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according to the coments please make changes to the paper and power point Attached you can find the rubic for the paper and power point I started reviewing your paper and PPT but did not finish reviewing the documents. I made some comments; however, I feel you are rushing through the assignment and missing critical pieces. The focus of these projects should be the patient’s medical conditions and the impact on the patient’s oral health. It appears your focus is on Periodontal therapy for a patient with periodontal disease. Please go back and look through the examples, instructions, and rubrics. Take your time to include what is necessary. If you have any questions, feel free to let me know.
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Using Non-Surgical Periodontal Therapy in Managing Stage II Periodontitis
Arielvys Fernandez Febles
MCPHS
February 18, 2024
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Using Non-Surgical Periodontal Therapy in Managing Stage II Periodontitis
The patient considered for assessment is a Hispanic female aged 36 years. The patient
had a history of hypercholesterolemia and hypertension, and poor oral health practices. She was
using Atorvastatin and Lisinopril to manage her hypercholesterolemia and hypertension, which
appeared to be closely associated with her oral health issues. The patient presented with a
Mallampati of IV, a class II occlusion on the right and a tendency to class III occlusion on the
left, midline asymmetry, moderate overbite, and attrition. Generalized light extrinsic staining
was noted, especially on the lingual aspect. The patient had moderate to heavy sub and supragingival calculus were noted during her assessment. Data gathered from the plaque index was of
great use to determine the effectiveness of the patient’s home care. This report aims to develop
non-surgical periodontal therapy for a Hispanic female aged 36 years diagnosed with Stage II
periodontitis by considering the following: medication review, risk assessment, assessment
findings, critical considerations, prevention, and treatment approaches.
History Review Condition
The patient had a history of hypercholesterolemia and hypertension managed using
Atorvastatin and Lisinopril. According to evidence-based literature, these medications are
associated with oral health issues, especially altered taste perception, oral lesions, and
xerostomia (Haas et al., 2021). These conditions increase the risk of an individual experiencing
oral health issues such as periodontal disease and dental caries. Evidence indicates that there is a
bidirectional relationship between hypertension and periodontal disease in that each of them can
contribute to the other if not well managed (Haas et al., 2021). Therefore, individuals using
medications related to hypertension and hypercholesterolemia should consider oral hygiene
practices to reduce their risk of developing oral health issues such as periodontal disease. Due to
the oral-systemic linkage between hypercholesterolemia, hypertension, and periodontal disease,
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it is critical to consider comprehensive management approaches to address or prevent oral and
systemic health issues. This implies that there is a need to consider an interdisciplinary
collaboration between medical providers and dental health professionals to ensure improved
patient outcomes and overall well-being among vulnerable individuals (Haas et al., 2021).
Besides, patient education is critical among individuals with such health issues to ensure that
they practice oral hygiene, such as teeth and tongue brushing, visiting dentists regularly, and
adhering to the prescribed hypercholesterolemia and hypertension medications.
Medication Review
According to the patient’s medication history, the drugs that she is currently using include
Fenofibrate, Lisinopril, and Atorvastatin to manage hypertension and hypercholesterolemia.
When prescribing these medications to a patient, it is critical to understand their drug
classification, actions, side effects, and oral health implications to ensure improved patient
education and comprehensive patient care (Khan et al., 2021). Through such understanding, it is
critical for a healthcare provider to understand the oral side effects that these medications could
have.
Fenofibrate
For instance, Fenofibrate is considered as a fibric acid derivative that is prescribed among
individuals with hypertriglyceridemia. Its action involves enhancing HDL cholesterol levels and
minimizing triglyceride levels. Although this medication has good tolerability, it is sometimes
associated with various side effects, such as gastrointestinal disturbances, especially diarrhea,
nausea, and abdominal pain. These side effects can significantly affect one’s dietary intake and
poor oral hygiene practices, thus contributing to oral health issues (Khan et al., 2021). This
medication has also been associated with rhabdomyolysis and myopathy as adverse effects,
although they are relatively rare.
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Lisinopril
Lisinopril is considered an angiotensin-converting enzyme (ACE) inhibitor that is prescribed
among patients with hypertension. This medication usually works by enhancing the relaxation of
the blood vessels, thus minimizing the blood flow pressure. This medication is well-tolerated,
although it is sometimes associated with various side effects among some patients. In most cases,
this medication causes a dry cough that may sometimes affect an individual’s oral health.
