Preventative Measures for Periodontal Disease - Essay Example

To understand the individualized preventive instruction and care plan, we must know the periodontal disease. A periodontal disease is a bacterial infection of the periodontium, which includes gingiva, cementum, periodontal ligament, and alveolar bone. Periodontal diseases are classified according to the severity of the infection. The two major stages of this disease are gingivitis and periodontitis. Gingivitis is reversible form of periodontal disease that is limited to an inflammation of the gingival tissues. Untreated gingivitis can advance to periodontitis with the potential of breaking down and destroying the tissues and supporting bone structure of the teeth. On the other hand, untreated periodontitis can lead to early tooth loss. According to Ere and Genco (2007), “periodontal disease is highly prevalent in older adults, affecting 34% of the American population ages greater than 30 years and it is severe in 13% .” Patient with certain genetic traits or systemic diseases such as diabetes, smokers, stress, medication, clenching, or grinding teeth suffer from increase susceptibility. Reducing gingivitis and destructive periodontal diseases among adults is one of the important oral health objectives since it entails proving good oral preventive instruction care. As a student, I want to contribute to the efforts aimed at decreasing prenatal disease care particularly with respect to the case of Mr. B. I have seen a number of patients with some periodontal disease. Such encounters have been very fundamental in broadening my knowledge and understanding on care related to such infections, a move that would be very critical in helping such patients. One of such cases is that of Mr. B who is 48 year-old male, divorced, and works 3-4 days a week far from home. Currently, he is serving as a salesperson. He happens to have been complaining of the appearance of the yellowing and stains teeth. Over the last three years, he has been to a dental specialist after every 4 months for checkups and cleaning. This patient clenches and grinds the teeth in the daytime and night. He does not floss and regularly uses hard tooth brush 3 times a week for approximately one minute with hydrogen peroxide and baking soda tooth paste. He has been smoking two packets of cigarettes per day and has not plan to quite any time soon. Also, he consumes four cups of coffee daily. The patient has type II diabetes under control with medication. The last physician visit was for hyperthyroidism thyroid gland with medication. He strives to reach a balance between works and leisure. As well, he abides by the recommendations proposed by the physician. Occasionally, he acts in accordance with the dental professional’s advice. However, he has a feeling that he is in good health conditions. This makes him get classified under the ASA status, particularly type II diabetes. On the intraoral examination, the patient is found to show enlarged uvula, and 2x2 mobile node located in the sub-mandibular region. The patient also presents the floor of mouth with 10mm x 4mm plaque. On the palatal, the following get observed multiple round, raised erythematous, and non-blister form papules. Radiograph: Patient present with 2-Class 5 and MODL amalgam, 4-MOD amalgam, 5-DO amalgam, #9 class3 mesial composite, 10 class 3 distal composite, 13- porcelain fill metal, 14- root canal with porcelain fill metal, 15-MOD amalgam,18- MO amalgam, 29- DO amalgam, 31-OL amalgam, and 30-gold crown. There was a large diffused area on the hard palate with multiple rounds of raised erythematous. From these signs, it could be that the patient was suffered from nicotine stomatitis since he has been a long time smoker. The “Smoker’s palate could have resulted from trauma caused by the heat from pipes and cigars, though it is common among tobacco smokers. In early stage, tissues on the palate turn red or slight grey in appearance” (Davis, 2005). There was localized small-diffused flat pigmentation around the gingival margin. His gingival tissue was generally firm, pale pink, and fibrotic. This was attributed to excessive smoking with generalized blunted papilla and rolled, and bulbous gingival margin around posterior molars. The patient has moderate generalized deep pockets up to 4mm, generalized recession estimated at 2-3mm, and attachment loss of 7 mm with many bleeding point. The risk factors are from plaque, calculus, restoration, medication, smoking, and hard toothbrush. Periodontists are chronic, generalized, and several. Therefore, it is worth concluding that the patient has furcation. This is because he has plaque buildup on the posterior teeth with a score of 55%. The patient’s 24 hours food diary is made up of cola, coffee, and beer as the main drinks. He does not consume any fruit. Instead, he spends much of his time eating in restaurant three times a day. He has a well balanced breakfast, lunch, and dinner. While at home, snacks are his primary meals. What dental treatment modifications are needed? The patient was given some nutritional counseling to help improve on his dietary and food culture. Compare to the dietary guideline recommendations, the amount of food intake by the patient was inadequate. Among the five food group (milk, meat, vegetable, fruit, bread-cereal), it was only the meat group whose intake level meet the recommended quantity. From Mr. B’s 24 hours dietary dairy, it was evidenced that sodas and soft drinks constituted much of his meals. Instead of asking him to reduce the amount of cola, it is better for him if he drink more fluoridated water. This would help reduce his glucose concentration levels, hence a major step in fighting diabetes type II. Also, the patient should increase his intake of fresh fruits in addition to snacks. This patient happens to be a heavy and addicted smoker of cigarette and other light drugs. Nield-Gehrig (2003) established that “smoking are 2.6 – 6 time more likely to exhibit periodontal than non-smokers. Smoking appears to be one of the two or three most important risk factors in the development and progression of periodontal disease”. The patient should plan to cut down from 2 packs per day to 2 packs of cigarette a week, and he should slowly quit tobacco. This would help in speeding up the healing process for the gingival tissue and thyroid gland problem. His plaque percentage was 55% with only 3 times a week brushing. Changing the patient’s attitude and value toward oral health is the first step in helping them to establish proper oral hygiene therapy. The current condition of his oral cavity would be revealed by extra/intra oral photographs or microscope. The intra oral photographs showed plaque, calculus, and the tissues surrounding those teeth were inflamed. Most of bacteria in the plaque sample will be highly mobile spirochetes. The patient might think again about his oral condition and the bacterial activities in the gingival pocket. Seeing the bacterial layers on his teeth necessitated the need to brush them with immediate effect. This education should have a major impact on the patient’s attitude. As long as he maintains brushing twice a day and flossing at least once a day, his oral condition would be much improved. The bass technique with 45 degree is the best focus on the removal of plaque and debris from gingival sulcus by the combined use of a soft toothbrush and dental floss for 2 minutes. This method is effective for removing plaque adjacent to and beneath the gingival margins, hence forming part of the self-care regimen for controlling periodontal disease and caries (Goday, 2004). Most men have large hands and fingers that prevent them from guiding the floss to posterior areas. Therefore, they should recommendutilizing floss holder. Some of the methods used to recommendutilizing floss include inserting and flossing it is gently with seesaw motion at the contact point with “C” shape around tooth. The gentle seesaw motion makes it possible to get though contact point and prevent snapping, thus avoiding tissue trauma. Flossing will result in the reduction in interproximal plaque and inflammation. The patient should also use non-alcohol fluoride mouth rinse daily to reduce possible bacterial infections and mouth odor. He could try some fluoride whitening toothpaste for better quality ingredient formula for his teeth. Mr. B goes for dental appointment every 4 month, and he is willing to comply with the physician’s advice in order to improve his physical and mental conditions. Gradually, he would reduce his rate of smoking, drink fluoridate water, brush twice a day with soft toothbrush and floss once a day. It is also recommended for the patient to use fluoride whitening toothpaste and mouth rinses. After scaling visit, Mr. B follows the new OHI as recommended. Consequently, he would look strong physically with good appearance. Read More