IUSD Research Day 2015

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Fabricating Tooth supported Overdenture using locators® as a method of retention :case report.
(4/13/2015) Alzayer, Yasmin; Levon, John; Alzayer, Yasmin; Levon, John; Prosthodontics
Tooth supported complete overdentures have been a treatment option for decades and they provide the patient with proprioception (the awareness of jaw-space relationships) which is normally lost when teeth are extracted. In addition, the overdenture provides the patient with improved biting force and neuromuscular control. The objective of this case presentation is to discuss a technique used to fabricate complete tooth supported overdenture. Assessments: 80 year old African American female presented to Graduate Prosthodontic Clinic at IUPUI complaining of difficulty in chewing food due to her partially edentulous mandible. Her medical history revealed a history of hypothyroidism, osteoarthritis, rheumatoid arthritis and hypertension. In 2013 root canal treatments were done to #22, 27 with post space preparations. Intraoral examination revealed a resorbed mandibular residual ridge. The prosthodontic treatment plan was to retain these two teeth and attach LocatorsÂ® to them to improve the retention of the denture. Impression was made of both post spaces and posts were waxed up on the master cast. Castto-Locator® attachments were incorporated in the wax ups, which were invested and cast in Type III Gold Alloy. The final posts with Cast-to-LocatorÂ® attachments were cemented with resin cement. Finally, the mandibular complete overdenture was adjusted and delivered to the patient. Evaluation: the LocatorÂ® attachments were stable in the gold posts without any neither periapical pathology nor gingival inflammation. In addition, the patient was able to properly clean the remaining root and the internal surface of the denture. In conclusion: This technique resulted in a very satisfying and retentive denture for the patient while utilizing minimum invasive procedures.
The Effects of Dilantin on the Oral Cavity Over Time.
(2015-04-13) Ames, Rachel; Rettig, Pamela; Ames, Rachel; Rettig, Pamela; Dental Hygiene
The 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.
Providing Adapted Care for Patients with Immune-mediated Mucous Membrane Conditions.
(4/13/2015) Bailey, Scheri; Taylor, Heather; Bailey, Scheri; Taylor, Heather; Dental Hygiene
Background: Immune-mediated diseases frequently manifest in the oral mucosa, which may be the first clinical sign for many patients. Some of these diseases present in ways that are pathognomonic (specific) for the condition; however, others have signs and symptoms that may appear very similar to systemic conditions unrelated to immune-mediated diseases. Thus, differential diagnosis can prove difficult. This case study examines a 50-year-old African-American female with co-diagnoses of Lichen Planus and Mucous Membrane Pemphigoid. These immune-mediated diseases affect the oral mucosa, causing the patient pain and burning sensations within the mouth. The symptoms associated with these conditions make maintenance of good oral hygiene difficult for the patient. Objectives: The objective of this case study was to explore Mucous Membrane Pemphigoid and Lichen Planus: the clinical and histological presentations, the implications for dental treatment, and the best proven therapies for management. Methods utilized during treatment will be presented. Methods: The patient presented to the IU School of Dentistry Dental Hygiene Clinic for routine periodontal maintenance and examination. The sensitive nature of the patient’s oral mucosa due to Lichen Planus and Mucous Membrane Pemphigoid required employment of alternative methods to routine dental care. Modifications to the patient’s diet and home oral care routines were suggested. Conclusion: Oral health providers should be conscious of the clinical manifestations of Lichen Planus and Mucous Membrane Pemphigoid, in addition to and differentiated from other oral conditions. Likewise, providers should be adept at altering routine dental care methods to accommodate patients with these and other immune-mediated conditions. If clinical treatment and oral care are administered properly, the patient should experience alleviated symptoms and suffer less discomfort and sensitivity on a day-to-day basis and during dental assessment and treatment.
Management Strategies for Patients with Xerostomia (Dry Mouth).
(4/13/2015) Chrzan, Marissa; Maxwell, Lisa; Chrzan, Marissa; Maxwell, Lisa; Dental Hygiene
Objective: 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.
Dental Anxiety: The Effects on Oral Health and Dental Treatment.
(4/13/2015) Cobb, Mandi; Rettig, Pamela; Cobb, Mandi; Rettig, Pamela; Dental Hygiene
Objective: 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.
Dental Hygienist's Role in Assessing Peri-Implantitis.
(04/13/15) Creed, Courtney; Skinner, A; Blanchard, Jane; Creed, Courtney; Blanchard, Jane; Dental Hygiene
The 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.
Caries Presentation in Illict Drug Users and Excessive Soft Drink Consumers.