Persistent coughing due to prolonged use of this medication can contribute to oral lesions
associated with angular cheilitis, ulceration, and mucosal irritation (Khan et al., 2021). Like other
ACE inhibitors, Lisinopril has been associated with angioedema, which is considered to have
life-threatening risks of swollen throat, tongue, and lips. The swellings can threaten patient
health and safety due to their potential to cause airway obstruction.
Atorvastatin
Atorvastatin is considered as an Atorvastatin that is prescribed among patients with
hypertriglyceridemia. It usually works by HMG-CoA reductase, which is an enzyme associated
with cholesterol synthesis (Martignon et al., 2019). Due to its action, it is usually aimed at
lowering LDL cholesterol levels, thus minimizing the risk of an individual experiencing
cardiovascular events. This medication has been associated with various side effects, although
the common ones include taste alterations and xerostomia (Martignon et al., 2019). Xerostomia
can potentially predispose an individual to various oral infections such as dental caries and
periodontal disease since it lowers the saliva flow, thus impairing the natural defense
mechanisms in the mouth. Besides, taste alterations can influence one’s dietary choices and
reduce oral hygiene practices that may contribute to oral health issues.
Risk Assessment
Caries Risk Assessment
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The evidence-based assessment tool necessary to determine the risk of the described
patient to develop dental caries is the Caries Management by Risk Assessment (CAMBRA) tool.
This assessment tool enhances understanding of the preventive measures and therapeutic
approaches to apply (Martignon et al., 2019). In this case, the tool considers various aspects such
as systemic conditions, past caries experience, oral hygiene practices, and dietary habits to
determine an individual’s risk of developing dental caries. As per the information available
regarding the patient described, she is highly likely to develop dental caries due to her different
aspects, such as the family history of dental caries, and poor oral hygiene practices. In this case,
consumption of sugary beverages and foods increases acid production and causes the risk for
enamel demineralization, thus predisposing an individual to caries development (Martignon et
al., 2019).
Besides, poor oral hygiene practices contribute to gingival inflammation and plaque
accumulation, thus increasing one’s risk of developing caries since they create a favorable
condition for biofilm formation and bacterial growth. Moreover, a family history of dental caries
indicates the possibility of a genetic predisposition that increases the susceptibility of family
members to developing dental caries (Martignon et al., 2019). Such risks can be minimized
through various practices, such as increasing fiber-rich food intake and reducing sugar food
intake to enhance saliva flow and minimize dental exposure to acids. Besides, the risk of
developing dental caries can be reduced through daily oral hygiene practices such as fluoride
use, flossing, and brushing to remineralize enamel and promote plaque control. Regular visits to
a dentist can also reduce such risks through fluoride treatments and professional cleanings.
Periodontal Risk Assessment
The AAP risk assessment tool is one of the most appropriate risk assessment tools
necessary to determine the risk of an individual developing periodontal disease. Some aspects
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that this risk assessment tool considers include smoking status, systemic conditions, gingival
health, and oral hygiene practices. Based on these aspects, the patient described poor oral
hygiene contributing to generalized gingival edema, inflammation, and plaque accumulation
(Raison et al., 2020). Individuals with poor plaque control are susceptible to inflammatory
responses and bacterial proliferation, contributing to periodontal tissue destruction and gingival
inflammation. In addition, various systemic health issues, such as hypercholesterolemia and
hypertension, increase the risk of periodontal inflammation due to vascular changes and immune
dysregulation. This makes the described patient to be at a high risk of periodontal disease since
she experiences the mentioned risk factors. However, the risk of developing this disease can be
minimized through various practices such as regular dental visits for periodontal assessments and
professional cleanings, proper use of plaque control techniques, and proper oral hygiene
practices.
