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Dental Hygiene Clinical Practice II
Kaite Manganaro
Patient Profile
51 year old Caucasian female
Health history reveals:
Dental history reveals:
• No medications
• Vitals WNL
• Environmental allergies- Hay
Fever, dust, trees
• Food allergy- Strawberries
(carries EpiPen)
• Job related stress
• Previous depression (2002)
• ASA Class II
• Brushes 1x daily with manual
soft toothbrush
• Flosses 1x monthly
• Slight dental anxiety
• #30 extracted approx. 25 years
ago
• Sensitivity to pressure #13
• Cold sores/canker sores approx.
2-3x per year
• Bruxism mostly at night,
sometimes during the daytime
• Very strong gag reflex
• Last hygiene visit was 6 months
ago
Extraoral and Intraoral
Examination Findings
•Lips: Slight dryness, fordyce
granules
•Bilateral slight linea alba
•Small bilateral 1mm bite
trauma and on apex of tongue
•Low maxillary frena
attachment, causing diastema
•Generalized slight attrition
•Localized abrasion on #21
•Slight decalcification on
molars
•Slight recession on mandibular
anteriors
•Slight clefting on buccal #21
•Angle’s Class I Occlusion (Right
molar N/A)
•#2 and #14 in torsoversion
•Overbite 60%
•Overjet 1mm
(Cleft on buccal of #21)
• Furcation Involvement on #3 and #14
•No mobility
•Mucogingival involvement #20
•BOP #’s 3, 4, 5 7, 10 and 24
• Generalized slight spicules of supra and subgingival calculus
• Generalized slight interproximal biofilm
• Plaque Control Record was 23% (Last appointment)
• Generalized slight yellow stain
• Hypersensitivity to pressure on the distal of #13
→ Generalized pale pink with localized marginal redness #6
#7, slightly enlarged tissue on the maxillary URQ, slight
recession on mandible, rounded tissue with localized clefting
on the buccal #20, stippling and edematous tissue type
Contributory Factors:
• Calculus
• Food impaction
• Position of teeth/malocclusion
• Un-replaced teeth
Periodontal Risk Factors:
• Hormonal involvement
• Stress
• Nutritional deficiencies
Radiographs
• Generalized slight bone loss with slight to moderate
bone loss on the mandible
• Amalgam restoration present on buccal of #19
• Overlapping on the maxillary canine shot, the
maxillary lateral incisor shot, slight distomesial overlap
on #20 #21
• Furcation involvement #3, #14, #19 Grade 1
• No calculus present radiographically
•AAP II
Generalized slight inactive chronic periodontitis with
generalized moderate inactive chronic periodotitis on the
mandible, localized slight active periodontitis URQ #3, #4, #5,
#7, and #10
Dental Hygiene Diagnosis: Issues that need to be addressed with Dental Hygiene Treatment
Circle issues present and provide summary below
Wellness Systemic
Head & Neck Pathology
Tobacco
Nutrition
Malocclusion/Parafunctional habits
Dental Condition/Caries/risk
Periodontal condition/risk
Self-care Trauma Staining/Esthetics Other:
Dental Hygiene Diagnosis: Moderate biofilm and calculus deposits due to inadequate home care & sugary diet
Goals
Client Goals: Whiter teeth
Treatment goals: Maintain stable perio condition and reduce plaque indices to 10%
Assessments (after initial assessments)
Implementation
Appt. 1
Radiographs
Additional diagnostics
Intra-oral photos
Time
needed
Disease Prevention/Health Education
Appt. 2
Appt. 3
Appt. 4
Appt. 5
Re-evaluation
Appt. 2
Appt. 3
Appt. 4
Appt. 5
Re-evaluation
Appt. 2
Appt. 3
Appt. 4
Appt. 5
Re-evaluation
20 min
Brushing Techniques (Modified Stillman)
Interdental Aids
Periodontal Disease
Dental Decay
Tobacco Cessation
Nutritional Education
Fluoride Therapy
Systemic Disease
Other
Time needed
Procedures
Implementation
Appt. 1
X
X
X
X
35 min
Implementation
Appt. 1
X
Review health history, oral exam, Indices
Re-assess previously treated areas
Anesthesia (Type: Drug & delivery method)
Power Driven Debridement /Area
ULQ
Hand Activated Debridement/Area
ULQ
Chemotherapeutic Procedures (type)
Plaque Removal (method)
Fluoride treatment (Type of fluoride)
Desensitization
Amalgam Polishing
Athletic Mouth Protectors
Study Models
Sealants
Total Appointment Time
1.5 hr
Re-care Interval : 6 week re-evaluation, 3 mo re-care
Referrals needed: Refer to general dentist, periodontist
X
X
X
X
URQ/LRQ
URQ/LRQ
LLQ
FMTB
Varnish
#13
2.5 hr
2 hr
Oral Self-Care
Current Oral Self-Care Methods: Soft manual brush 1x daily, Fl mouth rinse
Recommendations: Indicate recommendations below and include type method and frequency as necessary
Brush
Power
Dental floss/tape
Wax tape 1x day
Oral rinse(s)
Specialty Brush
Interproximal device
Floss threader/Aid
Fluoride product(s)
Continue current
rinse
Other: Rinse with water after
snacking, xylitol gum
APPOINTMENT ONE
MEDICAL HISTORY: Reviewed, no contraindications to treatment
PATIENT ASSESSMENT: EOE, IOE, dental charting, started GM’s on
periodontal assessment
APPOINTMENT TWO
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE & IOE, completed periodontal
assessment & gingival description
APPOINTMENT THREE
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE, IOE, deposit assessment
APPOINTMENT FOUR
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE, IOE
BIOFILM INDEX: 34%
RADIOGRAPHS: Intra-oral photos
DEBRIDEMENT: Power driven ULQ
OTHER INSTRUCTION: Gave patient home care instructions to brush 2x
daily, floss 1x daily before brushing, continue using ACT mouth rinse 1x
daily. Recommended & demonstrated Modified Stillman & proper flossing
technique. Went over treatment plan, Pt. responded well
APPOINMENT FIVE
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory EOE, IOE, Re-assessed ULQ
BIOFILM INDEX: 20%
DEBRIDEMENT: Completed URQ with Catvitron and hand scaling
APPOINTMENT SIX
MEDICAL HISTORY: Reviewed- no contraindications
PATIENT ASSESSMENT: Cursory IOE, EOE, Re-assessed previous quadrants
BIOFILM INDEX: 40%
DEBRIDEMENT: Power driven on LRQ, started LLQ
FINAL APPOINTMENT
MEDICAL HISTORY: Reviewed, no contraindications
PATIENT ASSESSMENT: Cursory IOE, EOE
BIOFILM INDEX: 23%
DEBRIDEMENT: Power driven LLQ
OTHER DENTAL HYGIENE SERVICES: Motor polished full mouth- Fine
pumice
FLUORIDE: "Gelato" foam fluoride w. xylitol tray for 4min, Pt. was given
instructions to not eat/drink/brush for a half hour afterward
RECARE: 4-6 weeks re-eval and 3 MTH recare
This was such a rewarding case. I gained a better understanding of
process of care, patient management, and worked on refining my
skill. After looking at the patient’s radiographs, I realized my GM
recordings were off & do not reflect the perio status of the patient. I
believe this is due to my inexperience at the time.
The 6 week re-evaluation was wonderful. The patient gained some
attachment and I was unable to accesses the previously found
furcations. The was also noticeable improvement to the color and
contour of the gingiva. The patient also had a lowered plaque index
score and was continuing recommended home care. It was such a
great feeling seeing how my treatment and instruction, can make a
difference.