28 year old male Good health Recently had arthroscopic knee surgery Iraq war veteran Calculus Classification: 3b Takes muscle relaxants and Ibuprofen BP was within normal limits each appointment
Last NSPT: 2008 Generalized gingivitis Heavy bleeding Moderate plaque levels Missing teeth: #1, 2, 15, 16, 17, 18, 31, 32 Malopposed teeth Fillings out Brushes 2x/day, Flosses 1x/day PSE: Generalized 4’s and 5’s posterior, 3’s and 4’sAnterior
Fluoridated toothpaste Drinks a lot of orange juice and coffee (ACIDIC!!) DOES NOT HAVE AN ESTABLISHED DENTAL HOME! Clinical Conditions: 1 or 2 new caries lesions/restorations in last 36 months Visible plaque Unusual tooth morphology 2 interproximal restorations Exposed root surface on #27 (1mm recession) Open margin on the gold crown on #3 MODERATE RISK FOR CARIES!!!
Susceptible tooth structure: rotated teeth andunsound dentition Inadequate fluoride intake (No professionalapplications) Poor oral hygiene: Attributed to accumulation ofmarginal plaque Viscous saliva: reduced cleansing ability Thick plaque reduces buffering ability of saliva Muscle relaxants may cause dry mouth
From 8/2011 What’s evident: Open margin on mesial of #3 Caries on distal of #4 #6 blown out Possible supernumerary tooth above #9 and #10 Calculus visible distal of #30, and mandibular anteriors
Taught patient proper brushing technique since he wascompletely missing the gumline On his final appointment, plaque levels had decreased Explained he’s at moderate risk for caries and that frequentcleanings and good home care are essential Emphasized importance of getting unsound dentition fixed What I learned: How big of a role saliva plays in caries prevention Just because people “claim” to brush and floss on a regularbasis, doesn’t mean they’ll have good oral health Can’t always believe patients: he thought he had an implanton #8 when it’s really just a crown with a post
Sroda, Rebecca. (2010) Nutrition for a Healthy Mouth.Baltimore, Maryland. WoltersKluwer Health/Lippincott Williams and Wilkins http://www.rxlist.com/flexeril-drug/patient-images-side-effects.htm