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This Concept Map, created with IHMC CmapTools, has information related to: Carrie Fissure.cmap, Pregnancy Gingivits Due to increased progesterone To reduce severity, recommend Remove Irritants: Good Home Care (Floss, Brush 2x daily and after meals, antimicrobial mouth rinse) Dental celanings every 4 months Brushing or rinsing with water to neutralize effects of morning sickness, Carrie Fissure 30 y/o Female presents with 2 year history of frequent, bilateral headaches around temples (patient believes headaches are dental-related), Nitrous oxide is contraindicated For this reason Keep appointments shorter Try to have them during the morning Manage pain with novocain, Carrie Fissure 30 y/o Female examination TMD exam Range of motion: 33mm opening 6/6/5 (right lateral, left lateral, protrusive) Above results are normal, Xanax (0.25mg, 2x/day) Benzodiazepine, binds GABA A receptor, suppresses HPA axis and Metformin (500mg, 2x/day) Suppresses hepatic gluconeogenesis, Pregnancy Of roughly 2 months duration Dental complications include Pregnancy Gingivits Due to increased progesterone, Xanax (0.25mg, 2x/day) Benzodiazepine, binds GABA A receptor, suppresses HPA axis most likely to treat Manic-depressive, possibly bipolar (sudden mood swings), Pregnancy Of roughly 2 months duration Because of pregnancy Nitrous oxide is contraindicated, Carrie Fissure 30 y/o Female past dental history (panorex images + MRI) Self Reported No history of jaw trauma No history of jaw locking Grinds teeth at night Wears a sports mouthguard to bed (infrequent) Frequently uses aspirin Red puffy gingiva bleed upon brushing, Nervous and tense (clenched fists; tense jaw; admits to being anxious) due to Fear of the dentist Lack of sleep (patient admits to getting only ~4 hours sleep/night) Emotional stress (asthmatic children, messy divorce, recent weight gain), 2 year history of frequent, bilateral headaches around temples (patient believes headaches are dental-related) further treatment of bilateral headaches occlusal appliance made for patients, Fear of the dentist Lack of sleep (patient admits to getting only ~4 hours sleep/night) Emotional stress (asthmatic children, messy divorce, recent weight gain) stressors may trigger/ contribute to 2 year history of frequent, bilateral headaches around temples (patient believes headaches are dental-related), Self Reported No history of jaw trauma No history of jaw locking Grinds teeth at night Wears a sports mouthguard to bed (infrequent) Frequently uses aspirin Red puffy gingiva bleed upon brushing Collection of symptoms suggest Pregnancy Of roughly 2 months duration, Carrie Fissure 30 y/o Female current medications Xanax (0.25mg, 2x/day) Benzodiazepine, binds GABA A receptor, suppresses HPA axis, Lithium (300mg, 2x/day) A mood stabilizer, used for depression, mania, bipolar, mechanism may include increasing serotonin synthesis and decreasing norepinephrone synthesis Conclusion of Psychiatric Evaluation Now seeing a therapist regularly. Implemented Self Management Techniques to better deal with stress, Pregnancy Of roughly 2 months duration Because of pregnancy Postpone dental treatment until after pregnancy, or until second semester for pressint treatment, Fear of the dentist Lack of sleep (patient admits to getting only ~4 hours sleep/night) Emotional stress (asthmatic children, messy divorce, recent weight gain) exacerbates Manic-depressive, possibly bipolar (sudden mood swings), Carrie Fissure 30 y/o Female demeanor Manic-depressive, possibly bipolar (sudden mood swings), Carrie Fissure 30 y/o Female examination Intra/extraoral exam Wear on cusps of molars and incisal edges of mandibular anterior teeth (evidence of bruxism) Chewed fingernails Generalized tenderness of masticatory muscles Palpation of masticatory muscles reproduces the pain that was the patient's primary complaint, Carrie Fissure 30 y/o Female past dental history (panorex images + MRI) Panorex Root canal + crowns on #s 3, 4 and 5 Crown on #15 Restorations on #s 14, 17, 18, 29, 30, and 32 Extracted #s 1, 2, 16, and 19