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Vaneta Ricard-Chum
April 2012
DHCPII
Perio Project
Perio Patient
42 year old female
 Vitals WNL
-BP 110/75, Pulse 85, Respiration 16
 Smoked since a teenager, quit
December 2011
 Medications (Lorazepam,
Oxcarbazepine, Venlafaxine HCL,
Lamotrigine, multivitamin) for epilepsy,
anxiety, and depression

Extra & Intra Oral Exams
 Bruxism
Attrition max&man
anteriors
R
Abrasion
unilateral
onclick
#’s 4,5,12,13,14
 Clenching
Class I occlusion
 Missing
50% overbite
1,16,17,18,31,32
 High
2mm caries
over-jet
risk due to high sugar
 intake
Linea alba

salivary
flow tongue
 Low
Slightly
scalloped
Dental History
-Mobility on #5
 -Generalized subgingival calculus
spicules
 -Generalized slight biofilm
 Plaque Index: 45%
 -Caries on 2 occlusal, 3 occlusal, 14
lingual, 15 distal, 19 occlusal, 30 buccal
occlusal

Current Home-care
Brushes twice daily with medium
toothbrush
 Patient flosses with when remembered,
on average 3 times per week
 Last hygiene appointment was over a
year ago
 Recently seen dentist for a chipped
incisor

Intraoral Photos
Maxilla
Mandible
Right & Left
Dental Chart
Risk Factors
Smoking, quit 2 months ago
 Hormonal involvement
 Medication
 Stress

Contributory Factors
 Position
Missing teeth
of teeth/malocclusion
 Occlusal
Class 1 mobility
discrepancies
on #5
 Un-replaced
Calculus
teeth
 #15
Faulty
supererrupted
restorations
 Toothbrush
Xerostomia trauma
 Parafunctional
Mouth breathing
habits
 Food impaction
 Mouth breathing
Perio Chart
Gingival Description

Generalized recessed, pink, shiny,
slightly spongy, rounded tissue.
Periodontal Findings
Localized BOP on 2, 4, 12, 20, 21, 28
 Generalized slight recession, with
localized moderate on 4, 5, and 12
 Mobility on 5

Graphic Perio Chart
Perio Diagnosis & AAP
Generalized slight, active, chronic
periodontitis, with localized moderate,
active, chronic periodontitis on #5
 AAP Type II

Treatment Plan
Treatment Plan
Anterior Periapicals
Bitewings
Posterior Periapicals
Radiograph Interpretation
31 has been extracted since FMX was
taken
 Generalized slight horizontal bone loss
 Triangulation on mesial of #4 and #19

Clinic Notes
1st appointment
-Reviewed history, no contraindications
-Vitals, EOE, IOE, D chart, began perio assess
2nd appointment
-Rev & update history
-Vitals, cursory EOE, IOE, complete perio
assess
3rd appointment
-Rev & update history
-Vitals, cursory EOE, IOE, calculus detection,
biofilm index
Summary

Due to this patient’s schedule, I was unable to even begin
debridement. This patient has severe xerostomia, which
greatly contributes to caries formation, especially combined
with insufficient biofilm removal, and a diet high in sucrose.
She could not afford restorations, so unnecessary
extractions were made. The removal of #18 left room for #15
to super-errupt. I advised her to schedule appointments for
restorations before the carious lesions on #’s 2, 3, 14, 15, 19,
30 expand. She is only 42, and cannot risk losing anymore
molars. If I had completed this patient, I would hope to see
improvements in home-care, no BOP, pink, stippled tissue,
an improvement in dry mouth from the Biotene. In addition to
a DMD referal, I would recommend this patient to a
periodontist for her recession and slight mobility. She would
definitely need to be on a 3 month recall to evaluate her
status, and to educate when if not complying with
recommendations. It would have been nice to complete and
do a re-eval; I will hopefully have the chance to do so during