Focused Case Studies

Focused Case Study

Leslie Bebber Summer 2009 Clinic Practice

Background Information 

19 yr old Caucasian female

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Lower middle socioeconomic status

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No medications

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ACL surgery: numbness of upper calf

Past Dental Treatment 

Prophy 5+ yrs ago

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Ortho 5+ yrs ago

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No fillings

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No extractions

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Sealants as a young teenager

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Note: lingual bar came off and the lower anterios shifted back question abount dental charting

Chief Complaint 

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Patient states that she is extremely embarrased of the way her mouth smells. Patient also states she wants to get her teeth straight and white.

Gingival Description 

Red, edematous, bulbous,soft, smooth and shiny in the lower anterior region

Anxiety and Dental Conerns Assessment 

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Moderate anxiety with a score of 10 Dental concerns: cost, being put down or lectured to and embarrassed about the condition of her mouth Note: discuss what we talked about

24hr Dietary Recall 

Sips on Dr. Peppers all day

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Does not consume many sweets

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Not a big snacker

Oral Risk Assessment 

Caries visible on xrays

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Crowding in lower anteriors

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Brushes 1x daily

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Rarley flosses

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Occasionally uses Listerine mouthwash Note: Patient states she does not like to brush often because it makes her gums bleed.

Recommendations 

Brush 2x daily, especially before bed with her Sonic Care

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Crest Pro-Health

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Waxed floss

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GUM soft pics after lunch

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Listerine for 30sec 2x daily prior to brushing

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Note: Patient has good dexterity

Findings 

Several 4mm pockets

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No furcations or moblity

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Attachment at the CEJ (above CEJ in lower anterior except for # 25 Stillman's Cleft)

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Mouth breather

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Tongue thrust

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question*

Mouth Breathers 

According to Wilkins mouth breathing causes dehydration of oral tissues in the anterior region which leads to changes in size, shape, surface, texture and consistency.

Etiologic Factors of Malodor 

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Intrinsic or Extrinsic Extrinsic: absorbed into the circulatory system and released through the respiratory system and saliva Intrinsic: 10% systemic, 90% directly related to intraoral sources Daniel and Harfst

O'Leary 

93, 87 and 56

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Generalized marginal and facial of lower anteriors

Patient Education 

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Continual process Discussed the bleeding gums and her source of bad breath

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Taught BASS method and proper flossing techniques

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Gave patient a sample of GUM soft pics

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Increasing brushing frequency

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Discussed the link of oral health to her overall health

Diagnosis 

Gingivitis

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Moderate BOP

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4mm pockets on the distal and mesials of third molars

Pain Management 

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Anxiety was moderate on paper with of score of 10 Patient's mother expressed concern that patient did not handle discomfort/pain well

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Extremely sensitive to probing: used Benzocaine 20%

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Oraqix for scaling

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Iatrosedation

Anticipated Outcomes 

O'Leary of 20%

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No BOP

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Gingiva: pale pink, firm, knife-edged with papillae that fill the interproximal space Most importantly: no halitosis following treatment with continued proper home care

Instrumentation 

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Hand instrumentation, slim tip to deplaque Most improvement needed with universal curette in the premolar region Patient's sensitivity, crowding and inflammed tissues in the lower anterior created the most challenge *

question

Evaluation

Self Assessment 

Good communication with the patient

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Patient was eagar to learn and asked good questions