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Periodontal Project WLAC 2010 Betty Tran Ruzan Ayvazyan. Personal History. Name : Pedro Zamora Age : 30 yrs old Sex : Male Race : Hispanic Occupation : Unemployed Marital Status : Single. Medical History. Past History:

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Periodontal Project

WLAC 2010

Betty Tran

Ruzan Ayvazyan


Personal history
Personal History

Name: Pedro Zamora

Age: 30 yrs old

Sex: Male

Race: Hispanic

Occupation: Unemployed

Marital Status: Single


Medical history
Medical History

Past History:

- Pt states having previous malnutrition due to lack of shelter and food.

- Prior physical trauma of head and mouth that resulted in the fracture of tooth #8, #9, #10

Present History:

- Systemic: Uncontrolled hypertension, history of substance use, smokes tobacco for the past 10 years

- Present illnesses: Pt states that he currently has an eating disorder where he over eats and has become obese.


Medical history1
Medical History

Current Medication: None

Baseline Vitals: 134/94 = 1st reading

128/90= 2nd reading

**Refer to physician


Dental history
Dental History

Past History:

Last dental visit: 1997

Previous restorations: #8,#9,#10 PFM

Amalgam #3 O

#14 O

#18 O

#19 BO

#30 BO

#31 O

Present status: New pt for dental hygiene services

CC: Would like crown re-cemented #10


Caries assessment
Caries Assessment

Pt has several clinical caries

- #10 Tx planned for RCT due to recurrent decay. New crown must be made

- Radiographs were undiagnosable

CAMBRA evaluation:

- Pt is at HIGH RISK for caries



Clinical examination
Clinical Examination

Extra oral:WNL

Intra oral:Slight attrition on lower anteriors

Abrasion on #6, #11, #12, #21, #22, #27, #29

TMD Evaluation:Asymptomatic clicking on right TMJ

Mandibular jaw slightly deviates to the right upon opening.


Oral hygiene evaluation
Oral Hygiene Evaluation

Skill level:Poor

Only brushes 1x a day and never flosses

Knowledge of periodontal disease:Unaware

Objective:Educate pt about the importance of stabilizing the present periodontal condition. Provide proper OH aids to best suit his needs.

Aids:Demonstrated modified bass w/manual TB, proper flossing techniques SonicCare toothbrush, floss holder, Antimicrobial rinse.

Barriers:Poor dexterity and motivation, lack of shelter, transportation and employment.


Indices
Indices

  • Oral Hygiene Index-Simplified= 4.7

    • The range is between 0-6. Level is high.

    • Measures debris and calculus level.

  • Periodontal Index= 3.7

    • Indicates an established destructive periodontal disease occurring.



Pre treatment pi 81 mbi 29
Pre TreatmentPI: 81%MBI: 29%


Occlusal evaluation
Occlusal Evaluation

Bilateral Class I molar and canine relationship

2mm overbite

1mm overjet


Periodontal evaluation
Periodontal Evaluation

Calculus:Generalized medium-heavy tenacious calculus

Plaque:Heavy

Restorations:#8,#9,#10 ill-fitting margins

Pocket depths:Generalized 3-4 mm w/localized 5-6 mm on posteriors and #8MB and #9 DB

Mobility:+ on teeth #7-11 and #23-27

Furcations:Buccal Class I #2,#3,#14,#15,#31,#30

Buccal Class II: #19


Periodontal evaluation1
Periodontal Evaluation

Gingival Description

  • Marginal:Generalized smooth, Edematous and erythematic, rolled borders, and glossy

  • Attached:GeneralizedPigmented, fibrotic and stippled


Periodontal evaluation2
Periodontal Evaluation

Diagnosis:Generalized Chronic Moderate Periodontitis modified by smoking and perpetuated by plaque

Prognosis:clinically = GOOD, however…

non-compliance

+ smoking

+ stress

+ poor oral hygiene

POOR


Treatment plan
Treatment Plan

4 quads SRP w/ local anesthesia

Re-evaluation in 4 weeks to assess

completed treatment.

Assess OH

Emphasis on Smoking Cessation


Treatment
Treatment

Appointment #1 (12/03/09)

Initial exam, FMX, intraoral photographs , full mouth probing, indices were taken, OHI, #10 PFM re-cemented by supervising dentist.

