DHYG 346 Periodontology II

Extra Credit Case Study

Patient Name Charlie Molar

AAP: IV
Age: 39
Gender: ☒ Male ☐ Female

Vitals: BP 128/79 Pulse 80

DENTAL HISTORY: Mr. Molar gets his teeth UNDER CARE OF PHYSICIAN:
cleaned every 3 months due to his periodontal ☒Yes
condition. The hygienist needs an hour and half for ☐No
Condition: Crohn’s Disease
his dental appointment, because this patient needs
Nitrous Oxide, full mouth Oraqix, and #4 has to HOSPITALIZED WITHIN THE LAST 5 YEARS:
have LA just to be able to scale that tooth. Pt cannot ☐Yes
tolerate the ultrasonic scaler due to sensitivity. ☒No
Reason: Click here to enter text.

CHIEF COMPLAINT: He hates to get his teeth HAS OR HAD THE FOLLOWING CONDITIONS:
cleaned because it is really uncomfortable for him. Crohn’s Disease 21 years with no recent flair ups or
He is also concerned as to why he has such bad complications.
perio at such a young age.
CURRENT MEDICATIONS:
CURRENT ORAL HYGIENE STATUS: Fair OH, Remicade (12 years)
tissue is generalized firm with area of edema. Lt/
SMOKES OR USES TOBACCO PRODUCTS:
Moderate subgingival plaque especially
☐Yes
interproximal and Lt. BOS He recently began ☒No
using a power toothbrush, and flosses 2 to 3
tx/week. PATIENT IS PREGNANT:
☐Yes
☐No
SUPPLEMENTAL ORAL EXAMINATION
☒N/A
FINDINGS:
Pt. has class II mobility on teeth #28, 21 & 20, MEDICAL HISTORY: Diagnosed with Crohn’s
with gen class II furcation’s on all molars Disease at the age of 18. Has been on Remicade for
12 years. This patient is in great Physical shape.

PERIODONTAL TREATMENT NEEDED: SOCIAL HISTORY: Ex-military, married with two

children.
3 Month Perio maint, with occasional quad scaling
if his perio condition gets out of control

TREATMENT PERFORMED:
Periodontal Maintenance 4910, 4 BWX 2 PAX,
DDS exam, FL2, full mouth oraqix, LA #4.
 DHYG 346 Periodontology II
Extra Credit Case Study

(Give a synopsis of this patient if you were seeing him for the first time)

Mr. Molar is a male 39-year-old 3MO recall PM with occasional quad scaling as needed. He prefers
Nitrous, full-mouth Oraqix, and LA on #4 during treatment due to sensitivity and does not like the
ultrasonic scaler. His tissue is generalized firm with localized edema, moderate subgingival plaque
especially in interproximal areas and light BOP.

Patient has class II mobility on #20-21 and 28 and generalized class II furcations on all molars.

Homecare is fair, using a powered toothbrush and flossing 2-3x weekly.

Mr. Molar was diagnosed with Crohn’s Disease at age 18. He has taken Remicade for the last 12 years
under care of his MD and the disease is well-controlled. The patient is otherwise healthy with normal
vitals and very regular exercise.

AAP Description based off of x-rays: AAP IV: generalized moderate horizontal bone loss.
Class II mobility on #20-21, 28 and class II furcation on all molars.

What is Crohn’s Disease: Crohn’s is a disease in which the gastrointestinal tract is chronically
inflamed. The cause is unknown, but researchers think the environment, genetics, and an
overactive immune system may contribute. The disease requires lifelong treatment.

What type of medication is Remicade:

a. Tumor necrosis factor (TNF)-alpha inhibitor

How would Remicade and Crohn’s disease affect his periodontal condition:
b. REMICADE: can cause increased gingival inflammation. Also puts patients at
increased risk for certain bone infections, so dental surgeries should be handled
with caution.
CROHN’S DISEASE: this disease can manifest itself in the oral cavity through
many ways, including erythema, gingivitis, mucosal tags, aphthous ulcers,
edema of the lips, dry mouth, inflammation of salivary ducts, and oral
granulomatosis.
A combination of both REMICADE and CROHN’S may be contributing to
Charlie’s ongoing periodontal issues.

How might you alter your treatment of this patient? TNF inhibitors like Remicade can put a
patient at increased risk for certain bone infections. If a patient requires any sort of dental
surgery, Remicade should be stopped one month prior to surgery.

Treatment Recommendations: Fluoride prescription toothpaste to combat the dry mouth

caused by Crohn’s Disease and regular Chlorhexidine rinses to help keep harmful oral bacteria
at a minimum. Consider also alternative oral hygiene aids to clean interproximal spaces,
including a floss holder, Water-Pik, IP brush, and/or rubber tip.