RE: New guidelines case discussions: Case 2

[Guest guest]

Provisional diagnosis: attrition plus erosion( tooth wear), minor apthous ulcersRadiograph: IOPA for Anterior teeth : to check the pulp exposure and for further management, to assess the root status in case RCT has to be performedNo radiographs for ulcersSpecial investigations: vitality tests,Study casts, diet chart, blood tests to determine iron deficiency, Serum b12 and folic acid levels, Urine test to exclude diabetes just in case,You can refer to GP for these blood and urine tests. From: doc_smriti <doc_smriti@...> Sent: Wednesday, 22 February 2012, 18:48 Subject: New guidelines case discussions: Case 2

Hi All,

Thanks a lot for participating in the last case.. Here's the outline for the next case..

25yr old Patient complains of tooth becoming short with time(6mnths) and ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy drinks and has a stressful life style. Asthmatic on steroid inhalors

As per the new guidelines some information will be provided before history taking: (so for this case)

photographs of the patient showing front teeth .

BPE score (212/211),

all teeth except third molars are present,

no visible caries.

History Taking:

Name: Ms Martha s

DOB: 12th Jan 1986

Occupation: Law Student

Address: #ab Street, London

Marital Status; Unmarried, No partner

C/o : 1. patient complains of tooth becoming short over last 6 mnths

2. Pt complains of ulcers that come and go for lat 10 yrs.

HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant region, sensitivity to hot and cold, no pain on biting, no change in colour of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic regurg.,

2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk, heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge, used bonjela

PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental treatment except scaling/polishing.

PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid inhalers – 10 yrs, no known latex/dental products allergy, no known medicine allergy, no other medication

SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

Alc- Social drinker- Red wine 4-5units/wk

Fizzy drink/citrus fruits/juice intake- high

Carbo/sugary intake- low

What would be your provisional diagnosis, which radiographic views will you ask for and why and what special investigations would you want to be done for this patient?

Hoping for your active participation..

Thanks and Regards,

[Guest guest]

forgot to mention that in special investigations we will also ask to check patients ovd

From: Aqsa Fatima Burki <aqsaburki@...>" " < > Sent: Wednesday, 22 February 2012, 20:17Subject: Re: New guidelines case discussions: Case 2

Provisional diagnosis: attrition plus erosion( tooth wear), minor apthous ulcers

Radiograph: IOPA for Anterior teeth : to check the pulp exposure and for further management, to assess the root status in case RCT has to be performed

No radiographs for ulcers

Special investigations: vitality tests,Study casts, diet chart, blood tests to determine iron deficiency, Serum b12 and folic acid levels, Urine test to exclude diabetes just in case,

You can refer to GP for these blood and urine tests.

From: doc_smriti <doc_smriti@...> Sent: Wednesday, 22 February 2012, 18:48Subject: New guidelines case discussions: Case 2

Hi All,Thanks a lot for participating in the last case.. Here's the outline for the next case.. 25yr old Patient complains of tooth becoming short with time(6mnths) and ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy drinks and has a stressful life style. Asthmatic on steroid inhalorsAs per the new guidelines some information will be provided before history taking: (so for this case)photographs of the patient showing front teeth .BPE score (212/211),all teeth except third molars are present, no visible caries.History Taking:Name: Ms Martha sDOB: 12th Jan 1986Occupation: Law StudentAddress: #ab Street, LondonMarital Status; Unmarried, No partnerC/o : 1. patient complains of tooth becoming short over last 6 mnths2. Pt complains of ulcers that come and go for lat 10 yrs.HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant

region, sensitivity to hot and cold, no pain on biting, no change in colour of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic regurg.,2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk, heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge, used bonjela PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental treatment except scaling/polishing.PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid inhalers – 10 yrs, no known latex/dental products allergy, no known medicine allergy, no other medicationSH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago), Alc- Social drinker- Red wine 4-5units/wk Fizzy

drink/citrus fruits/juice intake- highCarbo/sugary intake- lowWhat would be your provisional diagnosis, which radiographic views will you ask for and why and what special investigations would you want to be done for this patient?Hoping for your active participation.. Thanks and Regards,

[Guest guest]

Hi everyone.Treatment Plan. Emergency phase: Diet advice,to cut down on fizzy drinks and wine(patient drink more than recommended). Prescribe chlorhexidine mouthwash to avoid supra infection. Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal with sensitivity. Refer to GP,FBC (full blood count to exclude anaemia,B12 deficiency and folic acid) Take an impression and make a splint.Patient is stressed and grind hid teeth at night. Primary phase: OHI to improve oral hygiene, patient has gingivitis. S & P (scaling and polishing). Review ulcers,if ulcer do not heal for more than 2 week refer to specialist. To check OVD. If potential occlusal problem the specialist would be the right person to decide of the loss of the OVD and appearance of the teeth. Consider possible referral to specialist. Secondary phase: Work to be carried out by the specialist. Maintenance phase : Reinforce oral hygiene Reinforce stress reduction/relaxation. Review gingivitis.Best regards.Inna. From: aqsaburki@...Date: Wed, 22 Feb 2012 20:17:47 +0000Subject: Re: New guidelines case discussions: Case 2

Provisional diagnosis: attrition plus erosion( tooth wear), minor apthous ulcersRadiograph: IOPA for Anterior teeth : to check the pulp exposure and for further management, to assess the root status in case RCT has to be performedNo radiographs for ulcersSpecial investigations: vitality tests,Study casts, diet chart, blood tests to determine iron deficiency, Serum b12 and folic acid levels, Urine test to exclude diabetes just in case,You can refer to GP for these blood and urine tests. From: doc_smriti <doc_smriti@...> Sent: Wednesday, 22 February 2012, 18:48 Subject: New guidelines case discussions: Case 2

Hi All,

Thanks a lot for participating in the last case.. Here's the outline for the next case..

25yr old Patient complains of tooth becoming short with time(6mnths) and ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy drinks and has a stressful life style. Asthmatic on steroid inhalors

As per the new guidelines some information will be provided before history taking: (so for this case)

photographs of the patient showing front teeth .

BPE score (212/211),

all teeth except third molars are present,

no visible caries.

History Taking:

Name: Ms Martha s

DOB: 12th Jan 1986

Occupation: Law Student

Address: #ab Street, London

Marital Status; Unmarried, No partner

C/o : 1. patient complains of tooth becoming short over last 6 mnths

2. Pt complains of ulcers that come and go for lat 10 yrs.

HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant region, sensitivity to hot and cold, no pain on biting, no change in colour of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic regurg.,

2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk, heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge, used bonjela

PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental treatment except scaling/polishing.

PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid inhalers – 10 yrs, no known latex/dental products allergy, no known medicine allergy, no other medication

SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

Alc- Social drinker- Red wine 4-5units/wk

Fizzy drink/citrus fruits/juice intake- high

Carbo/sugary intake- low

What would be your provisional diagnosis, which radiographic views will you ask for and why and what special investigations would you want to be done for this patient?

Hoping for your active participation..

Thanks and Regards,

[Guest guest]

Also tell patient that his inhaler can also be the cause of ulcer so he should make sure he rinses his mouth after he uses inhalers,Also give patient benzydamine mouthwash along with triamcinolone gel.

From: Inna Yarovikova <innaiarovikova@...> Sent: Wednesday, 22 February 2012, 20:51Subject: RE: New guidelines case discussions: Case 2

Hi everyone.

Treatment Plan. Emergency phase: Diet advice,to cut down on fizzy drinks and wine(patient drink more than recommended).

Prescribe chlorhexidine mouthwash to avoid supra infection.

Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal with sensitivity.

Refer to GP,FBC (full blood count to exclude anaemia,B12 deficiency and folic acid)

Take an impression and make a splint.Patient is stressed and grind hid teeth at night.

Primary phase: OHI to improve oral hygiene, patient has gingivitis. S & P (scaling and polishing).

Review ulcers,if ulcer do not heal for more than 2 week refer to specialist. To check OVD. If potential occlusal problem the specialist would be the right person to decide of the loss of the OVD

and appearance of the teeth.

Consider possible referral to specialist.

Secondary phase: Work to be carried out by the specialist.

Maintenance phase : Reinforce oral hygiene

Reinforce stress reduction/relaxation.

Review gingivitis.

Best regards.

Inna.

From: aqsaburki@...Date: Wed, 22 Feb 2012 20:17:47 +0000Subject: Re: New guidelines case discussions: Case 2

Provisional diagnosis: attrition plus erosion( tooth wear), minor apthous ulcers

Radiograph: IOPA for Anterior teeth : to check the pulp exposure and for further management, to assess the root status in case RCT has to be performed

No radiographs for ulcers

Special investigations: vitality tests,Study casts, diet chart, blood tests to determine iron deficiency, Serum b12 and folic acid levels, Urine test to exclude diabetes just in case,

You can refer to GP for these blood and urine tests.

From: doc_smriti <doc_smriti@...> Sent: Wednesday, 22 February 2012, 18:48Subject: New guidelines case discussions: Case 2

Hi All,Thanks a lot for participating in the last case.. Here's the outline for the next case.. 25yr old Patient complains of tooth becoming short with time(6mnths) and ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy drinks and has a stressful life style. Asthmatic on steroid inhalorsAs per the new guidelines some information will be provided before history taking: (so for this case)photographs of the patient showing front teeth .BPE score (212/211),all teeth except third molars are present, no visible caries.History Taking:Name: Ms Martha sDOB: 12th Jan 1986Occupation: Law StudentAddress: #ab Street, LondonMarital Status; Unmarried, No partnerC/o : 1. patient complains of tooth becoming short over last 6 mnths2. Pt complains of ulcers that come and go for lat 10 yrs.HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant

region, sensitivity to hot and cold, no pain on biting, no change in colour of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic regurg.,2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk, heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge, used bonjela PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental treatment except scaling/polishing.PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid inhalers – 10 yrs, no known latex/dental products allergy, no known medicine allergy, no other medicationSH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago), Alc- Social drinker- Red wine 4-5units/wk Fizzy

drink/citrus fruits/juice intake- highCarbo/sugary intake- lowWhat would be your provisional diagnosis, which radiographic views will you ask for and why and what special investigations would you want to be done for this patient?Hoping for your active participation.. Thanks and Regards,

[Guest guest]

Hi,

That's an excellent treatment plan and advice!! Thank you so much Aqsa and

Inna..

I would just like to add here that in the secondary phase we'll have to mention

the expected treatment that the restorative specialist would carry out. Because

the new guidelines say that 'while referring the patient- give appropriate

justification(which u did) and also what the patient might expect from such a

referral (i.e the adv/disadv and risks associated)

Thanks and Regards,

Smriti

>

> Also tell patient that his inhaler can also be the cause of ulcer so he should

make sure he  rinses his mouth after he uses inhalers,Also give patient

benzydamine mouthwash along with triamcinolone gel.

>

>

> From: Inna Yarovikova <innaiarovikova@...>

>

> Sent: Wednesday, 22 February 2012, 20:51

> Subject: RE: New guidelines case discussions: Case 2

>

>

>  

> Hi everyone.

>

> Treatment Plan.  Emergency phase:   Diet advice,to cut down on fizzy drinks

and wine(patient drink more than recommended).

>                                                    

   Prescribe chlorhexidine  mouthwash to avoid supra infection.

>                                                    

   Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal with

sensitivity.

>                                                    

   Refer to GP,FBC (full blood count to exclude anaemia,B12 deficiency and

folic acid)

>                                                    

   Take an impression and make a splint.Patient is stressed and grind hid

teeth at night.  

>

>                          Primary phase:   OHI to improve oral

hygiene, patient has gingivitis. S & P (scaling and polishing).

>                                                  

Review ulcers,if ulcer do not heal for more than 2 week refer to specialist.

>                                                   To

check OVD. If potential occlusal problem the specialist would be the right

person to decide of the loss of the OVD 

>                                                   and

appearance of the teeth.

>                                                  

Consider possible referral to specialist.

>

>                        Secondary phase: Work to be carried out by

the specialist.

>                       

>                        Maintenance phase : Reinforce oral hygiene

>                                                    

  Reinforce stress reduction/relaxation.

>                                                    

  Review gingivitis.

>

> Best regards.

> Inna.

>

>

>

> From: aqsaburki@...

> Date: Wed, 22 Feb 2012 20:17:47 +0000

> Subject: Re: New guidelines case discussions: Case 2

>

>  

>

>

> Provisional diagnosis: attrition plus erosion( tooth wear), minor apthous

ulcers

>

>

> Radiograph: IOPA for Anterior teeth : to check the pulp exposure and for

further management, to assess the root status in case RCT has to be performed

>

> No radiographs for ulcers

>

> Special investigations: vitality tests,Study casts, diet chart, blood tests to

determine iron deficiency, Serum b12 and folic acid levels, Urine test to

exclude diabetes just in case,

>

>

> You can  refer to GP for these blood and urine tests.

> From: doc_smriti <doc_smriti@...>

>

> Sent: Wednesday, 22 February 2012, 18:48

> Subject: New guidelines case discussions: Case 2

>

>

>  

> Hi All,

>

> Thanks a lot for participating in the last case.. Here's the outline for the

next case..

> 25yr old Patient complains of tooth becoming short with time(6mnths) and

ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy

drinks and has a stressful life style. Asthmatic on steroid inhalors

>

> As per the new guidelines some information will be provided before history

taking: (so for this case)

> photographs of the patient showing front teeth .

> BPE score (212/211),

> all teeth except third molars are present,

> no visible caries.

>

> History Taking:

> Name: Ms Martha s

> DOB: 12th Jan 1986

> Occupation: Law Student

> Address: #ab Street, London

> Marital Status; Unmarried, No partner

>

> C/o : 1. patient complains of tooth becoming short over last 6 mnths

> 2. Pt complains of ulcers that come and go for lat 10 yrs.

>

> HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant region,

sensitivity to hot and cold, no pain on biting, no change in colour of teeth, no

recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle - stressful, h/o

high intake of fizzy drinks, no h/o eating disorder/acidic regurg.,

>

> 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk, heal

sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o recurrent

ulcers +nt, no boil before ulcer, no h/o trauma/accidental biting, not +nt

anywhere else mouth or otherwise, no bleeding/discharge, used bonjela

>

> PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental treatment

except scaling/polishing.

>

> PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid

inhalers †" 10 yrs, no known latex/dental products allergy, no known medicine

allergy, no other medication

>

> SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> Alc- Social drinker- Red wine 4-5units/wk

> Fizzy drink/citrus fruits/juice intake- high

> Carbo/sugary intake- low

>

> What would be your provisional diagnosis, which radiographic views will you

ask for and why and what special investigations would you want to be done for

this patient?

>

> Hoping for your active participation..

