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Case Studies 1

  
1. a) Chief Complaints:. Patient complains that during orthodontic treatment his gums in the lower anterior region have receded,causing him discomfort during brushing

    b) Other periodontal complaints: patient also complains of sensitivity to hot and cold foods in the lower anterior region since last 6 months

 

2. Systemic History: No relevant medical history
         
3. Family History: No relevant family history

4. Past dental experience: Patient is currently undergoing orthodontic treatment since last one year
5. Oral hygiene habits: Patient uses toothpaste and brush to clean his teeth twice a day using horizontal scrub manner since childhood. Patient also cleans his tongue everyday.

6. Tissue Abuse/Harmful habits:

7. Dietary enquiry: Patient has vegetarian diet. Patient has a habit of intermittent snacks between meals

8. General examination:

  • Normal gait
  • Afebrile

9. Extraoral examination:

  • Symmetry of face: Bilaterally symmetrical face
  • Lymph nodes: non tender
  • TMJ: normal

10. Intraoral examination:

a) General oral hygiene status: Good

b) Examination of gingiva:

  • Color: Pink with pigmentation in the maxillary anteriors and reddish pink in the mandibular anteriors. Reddish pink in posteriors.
  • Contour: Normal scalloping in all except in 31 where there is deep scalloping
  • Consistency: Firm and Resilient  with Knife edged margins except in 31
  • Surface texture: stippling present
  • Size: Normal except in 31 where it is reduced in horizontal dimension.
  • Position: At CEJ except in 31 where it is 8 mm below CEJ
  • Bleeding: Bleeding on probing in 31
  • Suppuration: Absent

c) Width of attached gingiva:
          Inadequate in Mandibular anterior region
d) Tension test: Positive in mandibular anterior region

e) Other clinical features (if any): Nil

f) Examination of teeth:

1.Teeth present: 11-17; 21-27,  31-37; 41-47.

2. Alignment: Proclined  31

3. Grades of mobility: ( patient undergoing orthodontic treatment)

 

 

 

 

I

I

I

 

I

I

I

 

 

 

 

7

6

5

4

3

2

1

 

1

2

3

4

5

6

 

7

 

 

 

 

I

I

I

 

I

I

I

 

 

 

 

 

4. Loss of tooth structure: - Nil

5. Restored teeth: - 15,36,46
                                      
6. Carious teeth: - none

7. Migration/Drifting: Nil

8. Prosthodontic/Orthodontic treatment (if any): - Undergoing orthodontic treatment

9. Faulty restoration: - Nil

10. Furcation involvement: - Nil
         
11. Proximal contacts: Tight contacts

12. Food impaction:Nil

13. Dental plaque: Generalized

14. Calculus: Supragingival calculus present

15. Material alba: Present

16. Occlusion: Absence of facets

17. Hypersensitivity: - Hypersensitivity to cold in lower anteriors.

18. Discoloration: - Extrinsic staining present in anteriors

 

19. Pocket depth (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Total attachment loss (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Etiological factors:

Systemic:

Local: Plaque, calculus, materia alba.,orthodontic brackets,frenal pull
,
12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.

 Intraoral periapical radiographs required of :1) 31,32,41,42                                            

13. Radiographic findings:

  • Interdental septum 1 mm below CEJ in 31 and 32
  • Intact lamina dura in 31,32,41,42

 

14. Provisional diagnosis:
Chronic generalized plaque induced gingivitis

 

 15. Prognosis:

  • Overall:Good
  • Individual: Good
  • Treatment plan:
  • Emergency treatment: - Nil
  • Planned treatment:

ETIOTROPIC PHASE (Phase I therapy):

  • Diet counseling
  • Removal of local irritants (plaque and calculus)
  • Root planing
  • Minor orthodontic movement for lingual displacement of root of 31
  • Advise orthodontic toothbrush and demonstrate bass brushing technique

EVALUATION OF RESPONSE TO PHASE I:

  • Gingival inflammation

Plaque and calculus

  • Pocket depth
  • Restoration

SURGICAL PHASE (Phase II therapy):Free gingival graft for root coverage of 31 along with the purpose of increasing the width of attached gingiva.
               