(04/13/15) Parker, Eric; Ehrlich, Ygal; Pfotenhauer, David; Bringas, Josef; Warner, Ned; Parker, Eric; Ehrlich, Ygal; Endodontics
Advanced cervical caries in anterior teeth is common to two different patient behaviors. Rampant cervical caries (“meth mouth”) is a common presentation in drug users. Extensive consumption of soft drinks also presents a similar pattern of cervical caries. Two cases are presented and dental treatment considerations are discussed. Case One: excessive soft drink consumption. A young male presented to IUSD for evaluation and treatment of a painful #9. Clinical exam: #9 had extensive facial and cervical caries with a pulp exposure. Cervical caries on teeth #6, 7,8,10,11,12,13. Patient’s history revealed frequent daily consumption of multiple sweet soft drinks. #9 had become increasingly painful and that caused him to seek treatment. Pulpal and Percussion/Palpation testing and radiographic exam of #9 were conducted. Diagnosis: #9 Pulpal Necrosis with Symptomatic Apical Periodontitis. Treatment: Oral hygiene instruction to reduce the frequency of soft drink consumption. #9 was endodontically treated and restored. Caries in #6, 7,8,10,11,12,13 were treated and teeth restored. Case Two: cocaine abuse. A young female presented to IUSD for evaluation and treatment of a painful #9. Clinical exam: #9 had extensive cervical caries. Cervical caries on #7, 8, 9 and dental attrition. Patient reports having used cocaine for many years. Pulpal and Percussion/Palpation testing and radiographic exam of #9 were conducted. Diagnosis: #9 Pulpal Necrosis with Symptomatic Apical Periodontitis. Treatment considerations: Local anesthesia was achieved without the use of epinephrine due to possible occasional unreported use of cocaine. #9 was endodontically treated and restored. Patient did not return for continued treatment at IUSD. Conclusion: Cervical caries in anterior teeth associated with soft drinks demonstrate similar characteristics to those observed in patients with reported cocaine abuse. This should alert dental providers dentists to be aware of both illicit drug use and soft drink intake as part of the patient’s medical, dental, and social history information.
Using Margin Elevation with Bonded Ceramics: A Case Report.
(04/13/15) Rouse, Matt; Cook, N. Blaine; Rouse, Matt; Cook, N. Blaine; Aesthetic Dentistry
Thirty years ago, glass ionomer was first used as a means of bonding resin matrix composite to dentin. Today this method is used to elevate the margin of a preparation to a level which gives the clinician more access to the operating field. This technique has been described in the dental literature with resin composites bonded with resin adhesives. There are still inherent problems with this approach, however, since resin adhesives are subject to hydrolysis, marginal leakage, and recurrent caries. Studies have demonstrated the ability of glass ionomer to chemically bond to dentin; glass ionomer can also be dissolved/etched by phosphoric acid and predictably bonded to resin composites, eliminating the problem of hybrid layer hydrolysis which occurs with resin bonding agents. Margin elevation takes advantage of the favorable properties of glass ionomer cements (adhesion through chemical bond to dentin, fluoride release, biocompatibility, coefficient of thermal expansion similar to tooth structure, and decreased interfacial bacteria penetration/caries activity) while allowing overlaying of a suitable direct or indirect restorative material. This technique should be utilized when a preparation stands an increased risk of contamination or has a gingival margin on dentin/cementum. This case describes restoration of a tooth with a deep subgingival margin located on cervical dentin. The tooth was prepared for a ceramic onlay. Resin-modified glass ionomer was then inserted into the mesial proximal box and re-prepared with the occlusal wall of the glass ionomer becoming the new gingival margin, allowing significantly increased access and isolation. The tooth was then restored with an e.max onlay and cemented with RelyX Unicem. The restoration has been examined at a 6-month recall. With proper case selection and attention to detail, glass ionomer margin elevation is an excellent technique for bonding ceramics to teeth which cannot be isolated adequately for impression and/or resin bonding.
Recognition and Treatment of Amlodipine (Norvasc) Induced Gingival Hyperplasia.
(04/13/15) Silcox, Darci; Thompson, N; Rackley, R. Hunter; Silcox, Darci; Rettig, Pamela; Dental Hygiene
Objective: The objective of this clinical case presentation is to help dental hygienist recognize and understand the treatment of gingival hyperplasia. Assessment: A 56 year old Caucasian male presented to the dental hygiene clinic with the chief complaint, “I want my teeth cleaned.” The patient’s last cleaning was in 2011 at Indiana University School of Dentistry (IUSD). The patient’s medical history revealed that he smokes one pack of cigarettes a day and has been taking the calcium channel blocker amlodipine for approximately two months for hypertension. The patient’s gum tissue presented clinically as pink, stippled, rolled, and bulbous with a hyperplastic appearance. The mandibular attached gingiva in particular, was firm and had an enlarged clinical appearance. Amlodipine is known to cause gingival hyperplasia. Drug-induced gingival hyperplasia was reclassified in 1999 by the APP as a dental plaque-induced gingival disease. Amlodipine is a commonly prescribed drug with the prevalence of gingival hyperplasia being reported as high as 33.3%. Gingival hyperplasia can manifest from mild to severe depending on modifying factors including the patient’s ability to remove plaque biofilm and the length of time the patient is on amlodipine. DH Care Plan: Treatment for this patient at the IUSD hygiene clinic includes scaling and root planing on the maxilla, with full mouth debridement, and a tissue re-evaluation 4-6 weeks after treatment. Each case of gingival hyperplasia should be treated based on the individual’s needs; this can include non-surgical therapy, surgical procedures, or a combination of both. Evaluation: Due to time constraints associated with this presentation, this patient has yet to be re-evaluated after treatment at IUSD. Conclusion: Hygienist must stress the importance of plaque control and spend quality time on oral hygiene instructions. If a patient is on a medication known to cause gingival hyperplasia it is important to note any changes at each visit.
Modification of Dental Hygiene Care in a Breast Cancer Patient.
(04/13/15) Stanton, Erica; Gudgel, S; Rettig, Pamela; Stanton, Erica; Rettig, Pamela; Dental Hygiene
Objective: 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.

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