Oral Cancer Assessment
Since no specific risk assessment tool can be applied in assessing an individual’s risk of
developing oral cancer, patient history and clinical examination can be considered. In this case,
patient history involves evaluating an individual based on various risk factors such as human
papillomavirus (HPV) infection, previous oral cancer history, and alcohol/tobacco use. Besides,
the clinical examination evaluates various risk factors, such as lymph nodes, soft tissues, and oral
mucosa signs that indicate the possibility of malignancy (Rajendiran et al., 2021) Besides, there
is a high prevalence of oral cancer among Hispanics compared to other ethnic groups, especially
in the United States. When performing an oral examination to determine an individual’s risk of
oral cancer, any suspicious abnormality, or lesions, especially white or red patches, non-healing
ulcers, indurations, and nodules, should be well examined. In this case, both extraoral structures
and oral cavity components, such as the floor of the mouth, palate, buccal mucosa, tongue, and
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lips, need to be examined (Rajendiran et al., 2021). Further diagnostic practices, especially
biopsy, can be considered in case of a condition where a suspicious lesion is noted.
Assessment Findings
Extraoral/Intraoral Examination
There were several findings made during the extraoral/intraoral examination. One of
them involved prominent papillae and a coated tongue. These findings indicate poor oral hygiene
practices, contributing to bacteria accumulation on the tongue surface. Based on these findings,
the patient should be educated on appropriate tongue-cleaning techniques for improved oral
hygiene (Rajendiran et al., 2021). The second one involved gingival redness and edema.
Marginal redness and generalized gingival edema are indications of inflamed gingival
inflammation caused by poor oral hygiene and plaque accumulation. This shows the need for
periodontal therapy and thorough plaque removal to restore gingival health and address
inflammation. Another finding involved extrinsic stains. Based on this finding, extrinsic stains
were noted in the entire mouth, indicating the possibility of poor oral hygiene, and poor dietary
habits, (Rajendiran et al., 2021).
Radiographs
Numerous findings were obtained radiographically, mainly bone loss, caries, and
radiographic calculus. For instance, there was a 15%-33% bone loss, as evident among patients
with Stage II periodontitis. This bone loss level shows moderate periodontal disease that should
be addressed through immediate interventions to prevent tooth loss and further progression of the
disease. This shows the need for treatment planning and restorative interventions.
Critical Considerations
Periodontal Probing
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There are various aspects considered in periodontal probing, especially the bleeding
points and pocket depths. Accurate assessment and identification of these aspects provide critical
information regarding the active inflammation presence and periodontal disease severity. In this
case, 3-4 mm of probing depth implies that there is mild to moderate periodontitis. Besides, 5
mm of localized pockets show advanced periodontitis.
Clinical Attachment Level (CAL)
CAL calculation is conducted by determining the distance between the cementoenamel
junction (CEJ) and the gingival margin or periodontal pocket base. This measurement shows
periodontal attachment loss and assists in determining periodontal disease severity. As per the
described patient, the CAL is six sites per tooth for comprehensive attachment level assessment.
Any issue noted between clinical attachment levels and probing depths may be explored later to
enhance the understanding of the possible diagnosis and necessary treatment plan.
Mucogingival Considerations
Mucogingival junction identification and attached gingiva assessment are critical in
periodontal evaluation. As per the patient assessment, the mucogingival junction was assessed
visually during probing for reference. Besides, the attached gingiva width was determined
between the mucogingival junction and the gingival margin by applying a periodontal probe
(Seyam et al., 2021). Different regions with inadequate attached gingiva of less than 1mm were
identified due to their susceptibility to recession and need special attention when developing a
treatment plan.
Mobility
Tooth mobility assessment is critical in periodontal ligament integrity and alveolar bone
support. In evaluating the described patient, every tooth was palpated gently, and then its
mobility was determined by applying a Miller classification system with a range of 0-3. The
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fremitus presence determined through teeth palpation when a patient taps the teeth together or
biting down shows the possibility of tooth malalignment or occlusal trauma causing mobility
(Seyam et al., 2021). The patient’s mobility measurement was recorded as 0-1 to assist in
determining the prognosis and making the treatment decisions.
Furcation Involvement
Furcation involvement’s accurate identification and classification are critical when
assessing patients with periodontal diseases to determine the severity of the condition and the
necessary treatment plan. Regarding the patient’s furcation involvement, it was assessed visually
and determined through a clinical process applying a periodontal probe. The furcation
involvement degree was noted as Class I by considering bone loss extent and furcation area
accessibility. Furcation involvement’s accurate documentation enhances periodontal health
monitoring and appropriate management.
Other Critical Aspects
Prognosis
As per the assessment information, the patient will likely experience a fair to good
prognosis. However, this can only be achieved if a timely treatment intervention is considered
(Weik et al., 2023). The general prognosis is determined through various considerations,
especially the tissue response to therapy, and the patient’s oral hygiene.
