our patient: 21 year-old female student & bartender social drinker smoker no exercise poor...
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![Page 1: Our Patient: 21 year-old female Student & Bartender Social Drinker Smoker No Exercise Poor Diet Anxiety Problems](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56649eb35503460f94bbae17/html5/thumbnails/1.jpg)
Our Patient:
21 year-old female Student & Bartender Social Drinker Smoker No Exercise Poor Diet Anxiety Problems
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C.C. “My mouth really hurts and there’s a bad taste”
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Medical Assessment
Recent Mononucleosis Suffers from Panic Attacks Insomnia Vitals: BP 108/68, BPM 90, RPM 18, Temp is
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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
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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.”
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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”.
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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)
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Periodontal Assessment/ Description:
Maxillary & Mandibular marginal erythema and edema & necrosis of anterior papilla, especially in the mandibular anteriors
OH is poor. PFI = 20%
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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.
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Periodontal Classification:
AAP classification is class V- Necrotizing Ulcerative Periodontitis.
WLAC Calculus Code: WLAC- 2 Light.
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Signs and Symptoms of Necrotizing Ulcerative Periodontits
Necrosis of interproximal papillae √Bleeding √Pain √Fetid Odor√Pseudomembrane over gingivaCervical lypmphadenopathy √Fever√
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Three Most Reliable Criteria ForRecognizing ANUP:
Necrosis of interproximal papillae √
Bleeding √Pain √
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It is an opportunistic infection of the gingiva.
It is associated with lifestyle risk factors such as stress & tobacco.
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Commonly called ANUG but more correctly called NUP
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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
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Human Needs:
Pain Control Specialist Referral and Diagnosis Understanding of Oral Diagnosis and
process. Patient’s Oral Health Responsibility
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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.
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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.
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Day Two:
Scale & Debride as much as pt. can tolerate. Pain should be reduced considerably.
Reinforce OHI.
Continue 3% Hydrogen Peroxide for 1 week.
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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.
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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.
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Three Month Recare Appointment
Regular mechanical dental hygiene care.
Topical fluoride application.
Reinforce OH and lifestyle changes to prevent the recurrence of NUP.
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