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Item 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; EndodonticsAdvanced 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.Item Recognition and Treatment of Amlodipine (Norvasc) Induced Gingival Hyperplasia.(04/13/15) Silcox, Darci; Thompson, N; Rackley, R. Hunter; Silcox, Darci; Rettig, Pamela; Dental HygieneObjective: 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.Item Importance of Vertical Dimension in Facial Esthetics.(04/13/15) Supornpun, Noppamath; Levon, John; Supornpun, Noppamath; Levon, John; Aesthetic DentistryThe 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.Item Histomorphological Comparison of Platelet Rich Fibrin Combinations for Ridge Preservation.(04/13/15) Hamada, Yusuke; John, Vanchit; Blanchard, Steven; Hamada, Yusuke; Blanchard, Steven; PeriodonticsBackground: Most commonly used techniques to preserve ridge dimensions following tooth extraction involve bone substitutes and membranes to cover the graft. The use of autologous Platelet Rich Fibrin (PRF) is a recent introduction to be used as a membrane as well as mixed with the graft material. PRF is an inexpensive autologous gel enriched with platelets from venous blood that is easily processed in a clinical setting and contains growth factors including PDGF, TGF-β, VEGF, EGF and IGF1. The aim of this case report is to compare the histomorphologic results of various combinations of PRF, freeze dried bone allograft (FDBA) and polylactic acid membranes (Guidor) in extraction sockets in a single patient. Material and Methods: A 49-year old female patient with a 12 pack-year smoking history presented for extraction of maxillary teeth for an implant retained complete denture. On the day of surgery, 40ml of venous blood was drawn and centrifuged to produce four PRF gels. Two PRF gels were minced and mixed with FDBA. Two clots were processed to be used as membranes to cover the sockets. Teeth #s 4, 6, 11, and 13 were extracted with minimal trauma and sockets were thoroughly debrided. Varying combination of FDBA, PRF, and Guidor membranes were used for ridge preservation grafting in the four sockets. Four and half months following extraction, trephine cores were taken at the time of implant placement and submitted for histological analysis. Results: Clinical healing was uneventful at all sockets but soft tissue healing appeared slightly rapid on sites covered with PRF membranes. However, histologic healing showed more vital bone formation around residual graft materials with Guidor membranes sites. Conclusions: Within the limits of this case report, although PRF membranes seemed to slightly enhance soft tissue healing, the use of Guidor membranes appeared to improve bone remodeling.Item Effects of Stannous and Sodium Fluoride on Human Gingival Fibroblasts.(04/13/15) Mummert, Lauren; Windsor, L. Jack; Mummert, Lauren; Windsor, L. Jack; PeriodonticsBackground: Periodontal diseases are inflammatory conditions of the tooth supporting tissues. Although bacterial byproducts have been linked to periodontal diseases, host responses have also been implicated. This includes the matrix metalloproteinases (MMPs) that are released from human gingival fibroblasts (HGFs) and induce connective tissue degradation. Fluoride has been shown to have inhibitory effects on MMPs in solution. The effects of fluoride on MMP expression from HGFs have not yet been examined. Methods: HGFs cultured from a sample of clinically non-inflamed gingival connective tissues were incubated with stannous fluoride and sodium fluoride to determine their effects on cell proliferation. HGFs were then incubated with or without stannous fluoride or stannous fluoride at the highest concentrations that did not affect cell proliferation and analyzed for MMP expression. Results: The highest concentrations that did not affect proliferation with respect to HGFs were 0.004% stannous fluoride and 0.0125% sodium fluoride. At these levels, MMP expression in HGFs did not differ significantly from untreated HGFs. Conclusions: MMP expression in HGFs was unaffected by treatment with stannous fluoride or sodium fluoride at the concentrations tested. Although these concentrations of sodium fluoride and stannous fluoride with respect to HGFs are lower than some fluoridated mouth rinses and dentifrices, the exact concentrations to which HGFs are exposed following exposure to a fluoridated medicament is unknown. This concentration is likely lower than the concentration of stannous fluoride or sodium fluoride in the medicament due to their position in the lamina propria.Item Racial Differences in Neutrophil Response.(04/13/15) Wagenknecht, Dawn; Kowalik, Michael; Galli, Dominique; Wagenknecht, Dawn; Galli, Dominique; Microbiology/Immunology/Oral BiologyBacterial lipopolysaccharide (LPS), or endotoxin, is a mediator of inflammation. Repeated translocation of endotoxin from oral and intestinal bacteria into the bloodstream has been associated with low-grade systemic inflammation which in-turn increases the risk for systemic disease. A recent IUSD study linked experimental gingivitis to low-grade endotoxemia in both African-Americans and Caucasians. Interestingly, the study also reported differences in neutrophil numbers and oxidative burst activity between the two races. The aim of this preliminary study was to assess the in vitro neutrophil response to low dose LPS priming and subsequent activation with formyl-methionyl-leucyl-phenylalanine (fMLP) by Caucasian (C, n=6) and African American (AA, n=6) males 18 – 40 years of age. Following 6% polysucrose sedimentation of whole blood to reduce red blood cell contamination, fresh neutrophils were isolated by centrifugation over Histopaque® separation media. Neutrophils were resuspended in RPMI medium supplemented with 5% autologous serum, primed with 1 ng/ml LPS for 30 or 60 min and then activated with fMLP. Subsequently, cell-free culture media were collected, aliquoted and stored frozen until tested by ELISA for levels of myeloperoxidase (MPO), bactericidal permeability increasing protein (BPI) and acyloxyacyl hydrolase (AOAH) as markers of neutrophil activation. Activated neutrophils from C subjects released significantly higher levels of BPI compared to AA subjects (p=0.0077 & 0.0197, 30 and 60 minute prime, respectively). Similarly, the mean MPO levels in culture supernatants were higher for C males although the differences were not significant. AOAH was undetectable in the cell culture supernatants. In conclusion, neutrophils from C males displayed a stronger response (BPI and MPO) to LPS than neutrophils from AA male subjects suggesting a biological basis for the reported racial disparity in neutrophil response. (Supported by the IUPUI Office of the Vice Chancellor for Research)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 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 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 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.
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