RESTORATIVE PHASE (Phase III therapy): _
 

         
MAINTENANCE PHASE (Phase IV therapy):
          Rechecking:

  • Gingival inflammation

Plaque and calculus

  • Restoration
  • Root coverage
  • Patient education and motivation using A-V aids, demonstrations and positive reinforcement.
  • Plaque control measures including brushing technique and interdental cleaning aids (interdental bottle brush).
  • Follow up visit after 1 week, 1 month and 3 months.
 
Case Studies 2

1. a) Chief Complaints: Patient complains of fractured teeth in the maxillary anterior region due to accidental trauma before 6 months. Patients wants to get his teeth restored.
     b) Other periodontal complaints: Patient complains of occasional bleeding from gums last 1 year. Bleeding from gums occurs while brushing and also when he wakes up in the morning.

2. Systemic History: Nil

3. Family History: No relevant family history

4. Past dental experience: - Patient had visited a dentist for opinion after accident, but did not undergo any treatment.

5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal scrub method, since childhood.

6. Tissue Abuse/Harmful habits: No such habits present.

7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals

8. General examination:

  • Normal gait
  • Afebrile

9. Extraoral examination:

  • Symmetry of face: Bilaterally symmetrical face
  • Lymph nodes: non tender
  • TMJ: normal

10. Intraoral examination:

a) General oral hygiene status: Fair

b) Examination of gingiva:

  • Color: Pink with pigmentation
  • Contour: Scalloped with knife edged margins
  • Consistency: Firm and resilient
  • Surface texture: Stippling present  
  • Size: Normal
  • Position: At CEJ
  • Bleeding: bleeding on probing generalized
  • Suppuration: absent

 

c) Width of attached gingiva:

Adequate

d) Tension test: Negative

e) Other clinical features (if any):

f) Examination of teeth:

1.Teeth present: 11-17; 21-27; 31-37; 41-47.

2. Alignment:  Well-aligned teeth

3. Grades of mobility:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

6

5

4

3

2

1

 

1

2

3

4

5

6

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Loss of tooth structure: - Horizontal Coronal Fracture of 11,21 involving enamel, dentine and pulp at cervical third of crown

5. Restored teeth: - Nil
                                      
6. Carious teeth: - Nil

7. Migration/Drifting: Nil

8. Prosthodontic/Orthodontic treatment (if any): -

9. Faulty restoration: -

10. Furcation involvement: - Nil
         
11. Proximal contacts: Tight contacts

12. Food impaction:

13. Dental plaque: Generalized

14. Calculus: Supragingival calculus present

15. Material alba: Present

16. Occlusion: Absence of facets

17. Hypersensitivity: - NAD

18. Discoloration: - NAD

19. Pocket depth (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Total attachment loss (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Etiological factors:

Systemic: -  Nil

Local: Plaque, calculus, materia alba,

12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.

Intraoral Periapical Radiographs required of : 11,21  region

13. Radiographic findings: Bone level at CEJ or just apical to CEJ in 11,21 region

14. Provisional diagnosis:
 Chronic generalized plaque induced gingivitis

15. Prognosis:

  • Overall: Good
  • Individual: Good
  •  Treatment plan:

 

  • Emergency treatment: -
  • Planned treatment:

 

ETIOTROPIC PHASE (Phase I therapy):

  • Removal of local irritants (plaque and calculus)
  • Root planing
  • Endodontic treatment of 11,21

 

EVALUATION OF RESPONSE TO PHASE I:

  • Gingival inflammation

Plaque and calculus

 

SURGICAL PHASE (Phase II therapy):
Crown lengthening in 11,21 region with apically displaced flap and osseus recontouring using osteoplasty and ostectomy
               
