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