Staging and Grading
According to the information available, the patient was diagnosed as Stage II
periodontitis, and Grade B. The factors considered in staging and grading include the severity
and extent of periodontal destruction. The staging can be confirmed through clinical attachment
loss (CAL) and radiographic bone loss (RBL). The grading can be attributed to the biofilm
destruction.
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Treatment Plan
For effective treatment of the assessment patient, an evidence-based treatment plan must
be developed. This involves considering non-surgical periodontal therapy and dental caries
management. Creating a treatment plan aims to restore periodontal health, caries progression
arrest, and prevent future disease. The plan created for this patient included scaling and root
planing by quadrant with local anesthesia, along with subgingival irrigation with Chlorohexidine
Gluconate 0.12%, and Arestin.
Informed Consent
Ethical considerations are critical when assessing and treating patients with various
health issues. One of the most appropriate ethical principles that should be considered in the
assessed patient case is informed consent (Slot et al., 2020). This involves informing the patient
about the procedures to be conducted, as well as their risks and benefits. The patient’s
acknowledgment allows healthcare providers to proceed with the treatment.
Prevention
Patient Education
When considering the prevention of various oral health issues, such as periodontal
disease, there are various aspects that are considered (Weik et al., 2023). However, one of them
is patient education. As per the patient’s assessment, the education necessary should focus on
dietary modifications, and oral hygiene. The education considered should aim at preventing the
disease from progressing.
Oral Self-Care
Another appropriate strategy for preventing periodontal disease progression is through
oral self-care. This involves effective tongue-cleaning, flossing, brushing and increased dental
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visits (Slot et al., 2020). The patient should be assessed regularly to ensure she adheres to these
practices.
Adjunctive Products
There are various products that can be applied in managing periodontal disease through
oral health promotion. Some include antimicrobial mouthwash and fluoride toothpaste to
minimize the risk of periodontal disease and caries (Slot et al., 2020). These products have been
proven effective through evidence. The patient was given a prescription for Chlorohexidine rinse
and Prevident 5000 dentifrice.
Nutrition Counseling
Nutritional counseling has been considered one of the most effective strategies for
addressing oral health issues (Van der Weijden et al., 2019). This involves educating the patient
on the food types to avoid and the ones to prioritize. For instance, the described patient should
reduce sugary food and increase a balanced diet.
Pain and Anxiety Control
Treatment approaches necessary to the described should effectively minimize pain and
anxiety. The use of local anesthesia was utilized to reduce the patient’s pain, thus reducing the
patient’s anxiety. Constant communication with the patient was also used to reduce her anxiety
during treatment. It was also recommended that the patient utilize her headphones to listen to
music to reduce anxiety.
Re-Evaluation
A follow-up plan involving the appointment for the patient’s return to the clinic should be
developed. This will ensure an effective re-evaluation of the patient’s health condition and
adjustment in the treatment plan. The tissue response for the previous quadrant was evaluated
during each treatment. The patient reported little to no bleeding during brushing or flossing. The
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patient was also scheduled to return in four weeks to assess the full tissue response and pocket
depths.
Self-Assessment
The practice involving comprehensive assessment and treatment of a 36-year-old
Hispanic female diagnosed with Stage II periodontitis was much educative and beneficial to my
clinical practice. I effectively performed the necessary clinical practices through evidence-based
approaches and consideration of patient-centered care services. The disease identified was
significantly supported by evidence, thus making it easy to develop a prevention and treatment
plan. If the patient adheres to the developed treatment plan, she will likely experience improved
outcomes.
