Perio Case Study

Periodontal
Case Study
Rio Digby
RDH 240 DH IV
Assessment
Section I:
Patient
Information
Patient Information
Demographic Chief Concern Health & Dental History
❖ Has medical and dental

❖ Male insurance
❖ 29 years old ❖ No CC - pt noted that ❖ Last DDS visit: April 2018
❖ College Graduate: BA in when he gets his teeth ❖ Alcohol: 3-4 alcoholic
Mathematics cleaned he normally beverages a week
❖ Job: Actuary has to be numb and he ❖ Marijuana: Smokes 5
❖ Born in New Jersey and doesn’t like needles. times a week
moved to WA for college ❖ ADHD
❖ Into men's fashion and ❖ Medications:
sports analytics Amphetamine-Dextroam
phetamine 10mg/day
Medical
History
❖ ASA II - Alcohol and Marijuana
❖ Pt is in good health
❖ Treated by a physician for ADHD
❖ Last medical exam 10/14/2019
❖ Last DDS appt 04/2018
❖ Pt takes
Amphetamine-Dextroamphetamine
10mg daily for ADHD
Dental Indications
❖ The patient has come in a total of 14 times to the
clinic to get his teeth cleaned.
❖ Pt was originally classified as LG II FM and then at his
first recall appointment which was 3 ½ months after
his last quad of SRP he was classified as LG II/III UR UL
& MOD II/III LR LL
❖ Pt became my periodontal case study when
reclassified at his recall appointment on 10/27/2021
Low dental IQ, value
and motivation
Fear of needles - had
to be numb for past
cleanings
Nutritional Diet Analysis
Day 1: Day 2: Day 3:
- Cup of coffee - Cup of coffee - Cup of coffee
- Slice of banana bread - Half of a banana - Avocado toast
- Hamburger - Avocado toast - Cup of cold brew coffee
- Fries - Bowl of pasta with veggie - 2 bowls of turkey chili
- 2 beers sauce, quinoa and sausage - Negroni
- Cup of cold brew coffee - 2 beers
- 2 bowls of turkey chili - Nachos
- Chicken wrap
- Fries
“Gingival bleeding and destructive periodontal disease are sensitive markers to both abnormalities
in macronutrient content (excessive carbohydrates or polyunsaturated fat intake, deficient protein
intake)” (Hujoel, 2017)
10/27/21
Assessment
Section II:
Clinical
Assessment
Oral Hygiene
4/3/21 Initial Visit: Brushes 2 times a day with manual toothbrush and
flosses at night
10/27/21 Recall Visit: Brushes 2 times a day with manual toothbrush and
flosses at night
4/3/21
Eo/IO, GD & Occlusion

Gingival description
Initial visit: Generalized pink, rolled and thickened, firm, stippled marginal &
papillary. Localized redness on lingual by mandibular molars.
Recall visit: Generalized moderate red, rolled and thickened, endemic marginal
and papillary.
# 3-MO composite
#14-MO composite
3rd molars present
Sealants were
completed at Pima
on 7/7/21
Referral
to Oral
Surgeon
Attrition
Dr. Magelsen recommended the pt use a NG
Significant signs on wear on teeth - pt does not think he grinds his

teeth
“Side effects included mild anxiety, insomnia, jaw tension and tooth
grinding, overstimulation, irritability and nose tingling” (Greenfield,
2005)
4/3/2021
4/3/2021
Initial Perio Chart 5/1/21
Recall Perio Chart 10/27/21
LG II Full Mouth
Stage I Grade A
Plaque Index: 51.56%

LG II/II UR UL & MOD
II/II LR LL
Stage I Grade A
Plaque Index: 33.33%

Perio, Oral Cancer & Caries
Risk Assessments
Treatment
Planning
Section III:
Case selection &
Tx Outcomes &
Therapeutic Strategy
● Reliable patient
● Thorough cleaning - make sure patient will not

need SRPs again
● Keep patient on a 3 month schedule
● No LA
Prevention Education &
Discussion Points
● Modified bass method
● Explained the importance of not brushing hard
● Encouraged pt to use electric toothbrush
● C wrap floss
● End tuft brush for 3rd molars
● Explained how important homecare is
Treatment Plan
4/3/21 10/27/21
- 4 Quads D4342 - 2 Quads D4342
- OHI - 2 Quads D4341
- Sealants on 2, 3, 14, 15, - OHI
18, 19, 31 - Recommended NG
- Recommended NG - EXT of 3rds
- EXT of 3rds
Informed consent signed for all tx

