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The dentist referred an 11 years old girl and her mother to me for providing her with effective Oral Health Advise on how to prevent the periodontal abscess. periodontal abscess is the dental diseases in which pus is collected at the gum. Pus is accumulated in the tooth supporting tissues, the periodontium (Demiriz and Bodrumlu, 2018). The main causative factor of this dental condition is the bacterial infection. periodontal abscess is a form of the advanced gum disease or periodontitis in which gum is infected by the bacteria thereby secreting pus. Poor oral hygiene is associated with developing this dental condition (Đuričković and Ivanović, 2020.).
The periodontal assessment and personal history analysis of this shows that:
The girl develops periodontal abscess from the last two weeks. She experiences different symptoms such as gum redness, pus discharge, swelling of the periodontium and bad smell from mouth.
The extra periodontal examination and soft tissue check of the patient show that she also has the gingival recession which contribute to worsening the gum condition.
The patient is primary school child who loves to eat junk foods and chocolates. As she has working parents and they are busy at their regular work schedule, the girl gets little guidance and advise from her parent regarding the oral hygiene. In most of the day she eats frozen foods and oily junk foods at the school canteen as her mother is unable to manage time to prepare healthy tiffin for her. She brushes her teeth only once and with negligence that leads to bacterial infection in her gums. Her parent does not show any strictness on her food habits and poor oral hygiene which contribute to deteriorate the dental health of the patient.
There are some barriers that are identified during the oral care delivery to the patient such as lack of parental support and guidance to the patient, poor parental consciousness regarding the oral health of their child and lack of knowledge of both parents and the patient regarding preventing periodontal abscess.
In this first session I have given the oral health advise to the patient and her mother regarding how to prevent periodontal abscess on patient’s teeth. The first session has been held at the staff’s room. On staring the advice, I provide a leaflet on periodontal abscess to the patient and tell the patient and her mother to go through the pictures and the written content the leaflet. Then I explain in details that what the periodontal abscess is, how it develops and what are the impacts of periodontal condition on the oral health. I use the demonstration teeth, pointer light and scalpel to describe each part of the human teeth and gum. I also show many images and videos on my laptop to the patient and her mother to inform them about the importance of a healthy gum and oral tissue in maintaining good heath and wellbeing. through the online images and videos of periodontal abscess I explain that how periodontal abscess can cause tooth decay, gingival recession and chronic gingivitis. Then I compare the gum of the patient with a demonstration gum structure of normal human being to show the mother and the patient that how much it is important for the girl to maintain a good oral hygiene to eliminate the risk of further tooth decay and gum infection.
I advise the patient to brush twice a day, once when she wakes up in the morning and once before she goes to bed. I recommend the patient to use the fluoride toothpaste that will protect the gum from any kind of bacterial infection. I advise the mother to replace her daughter’s toothbrush in every 3-4 months (Gao et al. 2020). I also recommend the patient to brush the teeth by holding the brush at 45-degree angle to gum. In this context I advise the patient to use the brush gently rather than aggressively.
I advise the patient to use therapeutic mouthwash, especially the fluoride mouthwash on regularly after eating foods. mouthwash keeps the gum clean and healthy thereby protecting from bacterial infection (Gasoyan et al. 2019.). I also recommend the mother to use floss to clean the area between her daughter’s (patient) teeth gently. In this context I recommend the mother to use Sulcabrush or oral B interdental floss.
I advise the mother to take special care of her daughter’s food habit which is important for having healthy teeth and gum. I recommend the mother to prepare healthy foods for her daughter that do not contain more sugar (Haque et al. 2019). I also advise the mother to provide delicious but healthy homemade foods for tiffin to her daughter to abolish her habit of eating external junk and packages foods. I advise the patients to avoid packaged, sugary and junk foods such as coco cola, pastries, chocolates and cookies
I advise the mother to take active part in developing healthy habits in the patient regarding maintaining oral hygiene. I recommend the mother to make proper watch on the oral hygiene of her daughter, to ensure that her daughter follows all the provided guidelines regarding the oral hygiene.
Finally, I provide the mother with another leaflet which contains all the instructions regarding maintaining healthy gum and teeth. I advise the mother to becomes more concern on patient’s oral health and which is important for preventing any further deterioration of the gum condition.
Demiriz, L. and Bodrumlu, E.H., 2018. Reasons for the Extraction of Primary Teeth in Primary School-age Children in Zonguldak, Turkey: A Retrospective Study. Meandros Medical and Dental Journal, 19(1), p.32.
Đuričković, M. and Ivanović, M., 2020. Dental health status in children with type 1 diabetes mellitus in Montenegro. Vojnosanitetski pregled, (00), pp.50-50.
Gao, S.S., Chen, K.J., Duangthip, D., Wong, M.C.M., Lo, E.C.M. and Chu, C.H., 2020. Preventing early childhood caries with silver diamine fluoride: study protocol for a randomised clinical trial. Trials, 21(1), pp.1-7.
Gasoyan, H., Safaryan, A., Sahakyan, L., Gasoyan, N., Aaronson, W.E. and Bagramian, R.A., 2019. School-based preventive dental program in rural communities of the republic of Armenia. Frontiers in public health, 7, p.243.
Haque, M., Sartelli, M. and Haque, S.Z., 2019. Dental infection and resistance—global health consequences. Dentistry journal, 7(1), p.22.
Karki, S., Laitala, M.L., Humagain, M., Seppänen, M., Päkkila, J. and Anttonen, V., 2018. Oral health status associated with sociodemographic factors of Nepalese schoolchildren: A population-based study. International dental journal, 68(5), pp.348-358.
