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Item Dental Anxiety: The Effects on Oral Health and Dental Treatment.(4/13/2015) Cobb, Mandi; Rettig, Pamela; Cobb, Mandi; Rettig, Pamela; Dental HygieneObjective: The objective of this case presentation is to educate the dental professional on the management of a patient with dental anxiety. Assessment: A 20 year old Caucasian male presented to the dental hygiene clinic for a cleaning at the request of his grandmother. The patient reported a negative medical history with the exception of anxiety to dental care. Due to this anxiety, consent was obtained from the patient to speak with the grandmother in regards to his medical history. At this time, the grandmother disclosed that the patient had a traumatic dental experience as a child and has not been to the dentist since that event occurred. Clinically, the patient presented with generalized severe gingivitis as evidenced by red, rolled, spongy tissue with bleeding upon probing due to the presence of heavy calculus. Despite the inflammation present, bones levels are healthy. The patient reported never brushing his teeth due to pain and fear of causing pain to himself. DH Care plan: Patient received full mouth debridement, modified adult prophylaxis, and extensive oral hygiene instruction. Treatment: Experimental techniques were utilized throughout the course of treatment in order to ease anxiety while providing effective treatment. Results: Experimental methods that were used throughout treatment proved effective for the completion of full mouth debridement and adult prophylaxis. Conclusions: The patient presented with extensive gingivitis and heavy calculus deposits. For optimal success in the future, a short recall is necessary for the patient to receive continued extensive dental hygiene therapy.Item Dental Hygienist's Role in Assessing Peri-Implantitis.(04/13/15) Creed, Courtney; Skinner, A; Blanchard, Jane; Creed, Courtney; Blanchard, Jane; Dental HygieneThe objective of this clinical case presentation is to discuss peri-implantitis due to its increasing prevalence in dental hygiene practice. Assessment: A 79 year old Caucasian female presented to the Dental Hygiene Clinic for periodontal maintenance and a dental exam. The medical history reveals a history of hypertension, atrial fibrillation, and the patient is taking Coumadin. The patient presented with generalized mild plaque-induced marginal and papillary gingivitis, however, the gingiva around the implant replacing #19 showed moderate gingival inflammation as evidenced by dark pink, bulbous, and spongy tissue with moderate bleeding on probing (BOP). The patient also presented with generalized chronic periodontitis as evidenced by 4-5mm clinical attachment level (CAL). Peri-implantitis was diagnosed on the implant with 6-9mm probing depths, 85% bone loss present on radiographs, and suppuration. DH Care Plan: Routine periodontal maintenance, oral hygiene instruction, and referral to the Graduate Periodontics Clinic for further evaluation of the implant. Follow up: The implant was diagnosed with a hopeless prognosis and scheduled for removal in the Graduate Periodontics Clinic. However, before the scheduled extraction, the patient reported that the implant had "fallen out" and it was not present at the 3 month periodontal maintenance appointment. Conclusion: Early recognition and intervention of peri-implant mucositis and peri-implantitis is crucial for the survival of the implant. Once peri-implantitis has reached an advanced stage, the prognosis of the implant is very poor and may require surgical treatment.Item The Dental Hygienist’s Role in Management in Oral Lichen Planus.(04/13/15) Lucas, Jessica; Magana, W; Maxwell, Lisa; Lucas, Jessica; Maxwell, Lisa; Dental HygieneObjective: To understand the dental hygienist’s role in the management of patients with oral lichen planus (OLP). Signs of OLP are clinically seen as lacy white, raised patches of tissue and/or as red, swollen, tender patches of tissue. These lesions are most commonly visible on the buccal mucosa; other common locations are the gingiva, tongue, alveolar mucosa, and the palate. Patients with OLP typically experience a burning sensation or pain in the area. Our patient presented with generalized slight to moderate plaque induced and localized non-plaque induced gingivitis evidenced by hypersensitivity involving the papilla, white and pale pink gingiva, blunted, and sloughing papilla. Raised white patches were clinically noted on the left buccal alveolar mucosa, the left buccal mucosa, and with similar but fewer patches on the right buccal tissues. Patient indicated being more symptomatic a couple weeks prior to her visit, but she was unsure why. She expressed that the inside of her cheeks felt very painful and these symptoms “come and go.” Patient reported no