Identify the caries risk of VP2, Ella, and to adapt a preventative treatment plant that best suits her personal and dental needs.

CAMBRA/caries risk identification project

 

J. Franc MSDH

 

Fall 2023

 

ECD 1

 

A diagram of a risk factor  Description automatically generated

 

Purpose:

 

The objective of this project is to identify the caries risk of VP2, Ella, and to adapt a preventative treatment plant that best suits her personal and dental needs.

 

Since you have already worked on this case (VP2) and have done some EVB research you can put your research to use by placing the patient in a caries risk category and making preventative recommendations. A few changes were made to the behavioral and social sections for this project. The additions added are in blue font and highlighted in yellow.

 

Grading

 

15 points maximum passing

 

10 points failing

 

Bonus question/Extra credit: >5 points

 

Due Date

 

November 5, 2023; 11:59 pm

 

Post the document to Exam Soft .

 

Directions

 

1. Read through VP 2.

 

2. Choose caries risk category: low, moderate, high or extremely high.

 

a. Give a brief explanation for your choice in risk category no more than 85 words. Give two evidence based/peer previewed references for the risk that was chosen.

 

3. Select and make recommendations on preventative agents and behaviors that are evidence based. Please, use no more than 100 words. The agents and behaviors chosen should be for the following:

 

a. Remineralization of carious lesions that could be remineralized.

 

b. Preventative agents to prevent future caries.

 

c. Antimicrobial agents.

 

d. Behaviors that aid in the prevention of poor oral health. These are personal oral hygiene recommendations.

 

e. Give 1-2 references per agent and behaviors chosen.

 

4. Included is a bonus question, worth 5 extra points. This would be included in the Body of the paper.

 

Bonus question. This question can be done for extra credit. It requires light research into patient centered approach to communication. The question is below.

 

Patient centered communication approaches will give the best yield for patient confidence/trust in your recommendations. Which three characteristics in a patient centered communication approach would yield trust and acceptance to your recommendations?

 

Format of writing project

 

This will be a written assignment. Write it word and please turn it in as WORD document in exam soft. The assignment should include an introduction that incorporates a brief background, and the chosen Caries Risk Category. The body should include a section for recommendations given. Both the introduction and the recommendations are no more than 250 words. If you decide to answer the “bonus” question, please add it to the end of the body in paragraph form. Please use no more than 75 words. Below is an example.

 

Example

 

Introduction/Background (<85 words)

 

Ella is placed in _____ caries risk category. This is determined by [Contributing conditions/risk factors, general health conditions, clinical conditions and/ if any, protective factors?] If Ella continues with [risk behavior incurring risk or protection] she will [enter your informed/educated projection for Ella’s oral health or disease status].

 

Here is an example, of an informed projection towards oral health. If Ella continues to drink soda between meals, she will be at risk of incurring more incipient white lesions which will become carious. Or If Ella were to use an end tuft brush the inflammation and bleeding on #32 distal would improve.]

 

Body of the paper/Recommendations (<100 words)

 

Ella is ___ ____ risk, due to [clinical conditions]. The use of [remineralizing, antimicrobial,] would help remineralize/reduce bacterial count/ are protective. Personal oral hygiene behaviors would include [choose practices, techniques, and cleaning aids]. [how often, time of day…etc.].

 

Communication….[if you decide to answer, no more than 75 words].

 

Citation/ references

 

Please use NML format for citations and references. Also, for references use sources that are peer reviewed quantitative or qualitative studies.

 

Data bases for references:

 

PubMed

 

CINAHL

 

DynaMed- also helps with dosages.

 

CASE STUDY: VP 2. Ella Cam Dales

 

Medical History

 

· Patient is a 21 y/o female who describes her health as good.

 

· Patient was hospitalized for pancreas pain in the past year, and reports being prescribed with medication to control the pain at that time. She was diagnosed with pancreatitis during her hospitalization. She notes that she has a history of gall stones.

 

· Patient also has a history of tuberculosis when she was 18 years old, and reports receiving treatment for 9 months to treat this condition.

 

· Patient is not currently taking any medications, vitamins, or supplements and has no known drug allergies.

 

· Vital signs taken: BP: 132/93 RAS, P: 67.

 

· Patient does not report any recreational drug use, alcohol consumption, or tobacco use.

