Our Patient:

21 year-old female Student & Bartender Social Drinker Smoker No Exercise Poor Diet Anxiety Problems

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C.C. “My mouth really hurts and there’s a bad taste”

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Medical Assessment

Recent Mononucleosis Suffers from Panic Attacks Insomnia Vitals: BP 108/68, BPM 90, RPM 18, Temp is

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Medications

Xanax- treatment for panic disorder • Significant xerostomia

Lunesta- treatment of insomnia• Unpleasant taste, xerostomia

Ortho Tri-Cyclen- prevention of pregnancy• Caution with prescribing antibiotics

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Dental History

Carries: 2,18,31 Restorations:

2,3,12,13,14,18,19,30.

Last Visit: Over one Year. “I have been too busy.”

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Oral Assessment

E/I Exam: Bilateral, palpable, tender cervical

lymph nodes Geographic tongue Fetid breath Adequate salivary flow, but patient

reports that mouth is “usually really dry”.

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Caries:

Suspicious area at the CEJ between 7 & 8.

Buccal caries on 2,18, 31. Interproximal caries between 2 & 3, and 13 & 14. (Seen in Chart)

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Periodontal Assessment/ Description:

Maxillary & Mandibular marginal erythema and edema & necrosis of anterior papilla, especially in the mandibular anteriors

OH is poor. PFI = 20%

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MBI, Probings, BOP:

It was too painful to record full probe, however spot probe reveals 4mm interpoximal depths on the facial aspects of all cuspids and first molars.

BOP= 100% for all 16 sites probed.

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Periodontal Classification:

AAP classification is class V- Necrotizing Ulcerative Periodontitis.

WLAC Calculus Code: WLAC- 2 Light.

Signs and Symptoms of Necrotizing Ulcerative Periodontits

Necrosis of interproximal papillae √Bleeding √Pain √Fetid Odor√Pseudomembrane over gingivaCervical lypmphadenopathy √Fever√

Three Most Reliable Criteria ForRecognizing ANUP:

Necrosis of interproximal papillae √

Bleeding √Pain √

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It is an opportunistic infection of the gingiva.

It is associated with lifestyle risk factors such as stress & tobacco.

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Commonly called ANUG but more correctly called NUP

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Human Needs:

C.C. “My mouth really hurts and there is a bad taste.”

Protection from health risks, anxiety, and stress.

Functional Dentition Periodontal Complication

Human Needs:

Pain Control Specialist Referral and Diagnosis Understanding of Oral Diagnosis and

process. Patient’s Oral Health Responsibility

Treatment

Treatment should progress daily during the acute phase of the disease because the pain often inhibits thorough cleaning by the client or hygienist at one time.

Day One:

Scale & Debride as much as pt. can tolerate. Ultrasonic may be more easily tolerated.

Encourage pt. to rinse with 3% Hydrogen Peroxide to sooth tissue and oxygenate anaerobic bacteria.

.12% Chlorhexidine 2x a day. OHI, Diet Counseling, Tobacco

Cessation.

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Day Two:

Scale & Debride as much as pt. can tolerate. Pain should be reduced considerably.

Reinforce OHI.

Continue 3% Hydrogen Peroxide for 1 week.

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Day Seven: 3rd Appt.

Finish any necessary Scaling & Debridment. Check patients OH with disclosing solution.

Discontinue 3% Hydrogen Peroxide. Continue on 0.12% chlorhexidine 2x daily for

2-3 weeks. Encourage use of xylitol products for dry

mouth.

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1 Month: Reevaluation

Reinforce OH. Scale and root plane if necessary. Evaluate patients progression with

lifestyle changes. Stress-Tobacco Cessation-Diet

Assess for Reduced Gingival Bleeding BOP<75%.

Switch to 10 mL clorhexidine rinse for 1 minute daily for 1 week each moth. -Caries protection.

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Three Month Recare Appointment

Regular mechanical dental hygiene care.

Topical fluoride application.

Reinforce OH and lifestyle changes to prevent the recurrence of NUP.

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