history of medication. Her oral hygiene habits consist of brushing once a day with an electric tooth brush, flossing once a day, and using Listerine mouth rinse once a day. While there is no cure for OLP, current treatment includes systemic and topical corticosteroids. Palliative care during a dental hygiene appointment would include the use of topical and local anesthetics. When treating a patient with OLP, it is important that the dental hygienist recognizes the signs and symptoms in order to determine an appropriate care plan while keeping pain and discomfort to a minimum; and to provide the patient with the knowledge to care for lichen planus at home.Item Diabetes and Periodontal Disease: The Need for Interprofessional Patient Care.(04/13/15) Zhuravlev, Elena; Chilman, L; Rackley, R. Hunter; Zhuravlev, Elena; Rackley, R. Hunter; Dental HygieneObjective: The objective of this clinical case presentation is to emphasize the importance of an interprofessional approach to health care. Specifically, this case will emphasize the importance of managing diabetes in a periodontal patient. Background: A 69 year old patient presented with the chief complaint of, “I want my teeth cleaned.” The medical history revealed several medications and conditions that could potentially impact the oral cavity. The patient presented with type II diabetes mellitus, which became uncontrolled during the treatment; was taking a calcium channel blocker to control his high blood pressure, and was using a bi-pap machine for his sleep apnea. The patient also was obese and gave a history of bariatric surgery, GERD, and recent back pain. Assessment: The initial clinical examination of this patient revealed generalized mild bone loss as evidenced by 3-4mm from the CEJ radiographically (generalized moderate plaque induced gingivitis with dark pink spongy tissue with bulbous papilla that did not adhere tightly to the tooth with bleeding) and generalized mild chronic periodontitis as evidenced by 4-5mm CAL and 6mm CAL associated with swollen gingiva. Localized severe periodontitis of 8mm CAL on tooth number 19 was present. Dental Hygiene Treatment Plan: Scaling and root planing was performed for selective areas along with a periodontal tissue re-evaluation. Treatment: The treatment was performed throughout three separate appointments. At the beginning of treatment the patient’s A1C was 8.5% and his blood glucose was 195 mg/dl. Results: The re-evaluation appointment revealed slight improvement in the health of the gingiva, but minimal to no improvement in probing depths. Conclusion: This case highlights the need for an interprofessional approach to patient care. Problems with diabetes management, as well as other contributing factors, have been known to impact periodontal therapy outcomes.Item The Effects of Dilantin on the Oral Cavity Over Time.(2015-04-13) Ames, Rachel; Rettig, Pamela; Ames, Rachel; Rettig, Pamela; Dental HygieneThe objective of this case presentation is to discuss the long-term effects of Dilantin in causing gingival hyperplasia as seen in a patient. Assessment: A 54 year old African American male patient presented to the Dental Hygiene Clinic at Indiana University School of Dentistry (IUSD) with a chief complaint of “I need to get my teeth cleaned for my three month appointment.” The patient was referred to our clinic from the IUSD Graduate Periodontal clinic for his three month periodontal maintenance appointment. Medical history indicates he suffers from epilepsy and has been taking Dilantin for over forty years. An intraoral examination revealed advanced localized periodontal disease in the lower right quadrant with probing depths ranging from 1-10mm and clinical attachment levels ranging from 1-8mm. Patient also presented with generalized healthy gingiva as evidenced by coral, firm, and stippled tissue. The intraoral radiographs reveal generalized mild bone loss as evidenced by 3-4mm from crest of bone to CEJ. The patient’s oral hygiene habits include: brushing twice a day, flossing once a day, and using an antimicrobial mouth rinse once a day. DH Care Plan: periodontal maintenance, topical fluoride varnish, review of oral hygiene, and review of the use of a water irrigator. Evaluation: The patient was referred to the Graduate Periodontal department for further evaluation due to the increase of gingival overgrowth on #31 distal and the presence of exudate. The dentist who performed the last dental exam in the Dental Hygiene Clinic feels the patient will need another gingivectomy. Conclusions: From the review of the evidence-based literature, the Dilantin is the cause of the gingival hyperplasia that this specific patient has been experiencing over the years and his need for continuous periodontal surgery.Item The Effects of Poor Dental Knowledge on Oral Health.