Transcript DH100 - Amanda Nickelson

Our Patient:
21 year-old female
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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
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Recent Mononucleosis
Suffers from Panic Attacks
Insomnia
Vitals: BP 108/68, BPM 90, RPM 18, Temp is
100.7°F.
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Medications
 Xanax- treatment for panic disorder
• Significant xerostomia
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 Lunesta- treatment of insomnia
• Unpleasant taste, xerostomia
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 Ortho Tri-Cyclen- prevention of pregnancy
• Caution with prescribing antibiotics
Dental History
 Carries: 2,18,31
 Restorations:
2,3,12,13,14,18,19,3
0.
 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.
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 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
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 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.
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 BOP= 100% for all 16 sites probed.
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Periodontal Classification:
 AAP classification is class VNecrotizing 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 For
Recognizing ANUP:
Necrosis of interproximal papillae √
Bleeding √
Pain √
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 It is an opportunistic infection of the gingiva.
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 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
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:
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 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.
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 Continue 3% Hydrogen Peroxide for 1 week.
Day Seven: 3rd Appt.
 Finish any necessary Scaling & Debridment.
 Check patients OH
with disclosing solution.
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 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.
Three Month Recare Appointment
 Regular mechanical dental hygiene care.
 Topical fluoride application.
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 Reinforce OH and lifestyle changes to
prevent the recurrence of NUP.