> Thanks and Regards,

>

[Guest guest]

Hi everyoneI have a doubt thhat can we give a splint before erosion is stabilised? because i read somewhere that if regurgitation is the cause of erosion and you give aspint to prevent attrition without stabilising the former , it leads to furthur erosion beacuse acid from regurgitation is trapped. But i am not sure about erosion from fizzy drinks and red wine. do we need to wait for that as well. your opinion will be much appreciated. thanks in advance.

regardsjasmineOn Thu, Feb 23, 2012 at 8:38 AM, doc_smriti <doc_smriti@...> wrote:

 

Hi,

That's an excellent treatment plan and advice!! Thank you so much Aqsa and Inna..

I would just like to add here that in the secondary phase we'll have to mention the expected treatment that the restorative specialist would carry out. Because the new guidelines say that 'while referring the patient- give appropriate justification(which u did) and also what the patient might expect from such a referral (i.e the adv/disadv and risks associated)

Thanks and Regards,

Smriti

>

> Also tell patient that his inhaler can also be the cause of ulcer so he should make sure he  rinses his mouth after he uses inhalers,Also give patient benzydamine mouthwash along with triamcinolone gel.

>

>

> From: Inna Yarovikova <innaiarovikova@...>

>

> Sent: Wednesday, 22 February 2012, 20:51

> Subject: RE: New guidelines case discussions: Case 2

>

>

>  

> Hi everyone.

>

> Treatment Plan.  Emergency phase:   Diet advice,to cut down on fizzy drinks and wine(patient drink more than recommended).

>                                                        Prescribe chlorhexidine  mouthwash to avoid supra infection.

>                                                        Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal with sensitivity.

>                                                        Refer to GP,FBC (full blood count to exclude anaemia,B12 deficiency and folic acid)

>                                                        Take an impression and make a splint.Patient is stressed and grind hid teeth at night.  

>

>                          Primary phase:   OHI to improve oral hygiene, patient has gingivitis. S & P (scaling and polishing).

>                                                   Review ulcers,if ulcer do not heal for more than 2 week refer to specialist.

>                                                   To check OVD. If potential occlusal problem the specialist would be the right person to decide of the loss of the OVD 

>                                                   and appearance of the teeth.

>                                                   Consider possible referral to specialist.

>

>                        Secondary phase: Work to be carried out by the specialist.

>                       

>                        Maintenance phase : Reinforce oral hygiene

>                                                       Reinforce stress reduction/relaxation.

>                                                       Review gingivitis.

>

> Best regards.

> Inna.

>

>

>

> From: aqsaburki@...

> Date: Wed, 22 Feb 2012 20:17:47 +0000

> Subject: Re: New guidelines case discussions: Case 2

>

>  

>

>

> Provisional diagnosis: attrition plus erosion( tooth wear), minor apthous ulcers

>

>

> Radiograph: IOPA for Anterior teeth : to check the pulp exposure and for further management, to assess the root status in case RCT has to be performed

>

> No radiographs for ulcers

>

> Special investigations: vitality tests,Study casts, diet chart, blood tests to determine iron deficiency, Serum b12 and folic acid levels, Urine test to exclude diabetes just in case,

>

>

> You can  refer to GP for these blood and urine tests.

> From: doc_smriti <doc_smriti@...>

>

> Sent: Wednesday, 22 February 2012, 18:48

> Subject: New guidelines case discussions: Case 2

>

>

>  

> Hi All,

>

> Thanks a lot for participating in the last case.. Here's the outline for the next case..

> 25yr old Patient complains of tooth becoming short with time(6mnths) and ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy drinks and has a stressful life style. Asthmatic on steroid inhalors

>

> As per the new guidelines some information will be provided before history taking: (so for this case)

> photographs of the patient showing front teeth .

> BPE score (212/211),

> all teeth except third molars are present,

> no visible caries.

>

> History Taking:

> Name: Ms Martha s

> DOB: 12th Jan 1986

> Occupation: Law Student

> Address: #ab Street, London

> Marital Status; Unmarried, No partner

>

> C/o : 1. patient complains of tooth becoming short over last 6 mnths

> 2. Pt complains of ulcers that come and go for lat 10 yrs.

>

> HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant region, sensitivity to hot and cold, no pain on biting, no change in colour of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic regurg.,

>

> 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk, heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge, used bonjela

>

> PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental treatment except scaling/polishing.

>

> PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid inhalers †" 10 yrs, no known latex/dental products allergy, no known medicine allergy, no other medication

>

> SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> Alc- Social drinker- Red wine 4-5units/wk

> Fizzy drink/citrus fruits/juice intake- high

> Carbo/sugary intake- low

>

> What would be your provisional diagnosis, which radiographic views will you ask for and why and what special investigations would you want to be done for this patient?

>

> Hoping for your active participation..

> Thanks and Regards,

>

[Guest guest]

Hi

It has been given in the guidance that we have to finally write the preferred treatment options for the best. So can anybody plz tell how we give the preferred treatment as it is the patient who chooses which treatment option to go with n we are not suppopsed to say this option is best for u..any suggestions plz!!!

Narjan

Sent from on Android

From:

jasmine chopra <contactjasmine288@...>;

To:

< >;

Subject:

Re: New guidelines case discussions: Case 2

Sent:

Thu, Feb 23, 2012 9:42:42 PM

Hi everyoneI have a doubt thhat can we give a splint before erosion is stabilised? because i read somewhere that if regurgitation is the cause of erosion and you give aspint to prevent attrition without stabilising the former , it leads to furthur erosion beacuse acid from regurgitation is trapped. But i am not sure about erosion from fizzy drinks and red wine. do we need to wait for that as well. your opinion will be much appreciated. thanks in advance.

regardsjasmineOn Thu, Feb 23, 2012 at 8:38 AM, doc_smriti <doc_smriti@...> wrote:

 

Hi,

That's an excellent treatment plan and advice!! Thank you so much Aqsa and Inna..

I would just like to add here that in the secondary phase we'll have to mention the expected treatment that the restorative specialist would carry out. Because the new guidelines say that 'while referring the patient- give appropriate justification(which u did) and also what the patient might expect from such a referral (i.e the adv/disadv and risks associated)

Thanks and Regards,

Smriti

>

> Also tell patient that his inhaler can also be the cause of ulcer so he should make sure he  rinses his mouth after he uses inhalers,Also give patient benzydamine mouthwash along with triamcinolone gel.

>

>

> From: Inna Yarovikova <innaiarovikova@...>

>

> Sent: Wednesday, 22 February 2012, 20:51

> Subject: RE: New guidelines case discussions: Case 2

>

>

>  

> Hi everyone.

>

> Treatment Plan.  Emergency phase:   Diet advice,to cut down on fizzy drinks and wine(patient drink more than recommended).

>                                                        Prescribe chlorhexidine  mouthwash to avoid supra infection.

>                                                        Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal with sensitivity.

>                                                        Refer to GP,FBC (full blood count to exclude anaemia,B12 deficiency and folic acid)

>                                                        Take an impression and make a splint.Patient is stressed and grind hid teeth at night.  

>

>                          Primary phase:   OHI to improve oral hygiene, patient has gingivitis. S & P (scaling and polishing).

>                                                   Review ulcers,if ulcer do not heal for more than 2 week refer to specialist.

>                                                   To check OVD. If potential occlusal problem the specialist would be the right person to decide of the loss of the OVD 

>                                                   and appearance of the teeth.

>                                                   Consider possible referral to specialist.

>

>                        Secondary phase: Work to be carried out by the specialist.

>                       

>                        Maintenance phase : Reinforce oral hygiene

>                                                       Reinforce stress reduction/relaxation.

>                                                       Review gingivitis.

>

> Best regards.

> Inna.

>

>

>

> From: aqsaburki@...

