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  • 1.  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
  • 2.  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
  • 3.  Saliva test: Resting saliva: 6.4 pH- Moderately Acidic Stimulated saliva: 3.7 ml-Low volume, 7.0 pH-normal Frothy Bubbly Saliva Buffer ability: Normal
  • 4.  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!!!
  • 5.  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
  • 6.  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
  • 7.  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
  • 8.  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