Instruments
Learned how to use the perio file - had to use on all 3rds
Loma Linda
Graceys
Barnhart 5/6
IMPLEMENTATION
Section IV:
TX Provided &
TX Revisions
4/3/21 Initial HH, RAD, EO, IO, GD
5/1/21 PC, DHCP, RA, DDS Exam, OHI, Informed Consent
5/10/21 LR SRP
5/15/21 Reassessment of LR & UR SRP
5/24/21 Reassessment of UR & LL SRP
6/16/21 Reassessment of LL & start of UL SRP
7/7/21 Finished UL SRP & Sealants placed on 2, 3, 14, 15, 18, 19, 31
10/27/21* Recall DHCP, GD, PC, OHI, Informed consent
11/10/21 UL SRP, arestin placement #15 DL & #16 ML
11/24/21 Reassess UL SRP & UR SRP, arestin placement #2 DL
12/1/21 LR Mock Board

1/6/22 Error removal from LR Mock board, LL SRP, Broke 11/12 gracey on #28 ML
3/1/22 4-6 week reeval, GD, PC, OHI, Debridement
3/29/22 RAD 6 VBWX, EO, IO, Gd, DHCP, DDS Exam, Informed consent, OHI,
D4910, Polish & Fluoride
Total: 14 appointments
Patient Care
Pt has very tenacious calculus and did not originally

respond to care and improve the quality of his
homecare
Pt became more motivated ½ through second

round of SRPs are wanted to take the time to learn
about his oral health
At his 3 month recall there was great improvements

in his oral health and he was classified as PL II/III
Periodontal
Re-Evaluation
Section V:
Post TX 4-6 REEVAL
4-6 Week Reeval
● Pt only received a 4-6 reeval after 2nd set of SRPs
● GD: Gen slight red, rolled and thickened, stippled, pointed marginal and
papillary with localized moderate red on the lingual of mandibular molars.
● PC: Gen 2-4 mm pockets with localized 5mm pockets in the posterior
region. Deep pockets of 6 and 7mm on #15, #16, #31, #32 are no longer
present. Class 1 furcations present on buccal of molars. Minimal BOP.
Moderate generalized recession.
● OHI: Plaque index 38.10%. Encouraged pt to use electric toothbrush.
Introduced end tuft brush for hard to reach 3rd molars and linguals on
mandibular posterior teeth
● Gave pt another copy of referral for 3rds
● 3 month recall schedule
Perio Chart
3/1/22
Before After
3 month RecalL 3/29/22
Lowest plaque score: 26.04%
GD: Gen slight red, rolled and thickened,

recessed, pointed, stippled with mod red
on lingual of mandibular posterior teeth.
PL II/III
Stage I Grade A
Section VI:
Student
Evaluation of
Therapeutic and
Preventative
Outcomes
Patient & Clinician
Outcomes
PATIENT CLINICIAN
- He learned that his medication causes - I learned a lot from this patient - how
him to clench and grind to scale properly, how to use the
- He learned that even though he was cavitron, how to place arestin, how to
brushing and flossing, his technique tackle tenacious calculus, the
wasn’t adequate enough importance of educating the patient
- He learned the importance of going to and making sure they understand.
the dentist regularly to control his
build up
TAke AWAY FINISH
I would have spent more time on OHI at the beginning and made
sure the patient understood - I would have introduced the end tuft
brush early because pt really liked it and felt like it made a difference
in his homecare routine.
It was hard at times with this pt because I know him personally - so

when he would report on his homecare I knew he was lying at times
References
Greenfield, B., & Hechman, L. (2005). Treatment of attention deficit
hyperactivity disorder in adults. Expert Review of Neurotherapeutics, 5(1),
107-21. doi:http://dx.doi.org/10.1586/14737175.5.1.107
Hujoel PP, Lingstrom P. Nutrition, dental caries and periodontal disease: a

narrative review. J Clin Periodontol 2017; 44 (Suppl. 18): S79-S84. doi:
10.1111/jcpe.12672

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Periodontal

❖ Has medical and dental

Eo/IO, GD & Occlusion

3rd molars present

Signiﬁcant signs on wear on teeth - pt does not think he grinds his

Plaque Index: 51.56%

Plaque Index: 33.33%

● Thorough cleaning - make sure patient will not

Informed consent signed for all tx

5/1/21 PC, DHCP, RA, DDS Exam, OHI, Informed Consent

5/15/21 Reassessment of LR & UR SRP

5/24/21 Reassessment of UR & LL SRP

6/16/21 Reassessment of LL & start of UL SRP

10/27/21* Recall DHCP, GD, PC, OHI, Informed consent

11/10/21 UL SRP, arestin placement #15 DL & #16 ML

11/24/21 Reassess UL SRP & UR SRP, arestin placement #2 DL

12/1/21 LR Mock Board

3/1/22 4-6 week reeval, GD, PC, OHI, Debridement

Pt has very tenacious calculus and did not originally

Pt became more motivated ½ through second

At his 3 month recall there was great improvements

GD: Gen slight red, rolled and thickened,

It was hard at times with this pt because I know him personally - so

Hujoel PP, Lingstrom P. Nutrition, dental caries and periodontal disease: a

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