> Date: Wed, 22 Feb 2012 20:17:47 +0000

> Subject: Re: New guidelines case discussions: Case 2

>

>  

>

>

> Provisional diagnosis: attrition plus erosion( tooth wear), minor apthous ulcers

>

>

> Radiograph: IOPA for Anterior teeth : to check the pulp exposure and for further management, to assess the root status in case RCT has to be performed

>

> No radiographs for ulcers

>

> Special investigations: vitality tests,Study casts, diet chart, blood tests to determine iron deficiency, Serum b12 and folic acid levels, Urine test to exclude diabetes just in case,

>

>

> You can  refer to GP for these blood and urine tests.

> From: doc_smriti <doc_smriti@...>

>

> Sent: Wednesday, 22 February 2012, 18:48

> Subject: New guidelines case discussions: Case 2

>

>

>  

> Hi All,

>

> Thanks a lot for participating in the last case.. Here's the outline for the next case..

> 25yr old Patient complains of tooth becoming short with time(6mnths) and ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy drinks and has a stressful life style. Asthmatic on steroid inhalors

>

> As per the new guidelines some information will be provided before history taking: (so for this case)

> photographs of the patient showing front teeth .

> BPE score (212/211),

> all teeth except third molars are present,

> no visible caries.

>

> History Taking:

> Name: Ms Martha s

> DOB: 12th Jan 1986

> Occupation: Law Student

> Address: #ab Street, London

> Marital Status; Unmarried, No partner

>

> C/o : 1. patient complains of tooth becoming short over last 6 mnths

> 2. Pt complains of ulcers that come and go for lat 10 yrs.

>

> HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant region, sensitivity to hot and cold, no pain on biting, no change in colour of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic regurg.,

>

> 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk, heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge, used bonjela

>

> PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental treatment except scaling/polishing.

>

> PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid inhalers †" 10 yrs, no known latex/dental products allergy, no known medicine allergy, no other medication

>

> SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> Alc- Social drinker- Red wine 4-5units/wk

> Fizzy drink/citrus fruits/juice intake- high

> Carbo/sugary intake- low

>

> What would be your provisional diagnosis, which radiographic views will you ask for and why and what special investigations would you want to be done for this patient?

>

> Hoping for your active participation..

> Thanks and Regards,

>

[Guest guest]

HHi jasmine, u r right before mouth guard, erosion should be controlled whether

cause from stomach or drinks. we must give pt diet chart, white wine & cider

cause erosion.

Yours

Ammar

> > >

> > > Also tell patient that his inhaler can also be the cause of ulcer so he

> > should make sure he rinses his mouth after he uses inhalers,Also give

> > patient benzydamine mouthwash along with triamcinolone gel.

> > >

> > >

> > > From: Inna Yarovikova <innaiarovikova@>

> >

> > >

> > > Sent: Wednesday, 22 February 2012, 20:51

> > > Subject: RE: New guidelines case discussions: Case 2

> > >

> > >

> > > Â

> > > Hi everyone.

> > >

> > > Treatment Plan. Â Emergency phase: Â Diet advice,to cut down on fizzy

> > drinks and wine(patient drink more than recommended).

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> >     Prescribe chlorhexidine  mouthwash to avoid supra infection.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Â Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal

> > with sensitivity.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Â Refer to GP,FBC (full blood count to exclude anaemia,B12

> > deficiency and folic acid)

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Â Take an impression and make a splint.Patient is stressed and

> > grind hid teeth at night. Â

> > >

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Primary phase: Â OHI to improve

> > oral hygiene, patient has gingivitis. S & P (scaling and polishing).

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Review ulcers,if ulcer do not heal for more than 2 week refer to

> > specialist.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â To check OVD. If potential occlusal problem the specialist would be the

> > right person to decide of the loss of the OVDÂ

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â and appearance of the teeth.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Consider possible referral to specialist.

> > >

> > > Â Â Â Â Â Â Â Â Â Â Â Â Secondary phase: Work to be carried

> > out by the specialist.

> > > Â Â Â Â Â Â Â Â Â Â Â Â

> > > Â Â Â Â Â Â Â Â Â Â Â Â Maintenance phase : Reinforce oral

> > hygiene

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Reinforce stress reduction/relaxation.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Review gingivitis.

> >

> > >

> > > Best regards.

> > > Inna.

> > >

> > >

> > >

> > > From: aqsaburki@

> >

> > > Date: Wed, 22 Feb 2012 20:17:47 +0000

> > > Subject: Re: New guidelines case discussions: Case 2

> > >

> > > Â

> > >

> > >

> > > Provisional diagnosis: attrition plus erosion( tooth wear), minor

> > apthous ulcers

> > >

> > >

> > > Radiograph: IOPA for Anterior teeth : to check the pulp exposure and for

> > further management, to assess the root status in case RCT has to be

> > performed

> > >

> > > No radiographs for ulcers

> > >

> > > Special investigations: vitality tests,Study casts, diet chart, blood

> > tests to determine iron deficiency, Serum b12 and folic acid levels, Urine

> > test to exclude diabetes just in case,

> > >

> > >

> > > You can  refer to GP for these blood and urine tests.

> > > From: doc_smriti <doc_smriti@>

> >

> > >

> > > Sent: Wednesday, 22 February 2012, 18:48

> > > Subject: New guidelines case discussions: Case 2

> > >

> > >

> > > Â

> > > Hi All,

> > >

> > > Thanks a lot for participating in the last case.. Here's the outline for

> > the next case..

> > > 25yr old Patient complains of tooth becoming short with time(6mnths) and

> > ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy

> > drinks and has a stressful life style. Asthmatic on steroid inhalors

> > >

> > > As per the new guidelines some information will be provided before

> > history taking: (so for this case)

> > > photographs of the patient showing front teeth .

> > > BPE score (212/211),

> > > all teeth except third molars are present,

> > > no visible caries.

> > >

> > > History Taking:

> > > Name: Ms Martha s

> > > DOB: 12th Jan 1986

> > > Occupation: Law Student

> > > Address: #ab Street, London

> > > Marital Status; Unmarried, No partner

> > >

> > > C/o : 1. patient complains of tooth becoming short over last 6 mnths

> > > 2. Pt complains of ulcers that come and go for lat 10 yrs.

> > >

> > > HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant

> > region, sensitivity to hot and cold, no pain on biting, no change in colour

> > of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle

> > - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic

> > regurg.,

> > >

> > > 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk,

> > heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o

> > recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental

> > biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge,

> > used bonjela

> > >

> > > PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental

> > treatment except scaling/polishing.

> > >

> > > PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid

> > inhalers †" 10 yrs, no known latex/dental products allergy, no known

> > medicine allergy, no other medication

> >

> > >

> > > SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> > > Alc- Social drinker- Red wine 4-5units/wk

> > > Fizzy drink/citrus fruits/juice intake- high

> > > Carbo/sugary intake- low

> > >

> > > What would be your provisional diagnosis, which radiographic views will

> > you ask for and why and what special investigations would you want to be

> > done for this patient?

> > >

> > > Hoping for your active participation..

> > > Thanks and Regards,

> > >

> >

> >

> >

>

[Guest guest]

Hi AmmarThanks a lot for your clearification. I really appreciate it.RegardsJasmine.On Thu, Feb 23, 2012 at 10:24 PM, ammar k <ammarkiliddar@...> wrote:

 

HHi jasmine, u r right before mouth guard, erosion should be controlled whether cause from stomach or drinks. we must give pt diet chart, white wine & cider cause erosion.