            RESTORATIVE PHASE (Phase III therapy): _

  • Post and core in 11,21 followed by porcelain fused to metal crowns

          MAINTENANCE PHASE (Phase IV therapy):
          Rechecking:

  • Gingival inflammation

Plaque and calculus

    • Pocket depth
    • Margins of crowns
    • Patient education and motivation using A-V aids, demonstrations and positive reinforcement.
    • Plaque control measures including brushing technique and interdental cleaning aids (interdental bottle brush).
    • Follow up visit after 1 week, 1 month and 3 months.
 
Case Studies 3

1. a) Chief Complaints: Patient complains of fractured teeth in the maxillary anterior region due to accidental trauma before 6 months. Patients wants to get his teeth restored.
     b) Other periodontal complaints: Patient complains of occasional bleeding from gums last 1 year. Bleeding from gums occurs while brushing and also when he wakes up in the morning.

2. Systemic History: Nil

3. Family History: No relevant family history

4. Past dental experience: - Patient had visited a dentist for opinion after accident, but did not undergo any treatment.

5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal scrub method, since childhood.

6. Tissue Abuse/Harmful habits: No such habits present.

7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals

8. General examination:

  • Normal gait
  • Afebrile

9. Extraoral examination:

  • Symmetry of face: Bilaterally symmetrical face
  • Lymph nodes: non tender
  • TMJ: normal

10. Intraoral examination:

a) General oral hygiene status: Fair

b) Examination of gingiva:

  • Color: Pink with pigmentation
  • Contour: Scalloped with knife edged margins
  • Consistency: Firm and resilient
  • Surface texture: Stippling present  
  • Size: Normal
  • Position: At CEJ
  • Bleeding: bleeding on probing generalized
  • Suppuration: absent

 

c) Width of attached gingiva:

Adequate

d) Tension test: Negative

e) Other clinical features (if any):

f) Examination of teeth:

1.Teeth present: 11-17; 21-27; 31-37; 41-47.

2. Alignment:  Well-aligned teeth

3. Grades of mobility:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

6

5

4

3

2

1

 

1

2

3

4

5

6

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Loss of tooth structure: - Horizontal Coronal Fracture of 11,21 involving enamel, dentine and pulp at cervical third of crown

5. Restored teeth: - Nil
                                      
6. Carious teeth: - Nil

7. Migration/Drifting: Nil

8. Prosthodontic/Orthodontic treatment (if any): -

9. Faulty restoration: -

10. Furcation involvement: - Nil
         
11. Proximal contacts: Tight contacts

12. Food impaction:

13. Dental plaque: Generalized

14. Calculus: Supragingival calculus present

15. Material alba: Present

16. Occlusion: Absence of facets

17. Hypersensitivity: - NAD

18. Discoloration: - NAD

19. Pocket depth (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Total attachment loss (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Etiological factors:

Systemic: -  Nil

Local: Plaque, calculus, materia alba,

12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and blood sugar level.

Intraoral Periapical Radiographs required of : 11,21  region

13. Radiographic findings: Bone level at CEJ or just apical to CEJ in 11,21 region

14. Provisional diagnosis:
 Chronic generalized plaque induced gingivitis

15. Prognosis:

  • Overall: Good
  • Individual: Good
  •  Treatment plan:

 

  • Emergency treatment: -
  • Planned treatment:

 

ETIOTROPIC PHASE (Phase I therapy):

  • Removal of local irritants (plaque and calculus)
  • Root planing
  • Endodontic treatment of 11,21

 

EVALUATION OF RESPONSE TO PHASE I:

  • Gingival inflammation

Plaque and calculus

 

SURGICAL PHASE (Phase II therapy):
Crown lengthening in 11,21 region with apically displaced flap and osseus recontouring using osteoplasty and ostectomy
               
