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Our Patient:. 21 year-old female Student & Bartender Social Drinker Smoker No Exercise Poor Diet Anxiety Problems. C.C. “My mouth really hurts and there’s a bad taste”. Medical Assessment. Recent Mononucleosis Suffers from Panic Attacks Insomnia
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Our Patient: 21 year-old female • Student & Bartender • Social Drinker • Smoker • No Exercise • Poor Diet • Anxiety Problems
Medical Assessment • Recent Mononucleosis • Suffers from Panic Attacks • Insomnia • Vitals: BP 108/68, BPM 90, RPM 18, Temp is 100.7°F.
Medications • Xanax- treatment for panic disorder • Significant xerostomia • Lunesta- treatment of insomnia • Unpleasant taste, xerostomia • Ortho Tri-Cyclen- prevention of pregnancy • Caution with prescribing antibiotics
Dental History • Carries: 2,18,31 • Restorations: 2,3,12,13,14,18,19,30. • Last Visit: Over one Year. “I have been too busy.”
Oral Assessment • E/I Exam: • Bilateral, palpable, tender cervical lymph nodes • Geographic tongue • Fetid breath • Adequate salivary flow, but patient reports that mouth is “usually really dry”.
Caries: • Suspicious area at the CEJ between 7 & 8. • Buccal caries on 2,18, 31. Interproximal caries between 2 & 3, and 13 & 14. (Seen in Chart)
Periodontal Assessment/ Description: • Maxillary & Mandibular marginal erythema and edema & necrosis of anterior papilla, especially in the mandibular anteriors • OH is poor. PFI = 20%
MBI, Probings, BOP: • It was too painful to record full probe, however spot probe reveals 4mm interpoximal depths on the facial aspects of all cuspids and first molars. • BOP= 100% for all 16 sites probed.
Periodontal Classification: • AAP classification is class V- Necrotizing Ulcerative Periodontitis. • WLAC Calculus Code: WLAC- 2 Light.
Signs and Symptoms of Necrotizing Ulcerative Periodontits Necrosis of interproximal papillae √ Bleeding √ Pain √ Fetid Odor√ Pseudomembrane over gingiva Cervical lypmphadenopathy √ Fever√
Three Most Reliable Criteria ForRecognizing ANUP: Necrosis of interproximal papillae √ Bleeding √ Pain √
It is an opportunistic infection of the gingiva. • It is associated with lifestyle risk factors such as stress & tobacco.
Human Needs: • C.C. “My mouth really hurts and there is a bad taste.” • Protection from health risks, anxiety, and stress. • Functional Dentition • Periodontal Complication
Human Needs: • Pain Control • Specialist Referral and Diagnosis • Understanding of Oral Diagnosis and process. • Patient’s Oral Health Responsibility
Treatment • Treatment should progress daily during the acute phase of the disease because the pain often inhibits thorough cleaning by the client or hygienist at one time.
Day One: • Scale & Debride as much as pt. can tolerate. Ultrasonic may be more easily tolerated. • Encourage pt. to rinse with 3% Hydrogen Peroxide to sooth tissue and oxygenate anaerobic bacteria. • .12% Chlorhexidine 2x a day. • OHI, Diet Counseling, Tobacco Cessation.
Day Two: • Scale & Debride as much as pt. can tolerate. Pain should be reduced considerably. • Reinforce OHI. • Continue 3% Hydrogen Peroxide for 1 week.
Day Seven: 3rd Appt. • Finish any necessary Scaling & Debridment. • Check patients OH with disclosing solution. • Discontinue 3% Hydrogen Peroxide. • Continue on 0.12% chlorhexidine 2x daily for 2-3 weeks. • Encourage use of xylitol products for dry mouth.
1 Month: Reevaluation • Reinforce OH. • Scale and root plane if necessary. • Evaluate patients progression with lifestyle changes. Stress-Tobacco Cessation-Diet • Assess for Reduced Gingival Bleeding BOP<75%. • Switch to 10 mL clorhexidine rinse for 1 minute daily for 1 week each moth. -Caries protection.
Three Month Recare Appointment • Regular mechanical dental hygiene care. • Topical fluoride application. • Reinforce OH and lifestyle changes to prevent the recurrence of NUP.