(04/13/15) Ison, Kayla; Helwig, Melissa; Rettig, Pamela; Helwig, Melissa; Rettig, Pamela; Dental HygieneObjective: The objective of this clinical case report is to evaluate the effects of low dental knowledge and low socioeconomic status on the oral health of an individual. Background: A 32 year old Hispanic male presented to the dental hygiene clinic as a new patient with a negative medical history with the exception of untreated hypertension diagnosed at his last physical examination 5 years earlier. Patient reported smoking 2 to 3 cigarettes per day. Patient had received a prophylaxis 5 years ago in Mexico at a free clinic, but he has never been able to receive regular dental care due to his low socioeconomic status. Patient had limited oral health education prior to his visit to the dental hygiene clinic. Assessment: Patient presented with generalized moderate to severe plaque induced marginal gingivitis as evidenced by red, spongy, rolled gingiva, and a bleeding score of 74%. The periodontal description revealed generalized mild chronic periodontitis as evidenced by 4-5mm CAL and localized moderate chronic periodontitis as evidenced by 6-7mm CAL on #1, #4, #5, #11, #13, #14, and #18. Patient also presented with generalized mild horizontal bone loss on radiographs as evidenced by 2.6mm to 3.5mm measurements from crest of alveolar bone to the CEJ. The patient’s plaque score ranged from 18% to 26% and generalized moderate to heavy supragingival and subgingival calculus was detected. Active decay was found on #2, #16, #17, #28, and #30. Dental Hygiene Care Plan: Patient received scaling and root planing in all four quadrants, a tissue re-evaluation and extensive oral hygiene instruction. Results: At the tissue re-evaluation, the patient’s gingival health and probing depths were improved. Conclusion: The patient’s positive response to treatment is the result of the thorough scaling and root planning therapy, extensive patient education, and patient compliance.Item Maintaining Oral Health with Parkinson’s disease and Arthritis.(04/13/15) Jones, Lindsey; Minett, C; Rettig, Pamela; Jones, Lindsey; Rettig, Pamela; Dental HygieneObjective: The objective of this case presentation is to discuss the modifications of dental care for a patient with Parkinson’s disease. Background: A 72 year old Caucasian male presented to the dental hygiene clinic for a periodontal maintenance appointment. Significant findings in the medical history include current treatment of Parkinson’s disease, arthritis in the hands and feet, and medications Omeprazole, Fluoxetine, Gemfibrozil, Gabapentin, Levodopa, and Clonazepam. Assessment: Patient presents with generalized moderate plaque induced gingivitis evidenced by reddish-pink gingiva, 60% BOP, bulbous, spongy papillae. Clinically the patient presented with generalized 4-8mm clinical attachment levels. Radiographically, the patient presented with generalized mild to moderate bone loss evidenced by 3-5mm from the CEJ. The primary contributing factor to the gingival inflammation was the plaque score of 97%. The patient struggles with oral hygiene due to his Parkinson’s disease and arthritis in hands. DH Care Plan: patient received full mouth debridement, instruction on a modified floss holder with clay, product recommendations of xylitol gum and toothpaste to reduce xerostomia. Results: Oral health indicators from previous appointments showed minimal or no improvements due to the patient’s medical condition. Conclusions: Since last recall a few sites had improved including probing depths by 1-2mm. Patient was referred to a comprehensive care clinic for extraction of tooth number four, and an implant is treatment planned for replacement. It is recommended that the patient continue on 3 month intervals to monitor his oral health status and identify dental disease earlyItem Management Strategies for Patients with Xerostomia (Dry Mouth).(4/13/2015) Chrzan, Marissa; Maxwell, Lisa; Chrzan, Marissa; Maxwell, Lisa; Dental HygieneObjective: To discuss management strategies for patients presenting in the clinical setting with xerostomia (dry mouth). Xerostomia is a multifactorial problem and many times it is disabling for the individual and challenging to manage. A 66 year old Caucasian female presented to the dental hygiene clinic with a chief complaint of “constant dry mouth.” The patient’s medical history indicated a previous habit of smoking along with a current history of asthma, chronic obstructive pulmonary disease, and oral candidiasis infection. Contributing factors to the patient’s dry mouth include: the use of a CPAP machine at night, oxygen during the day, and two prescription medications whose side effects cause dry mouth (Zoloft and Spiriva). Upon examination this patient was determined to be high caries risk and evidence of a new carious lesion was found on the mesial aspect of tooth #27. The