Yours

Ammar

> > >

> > > Also tell patient that his inhaler can also be the cause of ulcer so he

> > should make sure he rinses his mouth after he uses inhalers,Also give

> > patient benzydamine mouthwash along with triamcinolone gel.

> > >

> > >

> > > From: Inna Yarovikova <innaiarovikova@>

> >

> > >

> > > Sent: Wednesday, 22 February 2012, 20:51

> > > Subject: RE: New guidelines case discussions: Case 2

> > >

> > >

> > > Â

> > > Hi everyone.

> > >

> > > Treatment Plan. Â Emergency phase: Â Diet advice,to cut down on fizzy

> > drinks and wine(patient drink more than recommended).

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> >     Prescribe chlorhexidine  mouthwash to avoid supra infection.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Â Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal

> > with sensitivity.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Â Refer to GP,FBC (full blood count to exclude anaemia,B12

> > deficiency and folic acid)

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Â Take an impression and make a splint.Patient is stressed and

> > grind hid teeth at night. Â

> > >

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Primary phase: Â OHI to improve

> > oral hygiene, patient has gingivitis. S & P (scaling and polishing).

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Review ulcers,if ulcer do not heal for more than 2 week refer to

> > specialist.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â To check OVD. If potential occlusal problem the specialist would be the

> > right person to decide of the loss of the OVDÂ

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â and appearance of the teeth.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Consider possible referral to specialist.

> > >

> > > Â Â Â Â Â Â Â Â Â Â Â Â Secondary phase: Work to be carried

> > out by the specialist.

> > > Â Â Â Â Â Â Â Â Â Â Â Â

> > > Â Â Â Â Â Â Â Â Â Â Â Â Maintenance phase : Reinforce oral

> > hygiene

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Reinforce stress reduction/relaxation.

> > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > Â Â Â Review gingivitis.

> >

> > >

> > > Best regards.

> > > Inna.

> > >

> > >

> > >

> > > From: aqsaburki@

> >

> > > Date: Wed, 22 Feb 2012 20:17:47 +0000

> > > Subject: Re: New guidelines case discussions: Case 2

> > >

> > > Â

> > >

> > >

> > > Provisional diagnosis: attrition plus erosion( tooth wear), minor

> > apthous ulcers

> > >

> > >

> > > Radiograph: IOPA for Anterior teeth : to check the pulp exposure and for

> > further management, to assess the root status in case RCT has to be

> > performed

> > >

> > > No radiographs for ulcers

> > >

> > > Special investigations: vitality tests,Study casts, diet chart, blood

> > tests to determine iron deficiency, Serum b12 and folic acid levels, Urine

> > test to exclude diabetes just in case,

> > >

> > >

> > > You can  refer to GP for these blood and urine tests.

> > > From: doc_smriti <doc_smriti@>

> >

> > >

> > > Sent: Wednesday, 22 February 2012, 18:48

> > > Subject: New guidelines case discussions: Case 2

> > >

> > >

> > > Â

> > > Hi All,

> > >

> > > Thanks a lot for participating in the last case.. Here's the outline for

> > the next case..

> > > 25yr old Patient complains of tooth becoming short with time(6mnths) and

> > ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of fizzy

> > drinks and has a stressful life style. Asthmatic on steroid inhalors

> > >

> > > As per the new guidelines some information will be provided before

> > history taking: (so for this case)

> > > photographs of the patient showing front teeth .

> > > BPE score (212/211),

> > > all teeth except third molars are present,

> > > no visible caries.

> > >

> > > History Taking:

> > > Name: Ms Martha s

> > > DOB: 12th Jan 1986

> > > Occupation: Law Student

> > > Address: #ab Street, London

> > > Marital Status; Unmarried, No partner

> > >

> > > C/o : 1. patient complains of tooth becoming short over last 6 mnths

> > > 2. Pt complains of ulcers that come and go for lat 10 yrs.

> > >

> > > HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant

> > region, sensitivity to hot and cold, no pain on biting, no change in colour

> > of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism, Lifestyle

> > - stressful, h/o high intake of fizzy drinks, no h/o eating disorder/acidic

> > regurg.,

> > >

> > > 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for 1wk,

> > heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o

> > recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental

> > biting, not +nt anywhere else mouth or otherwise, no bleeding/discharge,

> > used bonjela

> > >

> > > PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental

> > treatment except scaling/polishing.

> > >

> > > PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking steroid

> > inhalers †" 10 yrs, no known latex/dental products allergy, no known

> > medicine allergy, no other medication

> >

> > >

> > > SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> > > Alc- Social drinker- Red wine 4-5units/wk

> > > Fizzy drink/citrus fruits/juice intake- high

> > > Carbo/sugary intake- low

> > >

> > > What would be your provisional diagnosis, which radiographic views will

> > you ask for and why and what special investigations would you want to be

> > done for this patient?

> > >

> > > Hoping for your active participation..

> > > Thanks and Regards,

> > >

> >

> >

> >

>

[Guest guest]

Hi,

Can you please tell us the source where it says that you have to stabilise

erosion caused by drinks before giving splints? The reason for doing so in

regurg. cases is to prevent acid from trapping in at night- when the splint is

worn, but i think that wouldn't happen with external erosion. Please correct me

if I am wrong.

Thanks..

Regards,

Smriti

> > > > >

> > > > > Also tell patient that his inhaler can also be the cause of ulcer so

> > he

> > > > should make sure he rinses his mouth after he uses inhalers,Also give

> > > > patient benzydamine mouthwash along with triamcinolone gel.

> > > > >

> > > > >

> > > > > From: Inna Yarovikova <innaiarovikova@>

> > > >

> > > > >

> > > > > Sent: Wednesday, 22 February 2012, 20:51

> > > > > Subject: RE: New guidelines case discussions: Case 2

> > > > >

> > > > >

> > > > > Â

> > > > > Hi everyone.

> > > > >

> > > > > Treatment Plan. Â Emergency phase: Â Diet advice,to cut down on fizzy

> > > > drinks and wine(patient drink more than recommended).

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > >     Prescribe chlorhexidine  mouthwash to avoid supra infection.

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â Â Â Â Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal

> > > > with sensitivity.

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â Â Â Â Refer to GP,FBC (full blood count to exclude anaemia,B12

> > > > deficiency and folic acid)

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â Â Â Â Take an impression and make a splint.Patient is stressed and

> > > > grind hid teeth at night. Â

> > > > >

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Primary phase: Â OHI to improve

> > > > oral hygiene, patient has gingivitis. S & P (scaling and polishing).

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â Review ulcers,if ulcer do not heal for more than 2 week refer to

> > > > specialist.

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â To check OVD. If potential occlusal problem the specialist would be

> > the

> > > > right person to decide of the loss of the OVDÂ

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â and appearance of the teeth.

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â Consider possible referral to specialist.

> > > > >

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Secondary phase: Work to be carried

> > > > out by the specialist.

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Maintenance phase : Reinforce oral

> > > > hygiene

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â Â Â Reinforce stress reduction/relaxation.

> > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > Â Â Â Review gingivitis.

> > > >

> > > > >

> > > > > Best regards.

> > > > > Inna.

> > > > >

> > > > >

> > > > >

> > > > > From: aqsaburki@

> > > >

> > > > > Date: Wed, 22 Feb 2012 20:17:47 +0000

> > > > > Subject: Re: New guidelines case discussions: Case 2

> > > > >

> > > > > Â

> > > > >

> > > > >

> > > > > Provisional diagnosis: attrition plus erosion( tooth wear), minor

> > > > apthous ulcers

> > > > >

> > > > >

> > > > > Radiograph: IOPA for Anterior teeth : to check the pulp exposure and

> > for

> > > > further management, to assess the root status in case RCT has to be

> > > > performed

> > > > >

> > > > > No radiographs for ulcers

> > > > >

> > > > > Special investigations: vitality tests,Study casts, diet chart, blood

> > > > tests to determine iron deficiency, Serum b12 and folic acid levels,

> > Urine

> > > > test to exclude diabetes just in case,

> > > > >

> > > > >

> > > > > You can  refer to GP for these blood and urine tests.