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References
Haas, A. N., Furlaneto, F., Gaio, E. J., Gomes, S. C., Palioto, D. B., Castilho, R. M., … &
Messora, M. R. (2021). New tendencies in non-surgical periodontal therapy. Brazilian
oral research, 35. https://doi.org/10.1111/idh.12450
Khan, S., Khalid, T., Bettiol, S., & Crocombe, L. A. (2021). Non-surgical periodontal therapy
effectively improves patient‐reported outcomes: a systematic review. International
journal of dental hygiene, 19(1), 18-28. https://doi.org/10.1111/idh.12450
Martignon, S., Pitts, N. B., Goffin, G., Mazevet, M., Douglas, G. V., Newton, J. T., &
Santamaria, R. M. (2019). CariesCare practice guide: consensus on evidence into
practice. British Dental Journal, 227(5), 353-362. https://doi.org/10.1038/s41415-0190678-8
Raison, M. H., Corcoran, R., Burnside, G., & Harris, R. (2020). Oral hygiene behaviour
automaticity: Are toothbrushing and interdental cleaning habitual behaviours?. Journal
of Dentistry, 102, 103470. https://doi.org/10.1016/j.jdent.2020.103470
Rajendiran, M., Trivedi, H. M., Chen, D., Gajendrareddy, P., & Chen, L. (2021). Recent
development of active ingredients in mouthwashes and toothpastes for periodontal
diseases. Molecules, 26(7), 2001. https://doi.org/10.3390/molecules26072001
Seyam, M. M., Ibrahim, S., Gawish, A. S., & Sherif, M. A. (2021). Evaluation of the Effect of
Fluoride Application on Periodontal Health during Orthodontic Treatment (A Clinical
Study). Al-Azhar Dental Journal for Girls, 8(1-A), 157-167.
10.21608/ADJG.2021.14177.1182
Slot, D. E., Valkenburg, C., & Van der Weijden, G. A. (2020). Mechanical plaque removal of
periodontal maintenance patients: A systematic review and network meta-analysis.
Journal of Clinical Periodontology, 47, 107-124. https://doi.org/10.1111/jcpe.13275
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Tomasi, C., Liss, A., Welander, M., Alian, A. Y., Abrahamsson, K. H., & Wennström, J. L.
(2022). A randomized multi‐centre study on the effectiveness of non-surgical
periodontal therapy in general practice. Journal of Clinical Periodontology, 49(11),
1092-1105. https://doi.org/10.1111/jcpe.13703
Van der Weijden, G. A., Dekkers, G. J., & Slot, D. E. (2019). Success of non-surgical
periodontal therapy in adult periodontitis patients: A retrospective analysis.
International journal of dental hygiene, 17(4), 309-317.
https://doi.org/10.1111/idh.12399
Weik, U., Shankar-Subramanian, S., Sämann, T., Wöstmann, B., Margraf-Stiksrud, J., &
Deinzer, R. (2023). “You should brush your teeth better”: a randomized controlled trial
comparing best-possible versus as-usual toothbrushing. BMC Oral Health, 23(1), 456.
https://doi.org/10.1186/s12903-023-03127-3
Stage II Periodontitis
Ari Fernandez
MCPHS
Purpose
• Provide an in-depth analysis of a case study involving a 36-year-old Hispanic
female with Stage II periodontitis.
• Explore the patient’s medical and dental history, assessment data, diagnosis, and
treatment plan.
• Discuss the implications of the case for general practice dental hygienists.
• Share insights and contribute to the collective knowledge in the field.
• Foster a deeper understanding of periodontal management and personalized
care strategies.
Case Profile
• Patient is a 36-year-old female
• She is undergoing nonsurgical periodontal therapy
• The patient is diagnosed with stage II periodontal disease
• During the assessment and received a total of two plaque
indices
• The first score was 35 %, and on her second visit, the
score decreased to 26%.
• It was identified that had generalized edematous and
marginal redness
• It was learned that failure of the patient to observer
dental hygiene contributes to periodontitis
Literature Review Summary
•
•
•
•
•
Non-surgical periodontal therapy crucial for managing periodontal diseases.
Periodontal diseases prevalent, impact overall well-being (Haas et al., 2021).
Understanding etiology, risk factors, and management crucial for optimal care.
Studies evaluate success of non-surgical periodontal therapy (Khan et al. 2021).
Van der Weijden et al. (2019) study shows successful recovery.
•
•
•
Tomasi et al. (2022) compare guided infection control and conventional therapy.
No significant differences, but guided therapy is more time-effective.
Patient’s journey highlights lessons in education and preventive care.
Patient Assessment Summaries
•
•
•
•
•
Patient assessed multiple times, received two plaque indices.
Initial score: 35%, second visit: impressive decrease to 26%.
Moderate supragingival calculus, light staining; subgingival plaque present.
Generalized 3-4 mm pockets, localized 5-6 mm pockets.