Appointment #2 (12/10/09)

Morning: Initiated smoking cessation, re-assessed OH – brushing & flossing,

LLQ SRP w/ local anesthesia.

Afternoon: ULQ SRP w/ local anesthesia


Treatment1
Treatment

Appointment #3 (1/21/10)

Morning: ULQ SRP w/ local anesthesia,

re-enforce OH and smoking cessation.

Afternoon: LLQ SRP w/local anesthesia,

2% NaF varnish was applied, CAMBRA Assessment, nutritional counseling

Appointment #4 (2/18/10)

Re-evaluation, full mouth probing, intraoral photographs, case study models, and indices were taken. Fine scaling to remove residual calculus.


Post treatment
Post Treatment

Probing: Generalized 3-4 mm w/localized 5 mm on #8MB, #31DB, #17MD

Gingival description:

  • Marginal: Generalized pink, smooth, firm, rolled borders

  • Attached: Generalized pigmented, fibrotic and stippled




Post treatment pi 18 mbi 9
Post TreatmentPI:18%MBI:9%


Post treatment3
Post Treatment

Patient consideration

- Pt had a good understanding of the tx that was completed and was excited to participate. However, pt’s circumstances made it difficult to maintain compliance.

- Complications during treatment:

* Pt did not have cell phone or number for direct contact

* Pt was dependant on friends driving him to and from appt

* No Show on 2 appts.


Post treatment4
Post Treatment

Operator Considerations:

- We did our best to reschedule broken appts

- Provided pt with Sonicare TB as well as ACT daily fluoride rinse, and other OH aids so pt would not have to buy on their own.

- It was difficult to attain the ideal resolution because pt was not compliant with smoking cessation & medical consults/check-ups.


Research
Research

  • Disease perpetuated & modified by smoking.

    • Evidence based research has shown that the prevalence and severity of periodontal disease is increased in smokers compared to non-smokers.

    • In an ex vivo study comparing non-smokers and smokers, it was suggested that smoking may influence the balance between T-helper cells 1 (Th1)/T-helper 2 (Th2) balance towards Th2, which results in a continuous B cell activation and less protective antibody production, leading to the progression and relapse of periodontal disease during Supportive Periodontal Therapy. ( Torres de Heens et al., 2008).


Research cont d
Research (cont’d)

  • Obesity may be linked to an increase risk of periodontal disease due to the adipose-tissue-derived cytokines (tumor necrosis factor alpha, lentin, and interleukin 6 ) and hormones that will increase the pro-inflammatory response. (Pischon et al., 2007)

  • Chronic periodontitis may play a role in elevating the serum level of anti-cardiolipin antibodies in hypertensive patients, resulting in a increased risk for atherosclerosis. (Turkoglu et al. 2008). Furthermore, the study suggest that both hypertension and chronic periodontitis may be related to exacerbating the other’s condition.


References
References

  • Khader Y.S., Bawadi, H.A., Haroun, T.F., Alomari, M., Tayyem, R.F. (2009). The association between periodontal disease and obesity among adults in Jordan. Journal of Clinical Periodontology, 36, 18-24.

  • Laxman, V., Annaji, S. (2008). Tobacco use and its effects on the periodontium and periodontal therapy. The Journal of Contemporary Dental Practice, 9(7), 2-11.

  • Pischon, N., Heng, N., Bernimoulin, J.P., Kleber, B.M., Willich, S.N., Pischon, T. (2007). Obesity, inflammation, and periodontal disease. Journal of Dental Research, 86(5), 400-409.

  • Torres de Heens, G.L., Kikkert, R., Aarden, L.A., van der Velden, U., Loos, B.G. (2009). Effects of smoking on the ex vivo cytokine production in periodontitis. Journal of Periodontal Research, 44, 28-34.

  • Turkogu, O., Baris, N., Kutukculer, N., Senarslan, O., Guneri, S., Atilla, G. (2008). Evaluation of serum anti-cardiolipin and oxidized low-density lipoprotein levels in chronic periodontitis patients with essential hypertension. Journal of Periodontology, 79(2), 332-340.


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