> > > > > From: doc_smriti <doc_smriti@>

> > > >

> > > > >

> > > > > Sent: Wednesday, 22 February 2012, 18:48

> > > > > Subject: New guidelines case discussions: Case 2

> > > > >

> > > > >

> > > > > Â

> > > > > Hi All,

> > > > >

> > > > > Thanks a lot for participating in the last case.. Here's the outline

> > for

> > > > the next case..

> > > > > 25yr old Patient complains of tooth becoming short with time(6mnths)

> > and

> > > > ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of

> > fizzy

> > > > drinks and has a stressful life style. Asthmatic on steroid inhalors

> > > > >

> > > > > As per the new guidelines some information will be provided before

> > > > history taking: (so for this case)

> > > > > photographs of the patient showing front teeth .

> > > > > BPE score (212/211),

> > > > > all teeth except third molars are present,

> > > > > no visible caries.

> > > > >

> > > > > History Taking:

> > > > > Name: Ms Martha s

> > > > > DOB: 12th Jan 1986

> > > > > Occupation: Law Student

> > > > > Address: #ab Street, London

> > > > > Marital Status; Unmarried, No partner

> > > > >

> > > > > C/o : 1. patient complains of tooth becoming short over last 6 mnths

> > > > > 2. Pt complains of ulcers that come and go for lat 10 yrs.

> > > > >

> > > > > HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant

> > > > region, sensitivity to hot and cold, no pain on biting, no change in

> > colour

> > > > of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism,

> > Lifestyle

> > > > - stressful, h/o high intake of fizzy drinks, no h/o eating

> > disorder/acidic

> > > > regurg.,

> > > > >

> > > > > 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for

> > 1wk,

> > > > heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o

> > > > recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental

> > > > biting, not +nt anywhere else mouth or otherwise, no

> > bleeding/discharge,

> > > > used bonjela

> > > > >

> > > > > PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental

> > > > treatment except scaling/polishing.

> > > > >

> > > > > PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking

> > steroid

> > > > inhalers †" 10 yrs, no known latex/dental products allergy, no known

> > > > medicine allergy, no other medication

> > > >

> > > > >

> > > > > SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> > > > > Alc- Social drinker- Red wine 4-5units/wk

> > > > > Fizzy drink/citrus fruits/juice intake- high

> > > > > Carbo/sugary intake- low

> > > > >

> > > > > What would be your provisional diagnosis, which radiographic views

> > will

> > > > you ask for and why and what special investigations would you want to

> > be

> > > > done for this patient?

> > > > >

> > > > > Hoping for your active participation..

> > > > > Thanks and Regards,

> > > > >

> > > >

> > > >

> > > >

> > >

> >

> >

> >

>

[Guest guest]

hhii, its from one of the rcs cases Mr Barry White.

> > > > > >

> > > > > > Also tell patient that his inhaler can also be the cause of ulcer so

> > > he

> > > > > should make sure he rinses his mouth after he uses inhalers,Also give

> > > > > patient benzydamine mouthwash along with triamcinolone gel.

> > > > > >

> > > > > >

> > > > > > From: Inna Yarovikova <innaiarovikova@>

> > > > >

> > > > > >

> > > > > > Sent: Wednesday, 22 February 2012, 20:51

> > > > > > Subject: RE: New guidelines case discussions: Case 2

> > > > > >

> > > > > >

> > > > > > Â

> > > > > > Hi everyone.

> > > > > >

> > > > > > Treatment Plan. Â Emergency phase: Â Diet advice,to cut down on

fizzy

> > > > > drinks and wine(patient drink more than recommended).

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > >     Prescribe chlorhexidine  mouthwash to avoid supra infection.

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Â Â Â Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal

> > > > > with sensitivity.

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Â Â Â Refer to GP,FBC (full blood count to exclude anaemia,B12

> > > > > deficiency and folic acid)

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Â Â Â Take an impression and make a splint.Patient is stressed and

> > > > > grind hid teeth at night. Â

> > > > > >

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Primary phase: Â OHI to improve

> > > > > oral hygiene, patient has gingivitis. S & P (scaling and polishing).

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Review ulcers,if ulcer do not heal for more than 2 week refer to

> > > > > specialist.

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â To check OVD. If potential occlusal problem the specialist would be

> > > the

> > > > > right person to decide of the loss of the OVDÂ

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â and appearance of the teeth.

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Consider possible referral to specialist.

> > > > > >

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Secondary phase: Work to be carried

> > > > > out by the specialist.

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Maintenance phase : Reinforce oral

> > > > > hygiene

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Â Â Reinforce stress reduction/relaxation.

> > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > Â Â Â Review gingivitis.

> > > > >

> > > > > >

> > > > > > Best regards.

> > > > > > Inna.

> > > > > >

> > > > > >

> > > > > >

> > > > > > From: aqsaburki@

> > > > >

> > > > > > Date: Wed, 22 Feb 2012 20:17:47 +0000

> > > > > > Subject: Re: New guidelines case discussions: Case 2

> > > > > >

> > > > > > Â

> > > > > >

> > > > > >

> > > > > > Provisional diagnosis: attrition plus erosion( tooth wear), minor

> > > > > apthous ulcers

> > > > > >

> > > > > >

> > > > > > Radiograph: IOPA for Anterior teeth : to check the pulp exposure and

> > > for

> > > > > further management, to assess the root status in case RCT has to be

> > > > > performed

> > > > > >

> > > > > > No radiographs for ulcers

> > > > > >

> > > > > > Special investigations: vitality tests,Study casts, diet chart,

blood

> > > > > tests to determine iron deficiency, Serum b12 and folic acid levels,

> > > Urine

> > > > > test to exclude diabetes just in case,

> > > > > >

> > > > > >

> > > > > > You can  refer to GP for these blood and urine tests.

> > > > > > From: doc_smriti <doc_smriti@>

> > > > >

> > > > > >

> > > > > > Sent: Wednesday, 22 February 2012, 18:48

> > > > > > Subject: New guidelines case discussions: Case 2

> > > > > >

> > > > > >

> > > > > > Â

> > > > > > Hi All,

> > > > > >

> > > > > > Thanks a lot for participating in the last case.. Here's the outline

> > > for

> > > > > the next case..

> > > > > > 25yr old Patient complains of tooth becoming short with time(6mnths)

> > > and

> > > > > ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of

> > > fizzy

> > > > > drinks and has a stressful life style. Asthmatic on steroid inhalors

> > > > > >

> > > > > > As per the new guidelines some information will be provided before

> > > > > history taking: (so for this case)

> > > > > > photographs of the patient showing front teeth .

> > > > > > BPE score (212/211),

> > > > > > all teeth except third molars are present,

> > > > > > no visible caries.

> > > > > >

> > > > > > History Taking:

> > > > > > Name: Ms Martha s

> > > > > > DOB: 12th Jan 1986

> > > > > > Occupation: Law Student

> > > > > > Address: #ab Street, London

> > > > > > Marital Status; Unmarried, No partner

> > > > > >

> > > > > > C/o : 1. patient complains of tooth becoming short over last 6 mnths

> > > > > > 2. Pt complains of ulcers that come and go for lat 10 yrs.