iteration of meticulous home care is an important role of the clinician in order to alleviate discomfort, taste disturbances, sore mouth, and to prevent future decay and candidiasis infections. Other recommendations that were given in order to combat dry mouth included: use of high fluoride toothpaste (PreviDent 5000), ACT dry mouth rinse, and ACT dry mouth lozenges. It is also important for this patient to drink eight glasses of water a day, avoid sugar containing beverages, and chew sugar-free gum to stimulate salivation. The patients’ overall quality of life can be improved if clinicians are able to properly recognize xerostomia and recommend personalized management routines.Item Modification of Dental Hygiene Care in a Breast Cancer Patient.(04/13/15) Stanton, Erica; Gudgel, S; Rettig, Pamela; Stanton, Erica; Rettig, Pamela; Dental HygieneObjective: The objective of this clinical case presentation is to evaluate the treatment of a patient undergoing chemotherapy for breast cancer and identify necessary modifications throughout the dental hygiene appointment. Background Information: A 72-year old, Caucasian female patient presented to the dental hygiene clinic with the chief complaint of “I want to get my teeth cleaned.” The patient also reported symptoms of xerostomia and burning sensation of the gingiva. The patient receives regular periodontal maintenance care every three months at a private practice. The medical history revealed breast cancer, hypertension and history of myocardial infarction. The patient’s breast cancer is currently being treated with chemotherapy and radiation. Clinical Examination: The patient presented clinically with generalized mild plaque-induced marginal papillary gingivitis as evidenced by red, rolled, spongy gingiva with bleeding on probing and generalized moderate chronic periodontitis as evidenced by 4-5mm clinical attachment levels. Radiographically, the patient presented with localized mild horizontal bone loss as evidenced by 3-4mm measured from the cementoenamel junction to the crest of the alveolar bone around teeth numbers 4 (distal), 15 (mesial), 19, 27, 29 and 31. Oral hygiene habits consist of patient brushing at least once per day, but seldom flossing or using mouthwash. The patient is at high risk for dental caries due to active decay, medication-induced xerostomia and inadequate home care. DH Care Plan: Periodontal maintenance with extensive oral hygiene instructions were performed. Toothpaste and mouth rinse for dry mouth were recommended at the initial appointment. Evaluation: This patient will return for periodontal maintenance in March 2015. At that time oral hygiene and caries risk will be evaluated. Conclusion: In this case report, the complaints of a patient with a history of breast cancer, xerostomia, and burning of the gingiva were addressed.Item Motivational Factors for the Non- Compliant Patient.(04/13/15) Miller, Nia; Ranis, D; Maxwell, Lisa; Miller, Nia; Maxwell, Lisa; Dental HygieneObjective: To evaluate the oral hygiene attitudes of non-compliant patients and find motivating strategies to improve their adherence to oral hygiene recommendations. Assessment: A 33 year old male Caucasian patient presented to our clinic with the chief complaint of “I need to get my teeth cleaned.” He had not been to the dentist in 17 years. His medical history was positive for HIV/AIDS. The patient stated that he has smoked a half of a pack of cigarettes daily for the last 20 years and that he drinks socially. The patient stated that he brushes once a day with a manual toothbrush and rarely flosses. His gingival description was generalized mild plaque induced marginal, papillary gingivitis as evidenced by pale pink, bulbous, spongy gingiva with slight BOP. Localized moderate to severe plaque induced gingivitis on lingual mandibular tissue as evidenced by red, rolled, inflamed papilla with easy BOP on the mandible. His periodontal description was generalized 4-6 mm CAL most likely due to inflammation from pseudo-pocketing. Generalized healthy bone levels as evidenced radiographically by 1-2 mm measurements from the CEJ to crest of alveolar bone. DH Care Plan: Prophylaxis, extensive OHI that includes finding motivating factors for this patient to maintain effective plaque control at home. Evaluation: When evaluating this patient’s success in treatment, we found he was not compliant 5 out of the 10 appointments that we had agreed to schedule. His behavior and attitude remained unchanged despite the efforts used to motivate the patient. His attitude reflected his desire for a quick resolution to improve his oral health, rather than making the commitment and effort to alter his lifestyle. Conclusion: Finding the right motivating strategies for your patient will determine how successful their treatment outcomes will be in achieving optimal oral health.