2.  28 year old male
 Good health
 Recently had arthroscopic knee surgery
 Iraq war veteran
 Calculus Classification: 3b
 Takes muscle relaxants and Ibuprofen
 BP was within normal limits each appointment

3.  Last NSPT: 2008
 Generalized gingivitis
 Heavy bleeding
 Moderate plaque levels
 Missing teeth: #1, 2, 15, 16, 17, 18, 31, 32
 Malopposed teeth
 Fillings out
 Brushes 2x/day, Flosses 1x/day
 PSE: Generalized 4’s and 5’s posterior, 3’s and 4’s
Anterior

5.  Saliva test:
 Resting saliva: 6.4 pH- Moderately Acidic
 Stimulated saliva: 3.7 ml-Low volume, 7.0 pH-normal
 Frothy Bubbly Saliva
 Buffer ability: Normal

6.  Fluoridated toothpaste
 Drinks a lot of orange juice and coffee (ACIDIC!!)
 DOES NOT HAVE AN ESTABLISHED DENTAL HOME!
 Clinical Conditions:
 1 or 2 new caries lesions/restorations in last 36 months
 Visible plaque
 Unusual tooth morphology
 2 interproximal restorations
 Exposed root surface on #27 (1mm recession)
 Open margin on the gold crown on #3
 MODERATE RISK FOR CARIES!!!

7.  Susceptible tooth structure: rotated teeth and
unsound dentition
 Inadequate fluoride intake (No professional
applications)
 Poor oral hygiene: Attributed to accumulation of
marginal plaque
 Viscous saliva: reduced cleansing ability
 Thick plaque reduces buffering ability of saliva
 Muscle relaxants may cause dry mouth

8.  From 8/2011
 What’s evident:
 Open margin on mesial of #3
 Caries on distal of #4
 #6 blown out
 Possible supernumerary tooth above #9 and #10
 Calculus visible distal of #30, and mandibular anteriors

9.  Taught patient proper brushing technique since he was
completely missing the gumline
 On his final appointment, plaque levels had decreased
 Explained he’s at moderate risk for caries and that frequent
cleanings and good home care are essential
 Emphasized importance of getting unsound dentition fixed
 What I learned:
 How big of a role saliva plays in caries prevention
 Just because people “claim” to brush and floss on a regular
basis, doesn’t mean they’ll have good oral health
 Can’t always believe patients: he thought he had an implant
on #8 when it’s really just a crown with a post

10.  Sroda, Rebecca. (2010) Nutrition for a Healthy Mouth.
Baltimore, Maryland. WoltersKluwer Health/
Lippincott Williams and Wilkins
 http://www.rxlist.com/flexeril-drug/patient-images-
side-effects.htm