Patient profile: Jerry, 58 years old, male. He has hearing impairment, live with his wife. He smokes approx 8 – 10 cigarettes a day.
Chief complaint: Jerry comes for periodontal assessment, refer by a in-house dentist.
Dental history: Jerry was seen by a dentist in my practice 4 weeks ago for an examination. His concern was a very loose tooth on the lower left side and bad breath. The dentist took OPG and determined teeth #24, #36, #46 have a hopeless prognosis, and has proceeded to extract them between the examination appointment and now. The dentist has referred Jerry to my care for a periodontal assessment and manage his periodontal health. Once his hygiene treatment is completed and his tissues have healed, the dentist will proceed with restoring the function of Jerry’s bite with a dental prosthesis.
Medical history: hearing impairment, smoking approx. 8 to 12 cigarettes daily.
Oral hygiene: brushing once a day, no interproximal cleaning.
Extra oral: NIL
Intra Oral: nil
Periodontal assessment:
PSR: 3 4 4* / 4* 2 3* indicates that the full mouth periodontal chart will be needed.
Generalised heavy plaque and calculus.
OPG review:
Generalised bone loss horizontally.
Periapical abscess due to periodontal disease presented: #24, #36, #46. Those teeth has been extracted by the dentist.
Vertically bone loss on #13M, #12D, #11M, #21MD, #22MD, #26D, #27M, #38M, #43M, #47M, #48M
Missing teeth: #24, #36, #31, #42, #46
Restoration: no restoration can see in OPG.
Risk assessment:
High risk of periodontitis, focus attention on modifiable risks.
Diagnosis: The patient’s OPG review shows generalised bone loss horizontally, with periapical abscesses in teeth #24, #36, and #46, which have already been extracted. Additionally, there is vertical bone loss in teeth #13M, #12D, #11M, #21MD, #22MD, #26D, #27M, #38M, #43M, #47M, and #48M. The patient is also missing teeth #24, #36, #31, #42, and #46. No restorations are visible in the OPG. Based on the findings, the patient is diagnosed with severe periodontitis and is considered to be at a high risk for developing.
Treatment done today: periodontal exam.
Discussion:
Medical history consideration: With a hearing impairment problem, basic sign language instruction will be a big benefit for Jerry. It is important to ensure effective communication with Jerry during the treatment process. Implementing basic sign language instruction will greatly improve his understanding and cooperation. Additionally, it is crucial to address the high risk of periodontitis and focus on modifying risk factors to prevent further damage to the remaining teeth. Oral hygiene instruction should include a demonstration of brushing technique with the tooth models and a demonstration of brushing with an interdental brush interproximal between two teeth. Furthermore, educating Jerry on the importance of regular dental check-ups and professional cleanings will aid in the prevention and early detection of any potential oral health issues. It is essential to emphasise the significance of maintaining a consistent oral hygiene routine, including flossing and using mouthwash. Providing Jerry with written instructions and visual aids, such as pamphlets or videos, can also enhance his understanding and compliance with the recommended oral hygiene practises.
The discussion continued: It is important to emphasise the importance of regular dental visits and the need for frequent professional cleanings and scaling to manage the severity of Jerry’s periodontitis. Additionally, it would be beneficial to discuss the potential impact of smoking on periodontal health and encourage Jerry to quit smoking for better treatment outcomes. Furthermore, it may be necessary to address any potential barriers to accessing dental care, such as transportation or financial constraints, to ensure Jerry receives the necessary treatment and follow-up care.
Advise Jerry should brush his teeth and use an interdental brush twice daily, morning and night, to prevent any further tooth loss. Regular brushing of teeth twice a day, using fluoride toothpaste, and incorporating interdental cleaning with brushes or flossing can help remove plaque and reduce the risk of gum disease. By following these recommendations, Jerry can improve his periodontal health and enhance the effectiveness of his treatment.
Using smoking result pictures to show him why smoking affects his health badly, particularly his oral health, Tobacoo contains nicotine, which causes damage to the lungs, blood vessels, and brain and has a bad effect on oral health. Show him the images of the oral cavity effects of tobacco use. Encourage the patient to try to quit smoking to protect his health and reduce the cost of living.
The patient has severe and moderate periodontitis. The treatment plan will be
First appointment: Debribement quarantines one and two by using powered instrumentation and hand scalers. Local anaesthetic if needed using the ASA block technique and IAN block.
OHI: demonstrate brushing and flossing techniques with the models. Introduce an interdental toothbrush to clean interproximally.
Second appointment: 2 weeks later. Review the plaque amount to see if the patient has improved his or her brushing technique. Emphasise and encourage the patient to make any improvements he has made. Debribement Q2 and 3 using pwered instrumentation and hand scalers Local anaesthetic if need buccal infiltration for 21, 22, IAN block for Q 3.
OHI: Introduce using chlorhexidine 0.09% mouthwash (10 ml) for 60 seconds, morning and night, for up to 1 month to prevent bacteria and help the healing process.
Third appointment: review after 1 month. Reinforcement about brushing and flossing techniques Ask the patient about tobacco cessation if he has any motivation to stop. Talking about the bad effects of tobacco use to patients again using 5 As Tobacco Cessation: ask, assess, advise, assist, arrange. If the patient shows motivation to quit tobacco use, provide resources and support to assist with tobacco cessation. Offer information about local smoking cessation programs, nicotine replacement therapy options, and counseling services. Emphasize the importance of quitting for overall oral health and the success of the treatment plan. Schedule a follow-up appointment to monitor progress and provide additional guidance if needed.
3 months of recall.
Prognosis:
Teeth 12, 11, 21, and 22 have significant bone loss and may require further intervention, such as root debribement. The patient may have a periodontal abscess due to bone loss and should be closely monitored for any signs of infection or inflammation. The patient will lose those front teeth if the bone loss continues. It is crucial for the patient to understand that tobacco use greatly worsens the prognosis and increases the risk of tooth loss. Therefore, it is important for the dentist to ask about the patient’s motivation to quit smoking and provide appropriate advice and assistance in tobacco cessation. Regular follow-ups should be arranged to closely monitor the patient’s progress and address any potential complications that may arise.