> > > > > >

> > > > > > HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant

> > > > > region, sensitivity to hot and cold, no pain on biting, no change in

> > > colour

> > > > > of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism,

> > > Lifestyle

> > > > > - stressful, h/o high intake of fizzy drinks, no h/o eating

> > > disorder/acidic

> > > > > regurg.,

> > > > > >

> > > > > > 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for

> > > 1wk,

> > > > > heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o

> > > > > recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental

> > > > > biting, not +nt anywhere else mouth or otherwise, no

> > > bleeding/discharge,

> > > > > used bonjela

> > > > > >

> > > > > > PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental

> > > > > treatment except scaling/polishing.

> > > > > >

> > > > > > PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking

> > > steroid

> > > > > inhalers †" 10 yrs, no known latex/dental products allergy, no known

> > > > > medicine allergy, no other medication

> > > > >

> > > > > >

> > > > > > SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> > > > > > Alc- Social drinker- Red wine 4-5units/wk

> > > > > > Fizzy drink/citrus fruits/juice intake- high

> > > > > > Carbo/sugary intake- low

> > > > > >

> > > > > > What would be your provisional diagnosis, which radiographic views

> > > will

> > > > > you ask for and why and what special investigations would you want to

> > > be

> > > > > done for this patient?

> > > > > >

> > > > > > Hoping for your active participation..

> > > > > > Thanks and Regards,

> > > > > >

> > > > >

> > > > >

> > > > >

> > > >

> > >

> > >

> > >

> >

>

[Guest guest]

Hi Ammar,

Thanks for the info.. But Mr Barry White has Gastro-oesophageal reflux too

apart from the diet and occupational factors. My question is, if a person has

only extrinsic erosion, should we wait to give the splint?

Regards,

Smriti

> > > > > > >

> > > > > > > Also tell patient that his inhaler can also be the cause of ulcer

so

> > > > he

> > > > > > should make sure he rinses his mouth after he uses inhalers,Also

give

> > > > > > patient benzydamine mouthwash along with triamcinolone gel.

> > > > > > >

> > > > > > >

> > > > > > > From: Inna Yarovikova <innaiarovikova@>

> > > > > >

> > > > > > >

> > > > > > > Sent: Wednesday, 22 February 2012, 20:51

> > > > > > > Subject: RE: New guidelines case discussions: Case 2

> > > > > > >

> > > > > > >

> > > > > > > Â

> > > > > > > Hi everyone.

> > > > > > >

> > > > > > > Treatment Plan. Â Emergency phase: Â Diet advice,to cut down on

fizzy

> > > > > > drinks and wine(patient drink more than recommended).

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > >     Prescribe chlorhexidine  mouthwash to avoid supra

infection.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Â Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal

> > > > > > with sensitivity.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Â Refer to GP,FBC (full blood count to exclude anaemia,B12

> > > > > > deficiency and folic acid)

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Â Take an impression and make a splint.Patient is stressed and

> > > > > > grind hid teeth at night. Â

> > > > > > >

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Primary phase: Â OHI to improve

> > > > > > oral hygiene, patient has gingivitis. S & P (scaling and polishing).

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Review ulcers,if ulcer do not heal for more than 2 week refer to

> > > > > > specialist.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â To check OVD. If potential occlusal problem the specialist would

be

> > > > the

> > > > > > right person to decide of the loss of the OVDÂ

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â and appearance of the teeth.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Consider possible referral to specialist.

> > > > > > >

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Secondary phase: Work to be carried

> > > > > > out by the specialist.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Maintenance phase : Reinforce oral

> > > > > > hygiene

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Reinforce stress reduction/relaxation.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Review gingivitis.

> > > > > >

> > > > > > >

> > > > > > > Best regards.

> > > > > > > Inna.

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > From: aqsaburki@

> > > > > >

> > > > > > > Date: Wed, 22 Feb 2012 20:17:47 +0000

> > > > > > > Subject: Re: New guidelines case discussions: Case 2

> > > > > > >

> > > > > > > Â

> > > > > > >

> > > > > > >

> > > > > > > Provisional diagnosis: attrition plus erosion( tooth wear), minor

> > > > > > apthous ulcers

> > > > > > >

> > > > > > >

> > > > > > > Radiograph: IOPA for Anterior teeth : to check the pulp exposure

and

> > > > for

> > > > > > further management, to assess the root status in case RCT has to be

> > > > > > performed

> > > > > > >

> > > > > > > No radiographs for ulcers

> > > > > > >

> > > > > > > Special investigations: vitality tests,Study casts, diet chart,

blood

> > > > > > tests to determine iron deficiency, Serum b12 and folic acid levels,

> > > > Urine

> > > > > > test to exclude diabetes just in case,

> > > > > > >

> > > > > > >

> > > > > > > You can  refer to GP for these blood and urine tests.

> > > > > > > From: doc_smriti <doc_smriti@>

> > > > > >

> > > > > > >

> > > > > > > Sent: Wednesday, 22 February 2012, 18:48

> > > > > > > Subject: New guidelines case discussions: Case 2

> > > > > > >

> > > > > > >

> > > > > > > Â

> > > > > > > Hi All,

> > > > > > >

> > > > > > > Thanks a lot for participating in the last case.. Here's the

outline

> > > > for

> > > > > > the next case..

> > > > > > > 25yr old Patient complains of tooth becoming short with

time(6mnths)

> > > > and

> > > > > > ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of

> > > > fizzy

> > > > > > drinks and has a stressful life style. Asthmatic on steroid inhalors

> > > > > > >

> > > > > > > As per the new guidelines some information will be provided before

> > > > > > history taking: (so for this case)

> > > > > > > photographs of the patient showing front teeth .

> > > > > > > BPE score (212/211),

> > > > > > > all teeth except third molars are present,

> > > > > > > no visible caries.

> > > > > > >

> > > > > > > History Taking:

> > > > > > > Name: Ms Martha s

> > > > > > > DOB: 12th Jan 1986

> > > > > > > Occupation: Law Student

> > > > > > > Address: #ab Street, London

> > > > > > > Marital Status; Unmarried, No partner

> > > > > > >

> > > > > > > C/o : 1. patient complains of tooth becoming short over last 6

mnths

> > > > > > > 2. Pt complains of ulcers that come and go for lat 10 yrs.

> > > > > > >

> > > > > > > HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand.

ant

> > > > > > region, sensitivity to hot and cold, no pain on biting, no change in

> > > > colour

> > > > > > of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism,

> > > > Lifestyle

> > > > > > - stressful, h/o high intake of fizzy drinks, no h/o eating

> > > > disorder/acidic

> > > > > > regurg.,

> > > > > > >

> > > > > > > 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for

> > > > 1wk,

> > > > > > heal sponta, no scar on healing, freq- 5-6mths since last 10yrs,

FH/o

> > > > > > recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental

> > > > > > biting, not +nt anywhere else mouth or otherwise, no

> > > > bleeding/discharge,

> > > > > > used bonjela

> > > > > > >

> > > > > > > PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental

> > > > > > treatment except scaling/polishing.

> > > > > > >

> > > > > > > PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking

> > > > steroid

> > > > > > inhalers †" 10 yrs, no known latex/dental products allergy, no

known

> > > > > > medicine allergy, no other medication

> > > > > >

> > > > > > >

> > > > > > > SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> > > > > > > Alc- Social drinker- Red wine 4-5units/wk

> > > > > > > Fizzy drink/citrus fruits/juice intake- high

> > > > > > > Carbo/sugary intake- low

> > > > > > >

> > > > > > > What would be your provisional diagnosis, which radiographic views

> > > > will

> > > > > > you ask for and why and what special investigations would you want

to

> > > > be

> > > > > > done for this patient?