 

· Antibiotic prophylaxis is not indicated. Due to her history of TB (now controlled) and recent hospitalization, the patient is ASA II.

 

· A medical clearance is required to rule out TB relapse.

 

Patient Medical Considerations and Management

 

Your patient appears to have malnutrition. When asked about her diet she mentions she has been having frequent stomach aches lately and finds it difficult to eat and has lost her appetite. Pancreatitis is painful and the patient is not allowed to eat until it resolves because eating stimulates pancreatic secretion of pancreatic digestive enzymes. 

 

You know that the major contributing factors causing pancreatitis are the following:

 

· Pancreatitis is associated with binge drinking alcohol. (binge drinking)

 

· Frequent bouts with gall stones. Gall stones can block the duct, the zymogens cannot pass through the duct into the intestines.

 

The patient says she eats cucumbers, rice, low-fat strawberry flavored yogurt, herbal teas with honey, toast and jam, sweet potatoes.

 

Dental History

 

· Patient presents for screening and COE. She reports a CC: “I need a cleaning”.

 

· Her last visit was two years ago for a cleaning. Her dental anxiety is low with a 1/10 with 10 being high. The patient reports not having any negative dental experiences.

 

· The patient reports brushing 1x a day with fluoridated toothpaste, flossing 1x a day and uses Scope mouth rinse once daily. The patient reports not having any areas of food impaction.

 

· The patient also reports having sensitivity to sweets. The patient reports getting cleanings every 6 months before this two-year span. The patient’s oral health goals are to keep her mouth clean.

 

Clinical Findings

 

Hard Tissue & Soft Tissue Findings

 

· Soft tissue findings: Fordyce granules were noted on the lower lip of the buccal mucosa near the anterior region. Bilateral linea alba, bilateral varicosities on lateral tongue and bilateral mandibular tori were noted. See mandibular tori in image below: mandibular tori

 

You will learn about the clinical findings listed below in this ODTP badge in the near future.

 

· Occlusion screening reveals the following findings: Open anterior occlusion, does not lack anterior disclusion, has no fremitus/mobility, wear facets on #3, 5, 19, 21, and 28, no abfractions, and no gingival clefts. Patients CR and CO are coincident, and the freeway space is greater than 2-3mm. Mounted diagnostic casts are warranted, and alginate impressions were taken. Angle classification of Class II on the right and Class I on the left and group function as occlusion function type. Facial profile is convex with 30% overbite and 5 mm overjet. The patient does have an anterior open bite but no teeth in crossbite. An orthodontic referral is not warranted.

 

· The patient does not have any prosthodontic appliances. There are no areas of reduced alveolar ridge. Prosthodontic consultation not warranted.

 

Clinical Findings

 

· #1 Missing

 

· #2 O composite, defective, OD shadowing, B ICDAS 2

 

· #3 Composite, defective, OL ICDAS 3, B ICDAS 3/4

 

· #10 Incisal decalcification

 

· #13 O ICDAS 3

 

· #14 MO Composite Intact, OL composite Defective

 

· #15 O ICDAS 4

 

· #16, 17 Missing

 

· #18 O ICDAS 4

 

· #19 O ICDAS 4, wear facet, B ICDAS 2

 

· #20 O ICDAS 3

 

· #21 Decalcification

 

· #22 Lingual bar abutment

 

· #27 Lingual bar abutment

 

· #30 O ICDAS 4, B decalcification

 

· #31 B Amalgam intact O ICDAS 4, DL wear

 

· #32 Missing

 

Perio Chart

 

Perio Chart

 

Radiographs & Photographs

 

Radiographic Findings

 

· A panorex, 4 bite wings, and two PAs (7 and 14) were taken and reviewed.

 

· #2 pulp stone, #3 Pulp stone, #9 calcified from trauma, #10 widened PDL, #12 E2/D1 D caries, #13 D1 MD, #14 OL D1 and pulp stone, #15 pulp stone, #18 O D1, #19 O D1, and #30 M E2

 

Radiograph

 

 

 

Radiographs

 

Photos

 

Photographs

 

EBP (Demineralization)

 

During your clinical exam you notate several teeth have bands of whitish demineralization (See clinical images above). You ask her if she had orthodontic treatment and she affirms she was in orthodontic treatment for three consecutive years!

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