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.

GPG... testing my dental materials knowledge

  As the semester is drawing to a close, I would like to reflect on my days spent in GPG. Wednesday is my last day spent in GPG land and I feel grateful to be finishing the rotations for now. I found the GPG experience to be very dependent on the day, dental student, and treatment. Overall I felt that it was difficult to find an eager dental student to allow me to perform a cleaning or to assist in the beginning of the semester. I have noticed that as the semester has gone by, the dental students seem much more willing to say yes to my assisting offers. My GPG experience changed with each dental student I helped out. Most of the dental students were confident, easy going, and were amazing with their patients.
      However, there were certain students who were nervous, did not seem to know what they should do next, or had horrible patient communication. In one rotation I worked with a D4 who seemed to be more concerned with time than explaining to his patient what needed to be done. The patient actually confided in me several times when the D4 left that she was confused and was not sure what had changed in her treatment plan. Once the D4 returned, I asked that he explain to his patient what he was doing, since she was confused. He merely stated that he was doing the same thing as before and that he was short on time to go in depth about it. I was quite shocked that he couldn't at least explain it to the patient while prepping the site. Hopefully this D4 will pay more attention to his patients once in practice.
       Aside from the dental students personalities, I felt that GPG allowed me time to review dental material properties. I often questioned the placement of certain dental materials and gained further information from the dental students. I was introduced to a few materials not covered directly in dental materials. Ti-Core is an example of such unknown materials. It was interesting to hear why it was placed and how it reacts. There are two separate parts, the white part is the catalyst and the grey is the hybrid composite (with titanium or lathanide). Ti-Core is self-curing when mixed and is chosen because of its strength and longevity. Ti-Core information 
         I hope that Wednesday's GPG will be well spent and educational. The GPG rotations have been helpful and have prepared me for future communication with dental students and dentists.