Risk factors indicated candidacy for non-surgical periodontal therapy.
Medical
Conditions
Medications
• Atorvastatin for
• Hypertension and high
cholesterol reduction.
cholesterol diagnosed in 2020.
• Steady blood pressure readings • Lisinopril for
hypertension.
within acceptable range.
• Fenofibrate as adjunct
• Evaluation for medical
therapy for cholesterol.
clearance not required.
Significance to
Oral Health
• Medications impact oral
health and may
contribute to conditions.
• Blood pressure
monitoring essential
during dental
appointments.
• Integral information for
tailored oral care
strategies.
Caries Risk
• No history of cavities;
diagnosed with three
cavities.
• Initial exposure to
caries, highlighting
preventive importance.
• Patient’s dental hygiene
impacts caries risk.
Periodontal
Risk
Oral Cancer Risk
• Diagnosed with
Stage II periodontal
disease.
• Generalized
edematous and
marginal redness
observed.
• Pocket depths and
gingival assessment
crucial for risk
evaluation.
• Coated tongue and
prominent papillae
noted.
• Detailed examination
essential for oral
cancer risk.
• Reflects the
importance of
comprehensive oral
assessments.
Extraoral & Intraoral Exam
• TMJ and neck within normal
limits.
• Chapped and dry lips observed.
• Overall examination reveals
normalcy.
IOE Findings
• Coated tongue and prominent
papillae noted.
• Class II occlusion on the right;
tendency to class III on the left.
• Generalized edematous and
marginal redness observed.
Radiographic Summary
• Bone Loss Assessment:
• 15%-33% bone loss observed across
six sextants.
• Periodontal status classified as Stage
II.
• Caries Examination:
• Three cavities identified, two in
posterior, one in anterior.
• First-time occurrence for the patient.
Periodontal Summary
• Risk factors
• Generalized edematous and marginal redness.
• Moderate supragingival calculus with light staining.
• Moderate supragingival and subgingival plaque present.
• Overall Periodontal Findings:
• Generalized 3–4mm pockets.
• Localized 5–6mm depths.
Diagnosis & Prognosis
Periodontal Diagnosis
• Stage II periodontal disease.
Periodontal Prognosis
• Generalized 3–4mm pockets, localized 5–6mm
depths.
• Favorable prognosis with intervention.
• Moderate supragingival calculus and plaque.
• Continued monitoring for maintenance.
• Edematous and marginal redness.
Rationale for Prognosis
• Successful plaque index improvement.
• Early-stage diagnosis allows effective management.
Rationale
• Positive response to initial therapy.
• Based on pocket depths, calculus, and plaque.
• Corroborated by visual signs of inflammation.
• Effective non-surgical periodontal therapy.
Treatment Plan & Treatment
Treatment Plan
Treatment
• Summary of Treatment Plan:
• Initiation of non-surgical therapy for
generalized gingival edema and redness.
• Scaling and root planning to address
pocket depths and promote periodontal
health.
• Caries management through restorative
procedures for diagnosed cavities.
• Implementation of preventive measures,
including fluoride application and oral
hygiene reinforcement.
• Evidence-Based Recommendations:
• Research-supported oral hygiene education to
empower the patient.
• Fluoride applications based on evidence to
strengthen enamel and prevent caries.
• Antibiotic therapy (Arestin, Atridox) supported by
literature for deep pocket areas.
• Ongoing oral health education emphasizing the
importance of brushing, flossing, and dietary
counseling.
Treatment Plan & Treatment
• Treatment Plan
• Treatment
• Fluoride application and oral hygiene
reinforcement.
• Preventive Services:
• Comprehensive oral hygiene education focusing on effective
brushing, flossing, and tongue cleaning.
• Fluoride applications to strengthen enamel and prevent caries.
• Personalized dietary counseling to minimize caries risk.
• Evidence-Based Recommendations:
• Research-supported oral hygiene education
to empower the patient.
• Fluoride applications based on evidence to
strengthen enamel and prevent caries.
• Antibiotic therapy (Arestin, Atridox)
supported by literature for deep pocket areas.
• Ongoing oral health education emphasizing
the importance of brushing, flossing, and
dietary counseling.
• Non-Surgical Periodontal Therapy:
• Scaling and root planning for calculus removal and smooth tooth
surfaces.
