TIMELINE FOR PATIENT MS
9-25-18 Initial visit - patient stated it has been five years since a dental checkup , was living in England . BWX and Panoramic x-ray were taken . “ Watch ” was placed on # 12,13,14,19,20 .
We recommended fluoride varnish be applied and gave patient 5000 ppm toothpaste to use twice daily .
Highest Diagnodent reading was # 15 O -52 . Gave patient our KOBRA ( Kick Out Bad Bacteria Resist Acid Attack ) educational / motivational handout and discussed possible SDF use in the future .
4-22-19 Six-month recall - patient stated she has been using 5000 ppm daily at home . We noted stable or slightly improved interproximal decal areas on BWX taken today and recommended we apply SDF in posterior today with fluoride varnish over it , and patient approved . We reviewed KOBRA with her . Diagnodent on # 15 -35 , lower than first visit .
10-28-19 Six-month recall - BWX taken and compared to previous BWX . No progression of any demineralization and some apparent re-min is occurring .
SDF was applied to left posterior interproximal areas with fluoride varnish applied over and full mouth within 10 seconds . Recommended 2 more consecutive applications before next recall . Dispensed 5000ppm toothpaste and reappointed patient for a follow-up application of SDF in 1 month .
12-2-19 One-month follow-up for another ( 2nd ) SDF application - we used Superfloss ( PHOTOS ATTACHED FOR TECHNIQUE ) to apply to all left posterior interproximal areas for two minutes , then covered with fluoride varnish . Reappointed for 1-month follow-up .
12-30-19 Follow-up for 3rd consecutive application of SDF - SDF applied with Superfloss again to left posterior interproximal and covered with fluoride varnish . 1 left BWX was taken to update progression or regression of de-min . Appearance of improvement with less shadows at contacts again this time . ( Separate BWX photo attached for this additional follow-up from the series of 3 within 2 years .)
8-18-20 COVID-19 recall appointment - Due to the pandemic outbreak and unavailable PPE , we were forced to cancel three months of our hygiene department recall appointments . Thus , there is a 9-month span between visits for patient MS . BWX revealed an increase in remineralization interproximal of left posterior teeth . I have included a Right BWX in our series to show that we may be getting an associated effect with the SDF / fluoride varnish treatments as some researchers report . Patient MS was seen 11-30-20 just for BWX and SDF / fluoride varnish application . We made a diagnosis to continue our course of treatment .
JANUARY / FEBRUARY 2021 | PENNSYLVANIA DENTAL JOURNAL 25