CASE STUDY.
Sandra is a 12-year-old patient who attends the AIH adolescent clinic for the first time for an oral examination. The last time she visited a Dental Therapist was 2 years ago in a general dental practice.
Sandra`s medical history reveals that she has Down Syndrome with mild intellectual impairment. Her medical history also suggests that Sandra had a heart operation when she was 2 years old, and since then Sandra has not experienced any problems related to her heart. She also takes Levothyroxine once a day on empty stomach.
Sandra appears happy to sit in the chair although she does tell you that her neck hurts when she lays back for long periods of time. Sandra also mentions that her tooth hurts sometimes and points to the lower left side of her cheek.
Her mother who attends with her for her appointment says she has noticed that Sandra seems to retain a lot of food in the sides of her mouth, she also mentions that Sandra`s gums bleed when she brushes once a day which usually takes place after breakfast and occasionally her breath smells most of the time throughout the day.
On visual examination: All deciduous molars are present. All permanent first molars, central incisors and lower lateral incisors are fully erupted. The upper permanent lateral incisors appear to be absent. The lower permanent canines are partially erupted and the upper deciduous canines show no sign of mobility. The permanent canines are not visible. Sandra has a Class 3 skeletal pattern and shows signs of excessive tooth wear on all deciduous teeth and slight wear is evident on the permanent incisors and first molars. Also, Sandra’s tongue seems to be larger for the size of her mouth.
Having carried out a full diet history it is very apparent that Sandra likes to snack a lot all kinds of sugary food. Her parents reveal that she is addicted to any kind of fizzy drink and will not drink water. Sandra also tells you during the examination that her upper teeth hurt when she drinks anything cold.
CLINICAL FINDINGS RELATED TO YOUR ORAL HEALTH ASSESSMENT
i. Amalgam Restorations:
74 & 64 disto – Occlusal
ii. Mesial Marginal ridge has broken down on the 75 because of dental caries, however, the tooth is symptomless.
iii. Large temporary filling (IRM) 65 mesial – appears sound
iv. 74 clinically appears sound however, there is a lesion present on the buccal surface of the 74.
v. The permanent incisors and first molar teeth show signs of mild- moderate hypoplasia.
vi. The mirror examination of palatal surfaces reveals the start of tooth surface loss on the palatal surfaces of the 11 and 21.
vii. Sandra`s oral Hygiene is very neglected with generalised mature plaque deposits detected along the upper and lower gingival margins as well as interproximal deposits including plaque biofilm and sub gingival calculus around the all posterior teeth. Fine supra gingival calculus was also apparent during your examination on the lingual aspects of the 33-43.
viii. Periodontal probing depths ranged generally between 2 and 4mm in most areas except on the mesial surfaces of 11, 21, 31 and 41, where it measured between 5 and 6 mm.
ix. You also noticed that Sandra had quite bad breath when she was speaking to you.
TASK DESCRIPTION
1. Develop and discuss an oral health care plan for this patient including the recall regime that you would implement. Your plan will necessarily consider the risk status of the patient and will discuss a range of possible treatment options, depending on further information and examination findings from a Dental Restorative and Periodontal perspective.
2. Explain your reasoning for each decision. Take care to indicate a complete homecare program you would design as well as the steps you would take to evaluate the effectiveness of this program to improve Sandra`s oral health.
3. Identify the characteristics of this patient which are typical of the patient with Down Syndrome, and indicate how you have considered these and other relevant characteristics in your oral health care plan