• Antibiotic therapy (Arestin, Atridox) in deep pockets for effective
periodontal management.
• Follow-up assessments and regular appointments for progress
monitoring.
• Adjunctive Periodontal Therapy:
• Ongoing oral health education for optimal oral hygiene practices.
• Emphasis on the power of toothbrushing with recommendations to
brush at least twice a day.
• Collaboration with restorative dentists for timely cavity
management.
Patient Education, Adjunctive Therapy &
Preventive Care Recommendations
• Patient Education:
• Preventive Care Recommendations:
• Promote effective brushing and flossing techniques daily.
• Advocate for regular dental cleanings and
check-ups.
• Emphasize the significance of regular oral health check-ups.
• Emphasize the role of personalized
• Educate on the importance of a balanced, anti-inflammatory
continuing care schedules.
diet.
• Reinforce the use of interdental aids for
• Encourage consistent adherence to recommended oral hygiene
plaque control.
practices.
• Provide tailored nutritional guidance for
• Adjunctive Therapy:
optimal oral health.
• Implement fluoride applications to strengthen enamel.
• Consider localized antibiotics (Arestin, Atridox) for specific
areas.
• Discuss the potential benefits of antimicrobial mouth rinses.
• Use of desensitizing agents to address patient discomfort.
Significant Findings / Points of Interest
• Oral Health Impact:
• Hypertension, hypercholesterolemia, and related medications impact oral health.
• Coated tongue observed due to inadequate tongue cleaning practices.
• Patient’s occlusion irregularities contribute to potential oral health challenges.
• Gingival edema and redness highlight the interconnectedness of oral conditions.
• Significant Findings:
• Steady blood pressure readings allowed uninterrupted non-surgical periodontal therapy.
• Plaque indices demonstrated impressive improvement despite instructed flossing restriction.
• Radiographic evaluation revealed 15%-33% bone loss, indicating Stage II periodontitis.
• Initial dental caries diagnosis was unexpected for a patient without previous cavities.
Plaque Smear
Final Thoughts
• Comprehensive Patient Care:
• There is a need for an integration of medical and dental considerations.
• Dentist needs to tailor patient education strategies.
• An ongoing collaboration with periodontal specialists is crucial for the patient recovery
• A continuous re-evaluation is effective for evolving care.
• Lessons Learned:
• This case has helped me in gaining insights on managing oral health with complex medical condition
• There is a need to remain prepared for unexpected aspects, such as the diagnosed dental caries.
• Proper diagnosis and treatment is fundamental in improving plaque indices during therapy.
• A need for holistic perspective for addressing oral-systemic links.
References
• Chandran, N. (2022). A comprehensive view on local drug delivery systems in Periodontics. EC Dental
Science, 21(12), 102-115.
• Haas, A. N., Furlaneto, F., Gaio, E. J., Gomes, S. C., Palioto, D. B., Castilho, R. M., … & Messora, M. R. (2021).
New tendencies in non-surgical periodontal therapy. Brazilian
oral research, 35.
• Khan, S., Khalid, T., Bettiol, S., & Crocombe, L. A. (2021). Non-surgical periodontal therapyeffectively improves
patient‐reported outcomes: a systematic review. International journal of dental hygiene, 19(1), 18-28.
• Martignon, S., Pitts, N. B., Goffin, G., Mazevet, M., Douglas, G. V., Newton, J. T., … & Santamaria, R. M. (2019).
CariesCare practice guide: consensus on evidence into practice. British Dental Journal, 227(5), 353-362.
• Nagarakanti, S., Gunupati, S., Chava, V. K., & Reddy, B. V. R. (2015). Effectiveness of subgingival irrigation as an
adjunct to scaling and root planing in the treatment of chronic periodontitis: a systematic review. Journal of clinical
and diagnostic research: JCDR, 9(7), ZE06.
• Raison, M. H., Corcoran, R., Burnside, G., & Harris, R. (2020). Oral hygiene behaviour automaticity: Are
toothbrushing and interdental cleaning habitual behaviours?. Journal of Dentistry, 102, 103470.
Cont.;
• Rajendiran, M., Trivedi, H. M., Chen, D., Gajendrareddy, P., & Chen, L. (2021). Recent development of active
ingredients in mouthwashes and toothpastes for periodontal diseases. Molecules, 26(7),