Milgrom, P., Horst, J.A., Ludwig, S., Rothen, M., Chaffee, B.W., Lyalina, S., Pollard, K.S., DeRisi, J.L. and Mancl, L., 2018. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. Journal of dentistry, 68, pp.72-78.
Süt, Z. and Çekim, D., Reasons for the Extraction of Primary Teeth in Primary School-Age Children in Zonguldak, Turkey: A Retrospective Study.
Topic: ‘Prevention of periodontal abscess’ Patient Group; Primary school children
Patient age: 11 years old Gender: Female Visit: “second”
The second visit is the follow up visit in which I examine the gum and teeth of the patient to analyse that whether there is any improvement in her oral health. First, I make a routine oral check up to check the strength and cleanliness of each teeth, the condition of gum, lower and upper quadrants and gingival areas. Then I perform the soft tissue check to see that whether there is reduction in the pus secretion in the periodontium. I also perform the periodontal assessment, extra oral examination and gum screening to see whether there is any improvement in the condition of the gum.
After analysing the results of all the above-mentioned tests, I come to fact that, there is improvement in the gum condition of the patient with reduction of pus collection on periodontium. There is also the sign of good oral hygiene as there is less smell from the mouth of patient as compared to her first visit. The lowering of bad smell from mouth shows the sign of reduction of the bacterial infection on the tooth supporting tissues (Antipovienė et al. 2021). In this context I appreciate the mother and the patient for their effort in following the prescribed guidelines and advice regarding maintaining gum health and oral hygiene. Additionally, I advise the mother to bring her daughter to dentist and oral health expert on every month for obtaining the clear update in patient’s oral health and gum condition.
Although there is sign of improvement in patient’s teeth, there are some still some aspects that rise my concern on the gum condition of the patient. Through performing the BPE score and the gum health examination, I find out that, there is no improvement in the gingival recession rather the condition shows high risk of developing chronic gingivitis. This examination proves that although good oral hygiene has been maintained by the patient, the advice that were given to the patient and mother regarding feeding habits of patient are not followed properly. On the other hand., the periodontal assessment also shows that although there is reduction of pus collection on gum, the periodontal ligament is still infected as it shows redness and swollen structure (Gavriilidon and Belibasakis, 2019).
In this context I suggest the mother that she must be more caring and stricter regarding developing a healthy food habit in the patient. I also suggest the mother that, despite giving instruction of avoiding unhealthy foods, there must be negligence in taking healthy and homemade foods by the patent which leads to the deteriorating gingival condition and infected periodontal ligament which can enhance the further worsening of periodontal abscess (Mlenga and Mumghamba, 2021).
Through performing periodontal screening and gum screening I notice the redness on the gum and swollen teeth tissues in patient (Oliveira et al. 2018). This screening test makes me understand that, the patient fails to follow the advice that were given to her first visits regarding using the fluoride toothpaste and mouthwash. I suggest the mother to be stricter on choosing the right toothpaste and mouthwash for her daughter, otherwise there may develop chronic infection on patient’s gum. I advise the patients and her mother that if they do not follow the advise properly that were given on their first visits, the gum condition will deteriorate with increasing infection and high amount of pus discharge.
I explain the patient that although there is improvement in her gum condition, there is not the expected level of recovery. In this context, I suggest the patient that she should avoid junk foods, packed foods, and the food are enriched with sugar and preservatives, ratter she must eat the homemade and healthy foods. I also suggest to administer that whether the patient follow all the advice regarding maintaining good oral health that were given her in her first visits.
The mother explains that despite she prepares the homemade tiffin of the patient, she (patient) uses to eat the junk foods of school canteen rather than taking the homemade foods. She also explains that as she is the working mother for her it is quite difficult to check all the time that whether her daughter keeps her mouth clean after each meal. In thick context I suggest the mother to cooperate with school teachers and the caretaker at home to take care of the oral hygiene of the patient on behalf of the mother (Ruff and Niederman, 2018). I also recommend that mother to go for weekly oral health check-up of her daughter that will assist them to known the condition of the oral health of the patients I also provide the mothers with a leaflet in which there are instructions on how to prevent the gum infection and how to maintain goo oral health. I suggest the mother to encourage the patient to follow all the instructions of this leaflet strictly to maintain good oral health.
Antipovienė, A., Narbutaitė, J. and Virtanen, J.I., 2021. Traumatic dental injuries, treatment and complications in children and adolescents: a register-based study. European journal of dentistry.
Gavriilidou, N.N. and Belibasakis, G.N., 2019. Root caries: the intersection between periodontal disease and dental caries in the course of ageing. British dental journal, 227(12), pp.1063-1067.
Mlenga, F. and Mumghamba, E.G., 2021. Oral Hygiene Practices, Knowledge, and Self-Reported Dental and Gingival Problems with Rural-Urban Disparities among Primary School children in Lilongwe, Malawi. International Journal of Dentistry, 2021.
Oliveira, B.H., Cunha-Cruz, J., Rajendra, A. and Niederman, R., 2018. Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis. The Journal of the American Dental Association, 149(8), pp.671-679.
Ruff, R.R. and Niederman, R., 2018. Comparative effectiveness of treatments to prevent dental caries given to rural children in school-based settings: protocol for a cluster randomised controlled trial. BMJ open, 8(4).
Schwendicke, F., Krois, J., Schiffner, U., Micheelis, W. and Jordan, R.A., 2018. Root caries experience in Germany 1997 to 2014: analysis of trends and identification of risk factors. Journal of dentistry, 78, pp.100-105.
Tan, H., Richards, L., Walsh, T., Worthington, H.V., Clarkson, J.E., Wang, L. and Velo, M.M.D.A.C., 2017. Interventions for managing root caries. The Cochrane Database of Systematic Reviews, 2017(8).
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