Mrs. Stain

      Last week a older woman presented to clinic for a cleaning with me. When speaking to the woman, she seemed very interested in her dental health. I briefly asked about her home care while updating her medical history. She stated her brushing and flossing was fairly regular. When I assessed her deposits, I noted only localized light biofilm accumulation and minimal calculus. These findings supported her home care routine. I was very surprised however when completing the perio charting and finding significant probing depths with bleeding. The radiographs provided even more evidence of the bone loss, with moderate vertical bone loss. In addition, I found moderate staining, localized to the lower anterior teeth. Mrs. Stain stated that she frequently drinks tea, which would explain the brown stains.
       Planing the patient's treatment plan was tricky, she had COPD which meant absolutely no cavitron. Removing any deposit was not difficult, but removing the stains (especially interproximally) was very hard. I could not finish the AP during the first appointment and had to reschedule the patient for a summer appointment. Once the patient left, I began thinking about what would benefit the patient the most. The periodontal disease was present, but why? There did not seem to be a local irritant (plaque/calculus). Suddenly the information seemed to stream in... the patient was a type II diabetic and had COPD.  Due to the diabetes, she would have delayed healing and an increased risk of periodontal disease. To treat the pockets, I will seek the advice of a perio resident. Local antimicrobial delivery and oral irrigation (with monoject and peridex) are two options I think may help the patient.
        I informed the patient before she left that we would need to assess the sites and home care at the next visit. I'm hoping that OHI will improve her gingival health somewhat. At the next appointment I plan to get a plaque free score, GI, and complete the AP. If the patient accepts, I would like to make her my case doc patient and help her in achieving improved dental health.
      This clinic session taught me to think outside the box of poor oral hygiene. I had to consider other reasons for the periodontal disease. In the future I will always assess the patient as a whole and take the knowledge I have gained from periodontics, theory, and other classes to create the best plan for the patient.