1. New York City College of Technology
Department of Dental Hygiene
Case Presentation
Michele Nadein
2. Patient Profile
• 24-year-old Uzbek male.
• Congenitally deaf (completely deaf since birth). Patient communicates
with non-ASL speakers through phone via notes or text messages.
• Last physical or dental exam/cleaning was in early 2018 during which
4 BWs were taken.
• Oral hygiene routine consists of brushing with the Oral B power TB
and Crest 3D White toothpaste twice per day. Traditional string floss
on occasion, no mouthwash, and no tongue cleaner.
• Chief complaint: Patient states “I need a check up on my teeth”.
3. Health
History
Overview
• Congenitally deaf.
• Baseline Blood Pressure: 109/68,
Pulse: 61, ASA I.
• Not taking any medication or
vitamins.
• No allergies.
• Social Hx: No smoking, has a
drink roughly once a month.
5. Radiographic interpretation:
• Generalized heavy interproximal calculus noted.
• Caries present on #3M. Incipient decay noted on #4D, #5D, #19D, and
#31M.
• No evident radiographic bone loss. Periapical pathology is within
normal limits.
• No presentation of #16 and #17- likely never developed (patient has
no memory of prior extraction).
6. Clinical
Findings
• EO exam: Dry lips. Pt reports a bump behind
head on the midline and a smaller bump on the
right side of the back of the neck that has
reportedly been there for years and has recently
gotten smaller- palpated and is asymptomatic
and non-mobile.
• IO: Exostosis bilaterally on canine eminence-
more prominent on right side. Short anterior
mandibular lingual frenum (moderate
ankyloglossia) resulting in slight bifurcation of
the tip of the tongue.
• Gingival description: Generalized dark pink,
slightly enlarged, marginal gingiva is rolled, and
interdental papillae fills the spaces, some
stippling and gingival margin is coronal to CEJ.
• Occlusion: Class III bilaterally (molar
relationship). Overjet: 3mm, Overbite: 20%.
• No clinical presentation of attrition, abrasion,
abfraction or erosion.
7. Dental Charting
• Multiple existing sealants present on maxillary and mandibular molars.
• Multiple interproximal decay present on maxillary and mandibular posteriors.
• #16 and #17 missing.
8. Periodontal
Status
• Generalized mild biofilm induced gingivitis with heavy calculus accumulations.
• Generalized 2-4mm probing depths with localized 5mm PD on #32D.
• Minimal-moderate BOP.
• Localized 1mm recession present on straight lingual of #22-#27.
• No mobility.
9. Pateint Treatment
(4 visits)
• Visit 1: Medical hx was reviewed, all
assessments were completed, tx plan
was proposed, obtained written
consent, and 4 BW’s and a PAN were
taken.
• Visit 2: OHI included demonstrating
proper use of power TB technique.
Ultrasonic and hand scaling was done on
quadrants 1 and 4. A referral was given
for caries evaluation of #3M, #4D, #5D,
#19D, and #31M.
Picture on right presents the patients
anterior teeth of mandibular arch after
scaling only quadrant 4 to show side by
side difference of existing calculus and
calculus removal (consent was received
and photo was shown to the patient).
10. Patient Treatment Continued
• Visit 3: Evaluated gingival response of quadrants 1 and 4 and assessed
for and rescaled residual calculus. OHI included demonstration of
proper string flossing technique. Ultrasonic and hand scaling was
done on quadrant 2.
• Visit 4: Evaluated gingival response of quadrant 2 and assessed for
and rescaled residual calculus. OHI included mouthwash demo and
the importance of daily use (ACT Anti-Cavity mouthwash was
recommended). Ultrasonic and hand scaling was done on quadrant 3.
Polished with engine and prophy paste and applied 5% NaF varnish.
11. Evaluation of Care and Prognosis
• Working with a deaf patient is similar to working with any other patient except it includes a
different style of communication and a larger emphasis on visualizations and demonstrations.
• The patient had no prior knowledge of gum disease or caries. I properly explained the process of
dental biofilm induced gingivitis as well as the caries process in plain English and in detail through
text messages (this way he can also re-read them for future recollection).
• Once the patient implements proper and daily use of interproximal aids and mouth rinse,
reduction and reversal of gingivitis is feasible as well as the prevention of periodontitis.
• Areas of incipient decay should be evaluated by his dentist, however the moderate caries lesion
on #3M should be cleaned out and filled as soon as possible.
• Due to the high caries risk, the patient was informed to ask his dentist about Colgate PreviDent
5000 prescription toothpaste. Used once daily in place of regular toothpaste can help arrest
existing decay and prevent further demineralization better than just using regular toothpaste due
to its increased fluoride dispersion.
