Periodontal Health and External Locus of Control

1. Periodontal Health and External Locus of Control By: Caity Falge March 28, 2014

2. Meet Mr. Wilcox 61 year old male Married Unemployed Uninsured Unconcerned with any past or present medical issues Came for cleaning not realizing severity of oral cavity

3. 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)

4. Health History/ Medications • Colon cancer recently removed • Arthritis (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

5. Dental History/ Charting • Last visit- 2 1/5 years ago • Cleaning was performed • Sl. Open Bite • Class III Occ. On left side and right canine • Class II Div. II on right molar • Charting: • Missing 3rds • PFM #4 • Amalgam #13 • PFM with RCT #14 • PFMs #18,19,30,31

6. Social History and Chief Complaint Unemployed and a geriatric patient Wife is employed but unable to get Mr. Wilcox on with her benefits No concerns/ complaints present at the initial appointment No concerns throughout treatment….. Even after alarming findings

7. 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

8. Supplemental Findings • Exudate • Fistula • Fractured Mesial Root **all found on #31

9. 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

10. 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

11. 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

12. Radiographs

13. Radiographs • Advanced bone loss • Furcation Involvement • Radiographic Calc • Fractured Root (urgent referral given… multiple times)

14. DH Human Needs Freedom from stress: not met- high BP and abscess Freedom from head and neck pain: not met- abscess Freedom from stress: met- never stated any concern or showed any concern Skin and mucous membrane integrity: not met- recession and rolling Biologically sound dentition: not met- fractured root Conceptualization and problem solving: met???? Responsibility for oral health: not met- not seeing a dentist in over 2 years Wholesome facial image: met

15. 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

16. Treatment Planned

17. Treatment Performed

18. Preventative Agents

19. Adjustments/ Modifications • Medical Clearance for high blood pressure • Carbocaine w/out epinephrine • N2O2 to help with lowering BP and to assist during injections • Rescheduling Patient • Herpetic lesion

20. 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***

21. 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

22. 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.

23. 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