IUSD Research Day

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https://hdl.handle.net/1805/9203

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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.
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 Hygiene
Objective: 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.
Impact of a Tobacco CE Program for Indiana Healthcare Providers.
(04/13/15) Harvey, Savannah; Romito, Laura; Harvey, Savannah; Romito, Laura; Tobacco
Purpose: To assess an evidence-based continuing education (CE) program for Indiana healthcare practitioners focusing on tobacco use and dependence which emphasized team-based tobacco dependence treatment. Methods: Program impact was assessed by changes in participants’ self-reported knowledge and clinical application of course concepts and strategies via a 26-item immediate post- CE survey and a 19 -item 3-month follow-up survey. Surveys included multiple-choice and 5-point Likert-style scaled items. The three month follow-up surveys were mailed / delivered electronically to participants; non-responders were sent two reminders. De-identified data were analyzed in aggregate using descriptive statistics, Spearman correlation coefficients, and Mantel-Haenszel chi-square tests. Results: CE programs were held in Tell City, Madison, Lafayette, Goshen, Richmond and Vincennes with a total of 252 participants. Initial survey response was 98.4% (n=248): dental assistants (2%), dental hygienists (83%), dentists (8.5%), and other healthcare professionals (6.45%). Overall, participants reported less knowledge before than immediately after (p<.0001) and 3 months after (p<.0001) the CE program. Reported knowledge at 3 months was less than immediately after the program (p<.002). Participants planned to apply CE program communication strategies (99%), implement brief tobacco intervention strategies (85%), and refer patients to local cessation resources (95%) or the Indiana Quitline (96%). Response rate for the 3 month survey was 54% (n=136). Respondents reported currently playing an active role in team-based tobacco cessation (48%,78), applying CE communication strategies (85%,109), and implementing brief tobacco interventions (71%,90). Sixty-eight respondents reported referring patients to local counselors; eighty-three referred to the Indiana Quitline. Conclusion: Tobacco dependence CE may be beneficial to enhance health care practitioners’ knowledge and willingness to integrate tobacco interventions in their healthcare settings. However, this does not assure that they will change their practice behaviors by utilizing the learned concepts and tobacco interventions with patients. (Funded by the Indiana State Dept. of Health)
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.
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 Hygiene
Objective: 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.
Motivational Factors for the Non- Compliant Patient.
(04/13/15) Miller, Nia; Ranis, D; Maxwell, Lisa; Miller, Nia; Maxwell, Lisa; Dental Hygiene
Objective: 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.
Maintaining Oral Health with Parkinson’s disease and Arthritis.
(04/13/15) Jones, Lindsey; Minett, C; Rettig, Pamela; Jones, Lindsey; Rettig, Pamela; Dental Hygiene
Objective: 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 early
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.
Importance of Vertical Dimension in Facial Esthetics.
(04/13/15) Supornpun, Noppamath; Levon, John; Supornpun, Noppamath; Levon, John; Aesthetic Dentistry
The objective is to discuss the importance in the determination of the vertical dimension of occlusion in prosthodontic treatment. Case I: A 43-year-old Caucasian female presented with chief complaints of both poor function and esthetics. The medical history revealed a history of cirrhosis, Hepatitis B and depression. In 2011, she presented edentulous with some lower impacted teeth. Three sets of complete dentures were fabricated and delivered. These dentures caused her various problems including complaint of the thick and overextended borders, unacceptable esthetics and ear pain. Due to lack of posterior inter-occlusal space, vertical dimension was increased so much that the resulting dentures were unsatisfying esthetically and auricular discomfort. Case II: A 75-year-old Caucasian male presented with a chief complaints of a broken denture, joint discomfort and esthetic concern. The medical history revealed a history of angina pectoris, hypertension and depression. He continuously complained about his joint pain and broken prosthesis since 2011. Repairs were done several times but they did not eliminate his problem. In 2013, he was diagnosed with a loss of vertical dimension. When his vertical was reestablished at its proper position, his joint discomfort was resolved and his esthetics was greatly improved. Conclusion: Determination of the proper vertical dimension of occlusion is a crucial factor in the overall success of a restorative case. For correct diagnosis and treatment, the restorative dentist should use past dental history, facial profile, past photographs, provisional prosthesis and mounted diagnostic casts.
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.

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