> > > > > > >

> > > > > > > Hoping for your active participation..

> > > > > > > Thanks and Regards,

> > > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

If the patient is not complaining of pain or sensitivity do v still take radiographs?

From:

doc_smriti <doc_smriti@...>;

To:

< >;

Subject:

Re: New guidelines case discussions: Case 2

Sent:

Fri, Feb 24, 2012 9:22:19 AM

Hi Ammar,

Thanks for the info.. But Mr Barry White has Gastro-oesophageal reflux too apart from the diet and occupational factors. My question is, if a person has only extrinsic erosion, should we wait to give the splint?

Regards,

Smriti

> > > > > > >

> > > > > > > Also tell patient that his inhaler can also be the cause of ulcer so

> > > > he

> > > > > > should make sure he rinses his mouth after he uses inhalers,Also give

> > > > > > patient benzydamine mouthwash along with triamcinolone gel.

> > > > > > >

> > > > > > >

> > > > > > > From: Inna Yarovikova <innaiarovikova@>

> > > > > >

> > > > > > >

> > > > > > > Sent: Wednesday, 22 February 2012, 20:51

> > > > > > > Subject: RE: New guidelines case discussions: Case 2

> > > > > > >

> > > > > > >

> > > > > > > Â

> > > > > > > Hi everyone.

> > > > > > >

> > > > > > > Treatment Plan. Â Emergency phase: Â Diet advice,to cut down on fizzy

> > > > > > drinks and wine(patient drink more than recommended).

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > >     Prescribe chlorhexidine  mouthwash to avoid supra infection.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Â Prescribe Sodium Fluoride toothpaste 0.619 % or 1.1% to deal

> > > > > > with sensitivity.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Â Refer to GP,FBC (full blood count to exclude anaemia,B12

> > > > > > deficiency and folic acid)

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Â Take an impression and make a splint.Patient is stressed and

> > > > > > grind hid teeth at night. Â

> > > > > > >

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Primary phase: Â OHI to improve

> > > > > > oral hygiene, patient has gingivitis. S & P (scaling and polishing).

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Review ulcers,if ulcer do not heal for more than 2 week refer to

> > > > > > specialist.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â To check OVD. If potential occlusal problem the specialist would be

> > > > the

> > > > > > right person to decide of the loss of the OVDÂ

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â and appearance of the teeth.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Consider possible referral to specialist.

> > > > > > >

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Secondary phase: Work to be carried

> > > > > > out by the specialist.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Maintenance phase : Reinforce oral

> > > > > > hygiene

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Reinforce stress reduction/relaxation.

> > > > > > > Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

> > > > > > Â Â Â Review gingivitis.

> > > > > >

> > > > > > >

> > > > > > > Best regards.

> > > > > > > Inna.

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > From: aqsaburki@

> > > > > >

> > > > > > > Date: Wed, 22 Feb 2012 20:17:47 +0000

> > > > > > > Subject: Re: New guidelines case discussions: Case 2

> > > > > > >

> > > > > > > Â

> > > > > > >

> > > > > > >

> > > > > > > Provisional diagnosis: attrition plus erosion( tooth wear), minor

> > > > > > apthous ulcers

> > > > > > >

> > > > > > >

> > > > > > > Radiograph: IOPA for Anterior teeth : to check the pulp exposure and

> > > > for

> > > > > > further management, to assess the root status in case RCT has to be

> > > > > > performed

> > > > > > >

> > > > > > > No radiographs for ulcers

> > > > > > >

> > > > > > > Special investigations: vitality tests,Study casts, diet chart, blood

> > > > > > tests to determine iron deficiency, Serum b12 and folic acid levels,

> > > > Urine

> > > > > > test to exclude diabetes just in case,

> > > > > > >

> > > > > > >

> > > > > > > You can  refer to GP for these blood and urine tests.

> > > > > > > From: doc_smriti <doc_smriti@>

> > > > > >

> > > > > > >

> > > > > > > Sent: Wednesday, 22 February 2012, 18:48

> > > > > > > Subject: New guidelines case discussions: Case 2

> > > > > > >

> > > > > > >

> > > > > > > Â

> > > > > > > Hi All,

> > > > > > >

> > > > > > > Thanks a lot for participating in the last case.. Here's the outline

> > > > for

> > > > > > the next case..

> > > > > > > 25yr old Patient complains of tooth becoming short with time(6mnths)

> > > > and

> > > > > > ulcers that come and go(10 yrs). Patient is a bruxer, takes a lot of

> > > > fizzy

> > > > > > drinks and has a stressful life style. Asthmatic on steroid inhalors

> > > > > > >

> > > > > > > As per the new guidelines some information will be provided before

> > > > > > history taking: (so for this case)

> > > > > > > photographs of the patient showing front teeth .

> > > > > > > BPE score (212/211),

> > > > > > > all teeth except third molars are present,

> > > > > > > no visible caries.

> > > > > > >

> > > > > > > History Taking:

> > > > > > > Name: Ms Martha s

> > > > > > > DOB: 12th Jan 1986

> > > > > > > Occupation: Law Student

> > > > > > > Address: #ab Street, London

> > > > > > > Marital Status; Unmarried, No partner

> > > > > > >

> > > > > > > C/o : 1. patient complains of tooth becoming short over last 6 mnths

> > > > > > > 2. Pt complains of ulcers that come and go for lat 10 yrs.

> > > > > > >

> > > > > > > HOPI: 1. Pt complains of tooth wear, noticed since 6mths, mand. ant

> > > > > > region, sensitivity to hot and cold, no pain on biting, no change in

> > > > colour

> > > > > > of teeth, no recent resto. on opposing teeth, +ve PFH - Bruxism,

> > > > Lifestyle

> > > > > > - stressful, h/o high intake of fizzy drinks, no h/o eating

> > > > disorder/acidic

> > > > > > regurg.,

> > > > > > >

> > > > > > > 2. 3 ulcers +nt, painful, all small 1-2mm, all on tongue, stay for

> > > > 1wk,

> > > > > > heal sponta, no scar on healing, freq- 5-6mths since last 10yrs, FH/o

> > > > > > recurrent ulcers +nt, no boil before ulcer, no h/o trauma/accidental

> > > > > > biting, not +nt anywhere else mouth or otherwise, no

> > > > bleeding/discharge,

> > > > > > used bonjela

> > > > > > >

> > > > > > > PDH: Regular attender, Brushes 2/day, no m/w, floss.. No dental

> > > > > > treatment except scaling/polishing.

> > > > > > >

> > > > > > > PMH: H/o Asthma (10yrs) / controlled/ never hospitalised/ Taking

> > > > steroid

> > > > > > inhalers †" 10 yrs, no known latex/dental products allergy, no known

> > > > > > medicine allergy, no other medication

> > > > > >

> > > > > > >

> > > > > > > SH: Non Smoker, h/o smoking (5yrs- 5cig/day, stopped 7mnths ago),

> > > > > > > Alc- Social drinker- Red wine 4-5units/wk

> > > > > > > Fizzy drink/citrus fruits/juice intake- high

> > > > > > > Carbo/sugary intake- low

> > > > > > >

> > > > > > > What would be your provisional diagnosis, which radiographic views

> > > > will

> > > > > > you ask for and why and what special investigations would you want to

> > > > be

> > > > > > done for this patient?

> > > > > > >

> > > > > > > Hoping for your active participation..

> > > > > > > Thanks and Regards,

> > > > > > >

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