Download File - Teaching Portfolio - Varsha Patel RDH

THE ASTHMATIC CLIENT
Presented by:
Varsha Patel
ASSESSMENT
• Matthew Port is a 16 year old male.
• He is asthmatic and is taking bronchodilators and anti-inflammatory
drugs.
• He was diagnosed at the age of 10.
• He has environmental allergies and is also allergic to latex.
• Factors that contribute to his asthmatic condition are his allergies to
pollen, ragweed, dust, and household animals.
• His medications are a systemic corticosteroid named prednisone
and a bronchodilator named albuterol.
• Plays recreational sports and soccer competitively.
• His chart shows that he had orthodontic treatment in 2004.
• He brushes twice, daily and he also flosses once, daily.
• He says that he tried the best he can to practice proper oral hygiene,
but his mouth often feels dry and he recognizes that he breaths
through his mouth.
ASSESSMENT
MEDICATIONS
• prednisone: Prednisone is an adrinocortical steroid that inhibits the
accumulation of inflammatory cells at the inflammation site. It
decreases or prevents tissue response to the inflammatory process.
Matthew takes 5-60 mg/day of prednisone in divided doses. Some
dental considerations of prednisone are to avoid aspirin containing
products, assess salivary flow and to monitor healing processes.
Infections such as periodontal disease and candidiasis can be a
factor because of the decreased salivary flow (Mosby, 2007, p.10111012).
• albuterol: Albuterol acts by relaxing the bronchial muscle. Its
therapeutic effects involve relieving bronchospasms and reduces
airway resistance. Before Matthew participates in any sports he
takes 2 puffs of his inhaler 15-30 minutes before the exercise. For
relief any other time, Matthew can inhale 2-4 mg, about 3-4 times a
day. Many of the dental consideration or albuterol are the same as
prednisone, so it is important to monitor the client’s salivary flow,
vital signs and to avoid aspirin. It is also suggested to keep client in
semi-supine position during treatment (Mosby, 2007, p. 74-75)
ASSESSMENT
INTRA AND EXTRA ORAL EXAMINATION
• no significant findings
• Angles class is one with an overbite of 20% and an
overjet of 3mm.
DENTAL CHARTING
• Since Matthew is asthmatic, he is on certain medications
that cause decreased salivary flow and xerostomia.
• He has multiple caries.
• He has sealants on most of his non decayed teeth.
• He has no rotations, which is related to him having
orthodontic treatment in the past.
• His third molars are still not present in the oral cavity, but
a radiograph will tell if they may be erupting soon.
ASSESSMENT
PERIODONTAL SCREENING AND RECORDING
3 1 3
3 1 2
DENTAL RADIOGRAPHS
• Matthew has multiple restorations in his posterior sextants
• The Dentist prescribed that 4 horizontal bitewing radiographs be
taken, along with a panorax. This choice was made based on the fact
that Matthew is prone to decay, and these radiographs will show any
re-decay or new caries in these susceptible areas.
• Since Matthew also is at an age where his third molars may be starting
to erupt, and since Matthew has undergone orthodontic treatment a
panorax was taken to see the status of the 3rd molars.
• Matthew’s radiographs showed that he has minimal incipient caries on
the interproximal areas of teeth 33D, 34M and 14D. These teeth will be
monitored but no present treatment will be done.
ASSESSMENT
PERIODONTAL ASSESSMENT
• generalized inflammation along with generalized edema.
• light extrinsic staining on the lingual aspects of his teeth,
which may be related to his consumption of sport drinks.
GINGIVAL INDEX
• His final rating was a 1.58 which places him in the
category of fair.
PLAQUE INDEX
• generalized plaque accumulation
• His final score was 0.30 which places him in category B.
PROPHYLAXIS CLASSIFICATION
• Class 1
DENTAL HYGIENE DIAGNOSIS
• Potential for caries related to ineffective
salivary flow
• Plaque accumulation related to ineffective
home care practices in brushing and
flossing
PLANNING
DENTAL HYGIENE CARE PLAN
GOALS
INTERVENTIONS
EXPECTED OUTCOMES
(1) Arrest development of
new carious lesions by next
CC.
(1a) Discuss the use of
Biotene mouthrinse and gum.
(1a) CT will use 15ml of
mouthrinse 2x/day AM&PM
and use gum when needed.
