BY: CAITY FALGEMARCH 28 , 2014
Periodontal Health and External Locus of Control
Meet Mr. Wilcox
61 year old maleMarriedUnemployedUninsuredUnconcerned with any past
or present medical issuesCame for cleaning not
realizing severity of oral cavity
External Locus of Control
“People with a high external locus of control believe that control over events and what other people do is outside them, and that they personally have little or no control over such things.”(Locus of Control, 2012)
Health History/ Medications
Colon cancer recently removedArthritis (lower back, knee, shoulder)High Blood Pressure (from 130/70-172/106)Med. Clearance (hypertension)Medications:
Losartan (BP)- Can cause hypotension Triamterene (Cholesterol)- No Contras Simvastatin (BP)- No Contras Ranitidine (antacid)- No Contras Baby Aspirin- excessive bleeding
Dental History/ Charting
Last visit- 2 1/5 years agoCleaning was performedSl. Open BiteClass III Occ. On left side and right canineClass II Div. II on right
molarCharting:
Missing 3rds PFM #4 Amalgam #13 PFM with RCT #14 PFMs #18,19,30,31
Social History and Chief Complaint
Unemployed and a geriatric patientWife is employed but unable to get Mr. Wilcox
on with her benefitsNo concerns/ complaints present at the initial
appointmentNo concerns throughout treatment….. Even
after alarming findings
Current Oral Hygiene Status
Oral hygiene status was always found to be fair
DI-S scores: 1st: 1.5 2nd: 1.2 3rd: 1 4th: .6 Re-eval: 1
Supplemental Findings
Exudate FistulaFractured Mesial Root
**all found on #31
Assessments
Initial Gingival Description: Color: Pale pink with blanched margins, posterior
interproximal redness Contour Papillary: Generalized blunting Marginal: Blanched and sl. rolled Consistency/ Tone: Generalized firm with posterior
interproximal sponginess Texture: Max. anterior facial stippling
Assessments
PPD- 2-3mm Generalized 4-7mm in Posteriors 13mm on 31 prior to radiographs Generalized Recesion
Severe in mand. Ants Class I Mobility on 23-26
Calc. Gen Mod.Calculus
CAMBRA
High Risk: Occlusal discoloration A lot of root exposure No fluoride mouthwash Only brushing once a day 6.8 pH… Close to 6.7 with the root exposure
Recommended fluoride mouthwash and to start brushing 2x/day
Radiographs
Radiographs
•Advanced bone loss•Furcation Involvement•Radiographic Calc•Fractured Root (urgent referral given… multiple times)
DH Human Needs
Freedom from stress: not met- high BP and abscessFreedom from head and neck pain: not met- abscessFreedom from stress: met- never stated any concern
or showed any concernSkin and mucous membrane integrity: not met-
recession and rollingBiologically sound dentition: not met- fractured rootConceptualization and problem solving: met????Responsibility for oral health: not met- not seeing a
dentist in over 2 yearsWholesome facial image: met
Patient Goal and DH Diagnosis
Pt goal: Receive cleaning and learn about oral hygiene
DH Diagnosis: Gen Chronic Advanced Periodontitis AAP Classification: IIB AAP Case Type: 4
Severe bone loss Tooth mobility Furcation involvement
Treatment Planned
Appt. #1 Appt. #2 Appt. #3 Appt. #4 Appt. #5 Appt. #6FMX
OHI OHI OHI OHI OHISRP 4 +teeth
SRP 4 +teeth
SRP 4 +teeth
SRP 4 +teeth
Anesthetic (Carbo w/epi)
Anesthetic (Carbo w/epi)
Anesthetic (Carbo w/epi)
Anesthetic (Carbo w/epi)
Fl. tx.Re-Eval
Treatment PerformedAppt. #1 Appt. #2 Appt. #3 Appt. #4 Appt. #5 Appt. #6
FMX
OHI OHI OHI OHI OHI
N2O2
Carbo W/epi
Carbo W/epi
Carbo W/epi
Carbo W/epi
SRP UR SRP LR W/ touching up
UR
SRP UL SRP LL W/ touching up other
quadrantsDesensitized roots w/
pro enamel and prophy
cupFl. Varnish
Coronal polished
Preventative Agents
Appointments
Aids and Advice
Appt. #1 None/ TimeAppt. #2 Floss holder and extra soft TBAppt. #3 Revisited TB and Flossing techniqueAppt. #4 End Tuff brushAppt. #5 Rubber tip and another floss holderAppt. #6 Sensodyne
Adjustments/ Modifications
Medical Clearance for high blood pressureCarbocaine w/out epinephrineN2O2 to help with lowering BP and to assist
during injectionsRescheduling Patient
Herpetic lesion
Evaluation of Outcome
Re-eavaluation: Some new calc formation (interproximal roughness) DI-S increased from a 0.6 to a 1.0 No BOP No dental treatment after several urgent needs
released and an early release of radiographs Probes decreased to generalized 1-4s with localized 5s
on #2, 3, 26, 30 Gingiva less rolled and less spongy
***Good and bad signs***
Recommendation
URGENT referrals!! Urgent referrals were given throughout the whole
process and the importance of seeing an outside dentist was always discussed
Radiographs were released at 2nd visit #31 had a large infection/ abscess 3 month re-care recommended Red flagged until urgent needs are taken care of
Reflection
It was a pleasure to work with Mr. Wilcox and this case has taught me a lot about patient views and attitudes. Because Mr. Wilcox is living with an external locus of control and never showed motivation to do anything for himself, I was able to experience what it is like to work with a patient that truly doesn’t understand severity of diseases and the importance of making personal changes. If I could go back, I would make several changes to how I was as a clinician and how well I documented everything. I never charted in Mr. Wilcox’s true recession readings and didn’t take clinical photos. If I would’ve taken photos throughout the process, maybe he would’ve become more motivated and/or pursued outside dental treatment. Adding in additional treatment such as irrigation would also be something that I would amend.
Resources
Carrington College California. (2013) Dental Hygiene Patient Chart. Retrieved from Carrington College California Dental Hygiene Department.
Locus of control. (2012). Retrieved from http://changingminds.org/explanations/preferences/locus_control.htm