Please answer each case in a minimum of 1 paragraph (100 words or less) Clinical Patient Care CASE 1 You are scheduled to perform nonsurgical periodontal instrumentation on a patient with a diagnosis of localized severe plaque-induced gingivitis. At the time of the appointment, the patient informs you that she is pregnant. With this information in hand, what would be the most appropriate periodontal diagnosis? CASE 2 A patient who has been cared for by your dental team suddenly exhibits poor self-care with quite a bit of plaque biofilm accumulation. This is unusual for this patient. Discussions reveal that the patient is having difficulty with brushing and flossing due to soreness of the mouth. Examination reveals numerous small mucosal ulcers. Further discussions reveal that the patient has been experiencing this soreness since she began using tartar control toothpaste. How might your dental team manage this patient’s diminished effectiveness of self-care? CASE 3 Your patient is a 12-year-old male, who despite good oral hygiene practices, presents with generalized marginal redness and bleeding upon probing. His demonstration of toothbrushing and flossing indicates high dexterity and an ability to remove plaque biofilm. In talking with his mother, she confirms that he practices daily oral hygiene. How would you explain the presence of gingival disease to this patient and what would you recommend to improve his gingival health? CASE 4 Your patient reports a change in his medical history from last visit; he is now taking Depakote as a mood stabilizer. The drug reference manual states it is an anticonvulsant and may cause gingival enlargement. How will this new information alter your plan for dental hygiene care and patient education? Ethical Dilemma Lily E, a 17-year-old high school senior, who is a routine 6-month recall patient, is your first patient of the afternoon. She received her driver’s license 3 months ago and has driven herself to today’s appointment. You review her medical history, and she states there are “no changes and that she has no chief complaint.” As you are performing your intraoral examination, you notice that the tissue between the maxillary central incisors does not appear to be normal. You observe a mushroom-shaped gingival mass projecting from the gingival papilla. It appears red, and bleeds easily upon digital palpation. You ask Lily if it bothers her, but she denies any discomfort. She also states that she was not aware of any problem. Answer each question in a minimum of 50-100 words. You are concerned that the lesion may be a pyogenic granuloma associated with pregnancy. You would like to discuss the possible implication of this lesion with Lily, but you are not sure how to proceed. 1. What is the best way for you to handle this ethical dilemma? 2. What is the best way to address/discuss Lily’s treatment plan with her? 3. Under the ethical principle of confidentiality, can you discuss this with your employer dentist, without violating Lily’s confidentiality? 4. Do you have the right to divulge your findings and concerns to her parents? 5. Can a 17-year-old consent to treatment, or must you receive parental consent?
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