(1b) CT will drink water
instead of sport drinks and
especially after using inhaler
(1c) CT will rinse with 10ml of
Weekly Fluorinse on Sunday
nights.
(1b) Discuss benefits of
drinking water throughout the
day
(1c) Discuss the use of a
weekly fluoride rinse.
(2) Improve GI from fair to
good by next CC.
(3)Improve PI from A to B by
next CC.
(2a) D+D modified bass
technique using a soft tooth
brush.
(2b) D+D spool flossing
method using waxed floss.
(2a) CT will brush 2x/day
AM&PM.
(2a) (2b)
(2a) (2b)
(2b) CT will floss 1x/day PM
after brushing.
PLANNING
COMPREHENSIVE TREATMENT PLAN
• OHI (Brushing, flossing, salivary substitutes, intake of water and
fluoride).
• PD+PA sext #1
#2
#3
#4
Using hand instruments
#5
#6
• Fluoride treatment using sodium fluoride (NaF) foam and trays.
• CC in 3 months (August 2008).
(Air polishing, power driven polishers and ultrasonic scalers are
contraindicated in asthmatic clients)
IMPLEMENTATION
Before the appointment
• Review medication and its side effects and
interactions.
• Tell him to bring his bronchodilator to the clinic.
• Ask about the frequency of his asthmatic attacks
and whether they are properly controlled.
• Since he is on prednisone, he will need a
consent letter from his physician in order to be
treated.
• KNOW HOW TO MANAGE AN ASTHMATIC
EPISODE
IMPLEMENTATION
1st Appointment
• Once Matthew is seated, the dental hygienist will make
sure he has a consent letter from his physician so that
he can be treated (for the use of prednisone).
• The dental hygienist will review his health history and
ask him again about the frequency of his asthmatic
attacks.
• His bronchodilator should be kept visible on the dental
cart.
• Since he mentioned being allergic to latex, a pair of
nonlatex gloves will be needed during his appointment.
• HH, BP, CE, C, PSR, 4 BW, PAN, GI, PI, CP, TP.
IMPLEMENTATION
2nd Appointment (one week later)
• Matthew should have his bronchodilator with him and have it on the
dental cart during treatment.
• Since he mentioned being allergic to latex, a pair of nonlatex gloves
will be needed during his appointment.
• Update HH, BP, CE, GI, PI, OHI, PD+PA. of sextants #1, #2 and #3.
3rd Appointment (2 weeks later)
• Matthew should have his bronchodilator with him and have it on the
dental cart during treatment.
• Since he mentioned being allergic to latex, a pair of nonlatex gloves
will be needed during his appointment.
• Update HH, BP, CE, GI, PI, review OHI, PD+PA. of sextants #4, #5
and #6, FL NaF foam with trays.
• Schedule appointment for evaluation and next CC appointment 3
months later.
EVALUATION
• Throughout his treatment. Matthew showed great
improvement in both his GI and PI scores.
• When he returned to the clinic in August 2008 for his CC
appointment, he did not have any new carious lesions.
• Matthew stated that he’s been using the Biotene
mouthrinse daily as well as the fluoride rinse once a
week.
• He also mentioned drinking water instead of sports
drinks and after using his inhaler.
• Matthew’s GI score improved from 1.58 to 0.07 which
places him in the “excellent” category.
• His PI score improved as well from 0.30 to 0.10 which
places him in the “A” category.
QUESTIONS
1. What is one of the most important things for an asthmatic
client to have visible when at a dental appointment?
a) Juice
b) An epipen
c) a bronchodilator
d) Doctor’s note allowing treatment
e) a & c
2. Which of the following is contraindicated when treating a client
with asthma?
a) air polishing
b) ultrasonic
c) fluoride treatment
d) a & b
e) all of the above
REFERENCES
• Darby, M.L., Walsh, M.M. (2003). Dental Hygiene Theory and
Practice. (2nd ed). Philadelphia, PA: W.B. Saunders Company.
• Mosby’s Dental Drug Reference (2007). (8th edition). St. Louis,
Missouri, Mosby Elsevier.
• Statistics Canada. (2008). Persons with asthma, by age and sex.
Retrieved April 6th, 2008 from
http://www40.statcan.ca/l01/cst01/health49b.htm
• Wilkins, E.M. (2005). Clinical Practice of the Dental Hygienist. (9th
ed.). Baltimore,MD: Lippincott, Williams and Wilkins.