dental clinical case Arestin patient by Michele Nadein

1. New York City College of
Technology
Department of Dental Hygiene
Case Presentation
Michele Nadein

2. Patient Profile
• Patient presents for her recall visit.
• 34-year-old Indian Asian female.
• Last physical exam was in early 2019 (3 years ago).
• Last dental cleaning and x-rays were in November
2021 (6 months ago), during which an FMS was
taken.
• At home hygiene routine includes brushing (Crest TP)
twice a day with a soft manual TB, floss piks on
occasion, ACT anti-cavity mouth wash on occasion,
and no tongue cleaner.
• Chief complaint: “I want a cleaning and im concerned
about my gum pockets”.

3. Health History Overview
• BP 119/88 P82 (corresponding to hypertension stage I).
• ASA II.
• Takes Vyvanse (lisdexamfetamine) 30mg daily for treatment of ADHD (dental
implication includes dry mouth). No allergies.
• Patient reports diabetes runs in her family, and she is concerned about
developing this disease in the future. She reports she is obese with regards
to her Body Mass Index and her lifestyle choices could be better including
poor diet and lack of exercise.
• Social Hx: No smoking, no drinking.

4. Radiographs- taken 6 months prior to current tx

5. Radiographic
Interpretation
• Heavy interproximal calculus
present.
• Interproximal decay on distal of #30.
• 15%-30% generalized horizontal
bone loss with localized vertical
bone loss.
• RCT on #17.
• Periapical pathology WNL.

6. Clinical Findings
• EO exam: WNL
• IO exam: Bilateral linea alba with cheek bites on right buccal mucosa.
• Gingival statement: Generalized melanin pigmentation, shiny, some
stippling, enlargement of marginal and interproximal gingival tissues,
gingival margin is rounded, interproximal papillae in the posterior fill's
spaces and cratered in the anterior.
• Occlusion: Class I occlusion with a tendency toward class II bilaterally. 2mm
overjet and 10% overbite.
• Moderate anterior mandibular crowding.
• Generalized moderate abrasion.
• Patient presented with occlusal caries on #16, #18, #19 and #30 (a referral
for the caries was given 6 months prior to current treatment but the patient
could not find the time to see her dentist).

7. Dental
Charting
- All 1st premolars missing.
- Multiple occlusal composite restorations on molars and premolars.
- Diastema between #24 and #25.
- Occlusal decay on #16.
- PFM crown on #17.

8. Periodontal
Status
• Generalized 2-4mm
probing depths.
• Localized 5-6mm pockets
present on molars.
• Generalized 1-2mm
recession.
• Moderate BOP.
• No mobility.

9. Patient Treatment
• Visit 1: Reviewed her medical hx, completed clinical assessments,
demonstrated the modified bass technique for oral hygiene
intervention, gave a new referral for a caries evaluation, received
consent for the tx plan and scaled UR and UL using ultrasonic and hand
instruments.
• Visit 2: Evaluated tissue response and assessed for residual calculus,
OHI included a demonstration of a proper string floss technique,
scaled UR and LR using ultrasonic and hand instruments, engine
polished with prophy paste, 5% NaF varnish tx, and placed Arestin on
#18ML, #18DL, #18DB and #15MB.

10. Evaluation of Care and Prognosis
- The patient was advised to see her physician for a physical exam to evaluate her health concerns.
- Currently, the main concern for this patient are her caries and ongoing periodontal disease.
- The patient is commended for her use of floss piks on occasion- for a more effective approach for
interproximal plaque removal, she was shown the string floss method and she demonstrated that she
understood the technique and was fully capable of using the floss method correctly. Additionally, she
was made aware that it would benefit her to clean between the teeth more often whether it be with
floss piks or traditional string floss.
- After the whole mouth was debrided of plaque and calculus, the antibiotic treatment Arestin was
placed directly in the four deepest pockets.
- We proposed that the removal of calculus in combination with Arestin treatment would optimize
pocket reduction and strengthen the health of oral soft tissues. She was advised that after treatment
she will have to do her part with daily brushing and flossing. She agreed to come back 3-4 weeks after
treatment so that we may evaluate for improvement of the pocket depth. The patient received a copy
of our post treatment instructions.
- The patient was reminded to seek evaluation for the treatment of caries, and she was informed that if
she ignores seeking treatment, the caries could worsen and may lead to more invasive procedures like
RCT or extraction. Furthermore, she was informed that using the ACT anti-cavity mouth wash more
often (recommended daily and without rinsing with water afterwards) would benefit in the prevention
of new caries.