Our Patient:

1. Our Patient: 21 year-old female • Student & Bartender • Social Drinker • Smoker • No Exercise • Poor Diet • Anxiety Problems

2. C.C. “My mouth really hurts and there’s a bad taste”

3. Medical Assessment • Recent Mononucleosis • Suffers from Panic Attacks • Insomnia • Vitals: BP 108/68, BPM 90, RPM 18, Temp is 100.7°F.

4. Medications • Xanax- treatment for panic disorder • Significant xerostomia • Lunesta- treatment of insomnia • Unpleasant taste, xerostomia • Ortho Tri-Cyclen- prevention of pregnancy • Caution with prescribing antibiotics

5. Dental History • Carries: 2,18,31 • Restorations: 2,3,12,13,14,18,19,30. • Last Visit: Over one Year. “I have been too busy.”

6. Oral Assessment • E/I Exam: • Bilateral, palpable, tender cervical lymph nodes • Geographic tongue • Fetid breath • Adequate salivary flow, but patient reports that mouth is “usually really dry”.

7. Caries: • Suspicious area at the CEJ between 7 & 8. • Buccal caries on 2,18, 31. Interproximal caries between 2 & 3, and 13 & 14. (Seen in Chart)

8. Periodontal Assessment/ Description: • Maxillary & Mandibular marginal erythema and edema & necrosis of anterior papilla, especially in the mandibular anteriors • OH is poor. PFI = 20%

9. MBI, Probings, BOP: • It was too painful to record full probe, however spot probe reveals 4mm interpoximal depths on the facial aspects of all cuspids and first molars. • BOP= 100% for all 16 sites probed.

10. Periodontal Classification: • AAP classification is class V- Necrotizing Ulcerative Periodontitis. • WLAC Calculus Code: WLAC- 2 Light.

11. Signs and Symptoms of Necrotizing Ulcerative Periodontits Necrosis of interproximal papillae √ Bleeding √ Pain √ Fetid Odor√ Pseudomembrane over gingiva Cervical lypmphadenopathy √ Fever√

12. Three Most Reliable Criteria ForRecognizing ANUP: Necrosis of interproximal papillae √ Bleeding √ Pain √

13. It is an opportunistic infection of the gingiva. • It is associated with lifestyle risk factors such as stress & tobacco.

14. Commonly called ANUG but more correctly called NUP

15. Human Needs: • C.C. “My mouth really hurts and there is a bad taste.” • Protection from health risks, anxiety, and stress. • Functional Dentition • Periodontal Complication

16. Human Needs: • Pain Control • Specialist Referral and Diagnosis • Understanding of Oral Diagnosis and process. • Patient’s Oral Health Responsibility

17. Treatment • Treatment should progress daily during the acute phase of the disease because the pain often inhibits thorough cleaning by the client or hygienist at one time.

18. Day One: • Scale & Debride as much as pt. can tolerate. Ultrasonic may be more easily tolerated. • Encourage pt. to rinse with 3% Hydrogen Peroxide to sooth tissue and oxygenate anaerobic bacteria. • .12% Chlorhexidine 2x a day. • OHI, Diet Counseling, Tobacco Cessation.

19. Day Two: • Scale & Debride as much as pt. can tolerate. Pain should be reduced considerably. • Reinforce OHI. • Continue 3% Hydrogen Peroxide for 1 week.

20. Day Seven: 3rd Appt. • Finish any necessary Scaling & Debridment. • Check patients OH with disclosing solution. • Discontinue 3% Hydrogen Peroxide. • Continue on 0.12% chlorhexidine 2x daily for 2-3 weeks. • Encourage use of xylitol products for dry mouth.

21. 1 Month: Reevaluation • Reinforce OH. • Scale and root plane if necessary. • Evaluate patients progression with lifestyle changes. Stress-Tobacco Cessation-Diet • Assess for Reduced Gingival Bleeding BOP<75%. • Switch to 10 mL clorhexidine rinse for 1 minute daily for 1 week each moth. -Caries protection.

22. Three Month Recare Appointment • Regular mechanical dental hygiene care. • Topical fluoride application. • Reinforce OH and lifestyle changes to prevent the recurrence of NUP.