            RESTORATIVE PHASE (Phase III therapy): _

  • Post and core in 11,21 followed by porcelain fused to metal crowns

          MAINTENANCE PHASE (Phase IV therapy):
          Rechecking:

  • Gingival inflammation

Plaque and calculus

  • Pocket depth
  • Margins of crowns
  • Patient education and motivation using A-V aids, demonstrations and positive reinforcement.
  • Plaque control measures including brushing technique and interdental cleaning aids (interdental bottle brush).
Follow up visit after 1 week, 1 month and 3 months.
Case Studies 4

1. a) Chief Complaints: Patient complains of enlarged gingiva in the lower anterior region since last 3 months. Patient is taking medicine (Amlodipine) for hypertension and the enlargement has started increasing since he has started the medicine since 3 months

     b) Other periodontal complaints: Patient complains of occasional bleeding from gums and malodor since last 6 months. Bleeding from gums occurs while brushing and also when he wakes up in the morning. Patient also complains of discomfort while eating due to the enlargement in the lower anterior region.

2. Systemic History: Hypertensive and undergoing medical treatment since last 3 years. Patient is on amlodipine since last 6 months.
         
3. Family History: No relevant family history

4. Past dental experience: -    Patient undergoes scaling of teeth every 3 years since last 10 years.

5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal and vertical scrub method, since childhood. Patient also cleans his tongue everyday.

6. Tissue Abuse/Harmful habits: No such habits present.

7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals

8. General examination:

  • Normal gait
  • Afebrile

9. Extraoral examination:

  • Symmetry of face: Bilaterally symmetrical face
  • Lymph nodes: non tender
  • TMJ: normal

10. Intraoral examination:

a) General oral hygiene status: Fair

b) Examination of gingiva:

  • Color: reddish pink  with pigmentation
  • Contour: accentuated scalloping in all
  • Consistency: Soft and edematous with rolled margins in mandibular anteriors
  • Surface texture: Stippling present in maxillary arch  
  • Size: Enlarged in horizontal and vertical dimensions in mandibular anterior regions
  • Position: 4-6 mm coronal to CEJ in anterior teeth
  • Bleeding: bleeding on probing generalized
  • Suppuration: absent

 

c) Width of attached gingiva:

Adequate

d) Tension test: Negative

e) Other clinical features (if any):

f) Examination of teeth:

1.Teeth present: 11-17; 21-27; 31-37; 41-47.

2. Alignment:  Well-aligned teeth

3. Grades of mobility:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

6

5

4

3

2

1

 

1

2

3

4

5

6

 

7

 

 

 

 

 

 

I

 

I

 

 

 

 

 

 

 

4. Loss of tooth structure: -

5. Restored teeth: - 25,26
                                      
6. Carious teeth: - Nil

7. Migration/Drifting: Nil

8. Prosthodontic/Orthodontic treatment (if any): -

9. Faulty restoration: -

10. Furcation involvement: - Nil
         
11. Proximal contacts: Tight contacts

12. Food impaction:

13. Dental plaque: Generalized

14. Calculus: Supra and Subgingival calculus present

15. Material alba: Present

16. Occlusion: Absence of facets

17. Hypersensitivity: - NAD

18. Discoloration: - NAD

19. Pocket depth (in mm): Gingival pockets

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Total attachment loss (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Etiological factors:

Systemic: -  Amlodipine associated gingival enlargement

Local: Plaque, calculus, materia alba,

12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.

Intraoral Periapical Radiographs required of : 34-44 region

13. Radiographic findings: Bone level at CEJ or just apical to CEJ in all teeth

14. Provisional diagnosis:
 Chronic generalized plaque induced gingivitis along with localized drug associated gingival enlargement

15. Prognosis:

  • Overall: Good
  • Individual: Good
  •  Treatment plan:

 

  • Emergency treatment: -
  • Planned treatment:

 

ETIOTROPIC PHASE (Phase I therapy):

  • Diet counseling
  • Removal of local irritants (plaque and calculus)
  • Root planing
  • Consultation with patient’s physician for replacement of amlodipine with another group of anti-hypertensive drug

 

 

EVALUATION OF RESPONSE TO PHASE I:

  • Gingival inflammation

Plaque and calculus

  • Gingival enlargement

SURGICAL PHASE (Phase II therapy):
Gingivectomy, if required after 3 months in regions where enlargement persists after nonsurgical therapy and replacement of drug.
               
