassess the OH, to assess improvement, and new problems, and to evaluate the frequency of follow-up with dental hygiene appointment.
Nutritional Recommendations • PT should exercise 30 minutes (suggestion). • PT should drink more water instead of coffee and bottled coffee flavored beverages. • Nutritional Counseling: Patient needs to consume more wholesome foods. Such as milk products, vegetables, fruits, whole grains, and low fat meats.
Re-evaluation Visit • Gingiva: Generalized pink, firm, and stippled • Probings: Generalized 2-3mm (localized 5mm decreased 1mm). • PI: 39% • PFI: 61% • MBI: 0% • WLAC Calculus Code: Light 1 • OHI: Modified Bass technique, C-fold flossing technique, with interproximal cleaning aids (proxybrush). • Nutritional recommendation: Based on patient’s data.
Cambra • The patient is considered a high risk patient because the patient has a history of restorations within a three year period. • Cambra recommends high risk patients to brush twice a day with a toothpaste containing 1.1% NaF. • Use a 0.2% NaFmouthrinse daily. • 3-4 month recall to evaluate caries risk and apply flouride varnish. • Saliva test and bacterial culture. • Chlorhexidinegluconate 0.12% (10ml). • Xylitol gum (6-10g daily). Two tabs a gum four times a day. • Use MI paste twice a day.
What would I have done differently? • Premedication is a must for patients with coarctation of the aorta according to the American Heart Association. • Try to manage clinic time accordingly. My patient left on a two week vacation that prolonged the treatment plan. • Overall time management needs improvement.
References • Removable prosthetics: Clinical Indication and Treatment Principles (2008). Retrieved June 10, 2009 from www.http//www.dentistrytoday.com • Rx for the Durable Partial Denture: Proper Maintenance Plan (2006). Retrieved June 10, 2009 from www.http//www.dentistrytoday.com • Dentures: Frequently asked Questions (2009). Retrieved June 10, 2009 from www.http//www.ada.org