            RESTORATIVE PHASE (Phase III therapy): _

  • Nil

          MAINTENANCE PHASE (Phase IV therapy):
          Rechecking:

  • Gingival inflammation

Plaque and calculus

  • Pocket depth
  • Gingival enlargement
  • Mobility
  • Patient education and motivation using A-V aids, demonstrations and positive reinforcement.
  • Plaque control measures including brushing technique and interdental cleaning aids (interdental bottle brush).
  • Follow up visit after 1 week, 1 month and 3 months till completion of orthodontic treatment.
 
Case Studies 5

1. a) Chief Complaints: Patient complains of enlarged gingiva in the lower anterior region since last 3 months. Patient is taking medicine (Amlodipine) for hypertension and the enlargement has started increasing since he has started the medicine since 3 months

     b) Other periodontal complaints: Patient complains of occasional bleeding from gums and malodor since last 6 months. Bleeding from gums occurs while brushing and also when he wakes up in the morning. Patient also complains of discomfort while eating due to the enlargement in the lower anterior region.

2. Systemic History: Hypertensive and undergoing medical treatment since last 3 years. Patient is on amlodipine since last 6 months.
         
3. Family History: No relevant family history

4. Past dental experience: -    Patient undergoes scaling of teeth every 3 years since last 10 years.

5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal and vertical scrub method, since childhood. Patient also cleans his tongue everyday.

6. Tissue Abuse/Harmful habits: No such habits present.

7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals

8. General examination:

  • Normal gait
  • Afebrile

9. Extraoral examination:

  • Symmetry of face: Bilaterally symmetrical face
  • Lymph nodes: non tender
  • TMJ: normal

10. Intraoral examination:

a) General oral hygiene status: Fair

b) Examination of gingiva:

  • Color: reddish pink  with pigmentation
  • Contour: accentuated scalloping in all
  • Consistency: Soft and edematous with rolled margins in mandibular anteriors
  • Surface texture: Stippling present in maxillary arch  
  • Size: Enlarged in horizontal and vertical dimensions in mandibular anterior regions
  • Position: 4-6 mm coronal to CEJ in anterior teeth
  • Bleeding: bleeding on probing generalized
  • Suppuration: absent

 

c) Width of attached gingiva:

Adequate

d) Tension test: Negative

e) Other clinical features (if any):

f) Examination of teeth:

1.Teeth present: 11-17; 21-27; 31-37; 41-47.

2. Alignment:  Well-aligned teeth

3. Grades of mobility:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

6

5

4

3

2

1

 

1

2

3

4

5

6

 

7

 

 

 

 

 

 

I

 

I

 

 

 

 

 

 

 

4. Loss of tooth structure: -

5. Restored teeth: - 25,26
                                      
6. Carious teeth: - Nil

7. Migration/Drifting: Nil

8. Prosthodontic/Orthodontic treatment (if any): -

9. Faulty restoration: -

10. Furcation involvement: - Nil
         
11. Proximal contacts: Tight contacts

12. Food impaction:

13. Dental plaque: Generalized

14. Calculus: Supra and Subgingival calculus present

15. Material alba: Present

16. Occlusion: Absence of facets

17. Hypersensitivity: - NAD

18. Discoloration: - NAD

19. Pocket depth (in mm): Gingival pockets

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Total attachment loss (in mm):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

7

6

5

4

3

2

1

 

1

2

3

4

5

6

7

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Etiological factors:

Systemic: -  Amlodipine associated gingival enlargement

Local: Plaque, calculus, materia alba,

12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.

Intraoral Periapical Radiographs required of : 34-44 region

13. Radiographic findings: Bone level at CEJ or just apical to CEJ in all teeth

14. Provisional diagnosis:
 Chronic generalized plaque induced gingivitis along with localized drug associated gingival enlargement

15. Prognosis:

  • Overall: Good
  • Individual: Good
  •  Treatment plan:

 

  • Emergency treatment: -
  • Planned treatment:

 

ETIOTROPIC PHASE (Phase I therapy):

  • Diet counseling
  • Removal of local irritants (plaque and calculus)
  • Root planing
  • Consultation with patient’s physician for replacement of amlodipine with another group of anti-hypertensive drug

 

 

EVALUATION OF RESPONSE TO PHASE I:

  • Gingival inflammation

Plaque and calculus

  • Gingival enlargement

SURGICAL PHASE (Phase II therapy):
Gingivectomy, if required after 3 months in regions where enlargement persists after nonsurgical therapy and replacement of drug.
               
            RESTORATIVE PHASE (Phase III therapy): _

  • Nil

          MAINTENANCE PHASE (Phase IV therapy):
          Rechecking:

  • Gingival inflammation

Plaque and calculus

  • Pocket depth
  • Gingival enlargement
  • Mobility
  • Patient education and motivation using A-V aids, demonstrations and positive reinforcement.
  • Plaque control measures including brushing technique and interdental cleaning aids (interdental bottle brush).
  • Follow up visit after 1 week, 1 month and 3 months till completion of orthodontic treatment.
Case Studies 6

a) Chief Complaints: Patient complains of bleeding gums in the morning, since last 4-5 years. Gums bleed when patient gets up in the morning, and also when patient brushes her teeth.

 

b) Other periodontal complaints:

    • Patient also complains of bad breath from her mouth when she wakes up since last 1 year
    • Patient also complains of mobility in lower anterior teeth since the past 1 year.

2. Systemic History: No relevant medical history
         
3. Family History: No relevant family history

4. Past dental experience: - First dental visit

5. Oral hygiene habits: Patient uses toothpaste and brush to clean her teeth once in a day using horizontal scrub manner since childhood. Patient also cleans her tongue everyday.

6. Tissue Abuse/Harmful habits: No such habits present.

7. Dietary enquiry: Adequate diet

8. General examination:

  • Normal gait
  • Afebrile

9. Extraoral examination:

  • Symmetry of face: Bilaterally symmetrical face
  • Lymph nodes: non tender
  • TMJ: normal

10. Intraoral examination:

a) General oral hygiene status: Poor

b) Examination of gingiva:

  • Color: reddish pink except in lower anteriors, where it is bluish pink
  • Contour: normal scalloping in all except in 31-33 and 41-43 where there is deep scalloping
  • Consistency: Soft and edematous with rolled margins
  • Surface texture: stippling absent  
  • Size: normal
  • Position: at CEJ except in 31 and 41 where it is apical to CEJ.
  • Bleeding: bleeding on probing generalized
  • Suppuration: present in 13-22, 31 region

 

c) Width of attached gingiva: Arial

d) Tension test: Negative

e) Other clinical features (if any):

f) Examination of teeth:

1.Teeth present:
11-17
21-28
31-38
41-47

2. Alignment: Spaced maxillary anterior teeth.

3. Grades of mobility:

 

 

 

 

 

 

I

 

I

 

 

 

 

 

 

7

6

5

4

3

2

1

 

1

2

3

4

5

6

 

7

 

 

 

 

I

II

II

 

III

II

I

 

 

 

 

 

4. Loss of tooth structure: -

5. Restored teeth: -
                                      
6. Carious teeth: -

7. Migration/Drifting: Extruded 31

8. Prosthodontic/Orthodonti