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Dental Hygiene Case Study

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by

Judith Elizondo

on 31 October 2012

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Transcript of Dental Hygiene Case Study

Turning Point Success Challenge Dental Hygiene
Case Study by: Judith Elizondo Case Overview: Dan is 50 years of age who has been attending the dental office since 2011. He discovered he had type II diabetes mellitus 5 years ago. Also in the last year he discovered he had Hepatitis B.

Medication taking: Metformin x2 daily 500mg.

Chief complainant at initial assessment: Bleeding gums.

Social History: Patient is a non-smoker, and a casual drinker.

Dental History: mildly filled dentition, in 2011, patient required dental referral for 2 restorations. Intra oral- NAD
Extra oral- NAD
Class I: L & R, with mild lower anterior crowding Dental Findings: Clinical (white spot lesions): 17 distocclusal, 47 occlussal
BW radiographs - no suspicion of caries
Diet: he likes to occasionally binge on fizzy drinks particularly L& P. Dental Chart: Periodontal findings: .moderate generalised build up of plaque

. localised subgingival calculus ++

. general appearance of gingiva:
red and edematous
bulbous interdental papilla.

. localised recession.

. probing depths 1-4 mm, with some localised areas of 5 to 7 mm pockets.

. Generalised BOP ++ Oral Health Assessment
Review Findings: "Wisdom is the practical application of knowledge" Diabetes Mellitus is the absence or insufficient production of (insulin) a hormone produced by the pancreas. Factors contributing to disease Research suggests there is a two way relationship, between diabetes and periodontal disease (Nield-Gehrig & Willmann, 2011). Metformin Causes oral complications such as xerostomia. altered function of cells
altered wound healing
increased systemic inflammation
poor glycemic control Risk Factors altered function of cells
altered wound healing
increased systemic inflammation
poor glycemic control Oral Health Assessment
Review.....continued Oral Health Assessment
Review.....continued Risk Analysis: Risk Management Inadequate oral hygiene:
. Plaque biofilm
. Calculus deposits

Diet:
. Poor dietary habits


Medications:
. Causing dry mouth



Diabetes:
. Duration
. Poor glycaemic control


Hereditary:
. Family history of disease



Alcohol
. Increases blood glucose Poor self care:
. Improve plaque biofilm control
. Frequent professional care

Diet:
. Advised on fermentable carbohydrates
. Frequency of sugars

Medications:
. Aids in dry mouth
. Good oral hygiene
. Avoid sticky and sugary foods
. Fluoride

Diabetes:
. Work with physician
. Good glycaemic control


Hereditary:
. Chemotherapeutics
. Frequent professional care

Alcohol
. advice on lowering consumption (standard drinks)/advise on alcohol rehabilitation (suspected alcohol abuser) Periodontal Chart (Wilkins, 2009)

Objective:
. Control inflammation in the periodontium
. Preserve tooth attachment levels
. Maintain alveolar bone levels
(in turn maintaining the dentition throughout the life of the patient) Supportive Periodontal Therapy: Dental Management . Diet : Frequency of sugars, fermentable carbohydrates

. Discuss dental caries disease process.

. Stress importance of oral hygiene: Demonstrate modified Bass.

. Motivate patient: 30 day plan.

. Higher use of fluoride: GC Tooth Mousse Plus (white spot lesions), help replace lost minerals from the teeth.

. GC Dry Mouth: Alleviate dry mouth, sugar free gum & frequent water intake. Periodontal Management . Non surgical debridement -Appt 1- Q2, Q3
Appt 2- Q1, Q4

. Discuss periodontal disease process

. Advised on (Colgate Total) antibacterial tooth paste: (active ingredient is triclosan), reduces supragingival calculus & reduces gingival inflammation.

. Use of Savacol for 2x daily for 2 weeks. After 30min from brushing. To reduce periodontal pathogens.

. Encouraged the use of Listerine daily (essential oils), after having had used Savacol.

. . Universal standard precaution (infection control)
. Vaccination
. No ultrasonic- viral infections can be transmitted through aerosols produced by utlrasonic Treatment precautions: talk about imbalance Medium Manual toothbrush
Brushes 2 twice a day, at times doesn't brush at night
Flosses 2-3 times a week (sometimes uses toothpicks)
Sometimes uses Listerine Current Oral Hygiene Habits: Periodontal chart Periodontal Chart Diagnosis Localised Severe Chronic Periodontitis Diagnosis Gingivits, with
Localised Severe
Chronic Periodontitis Caries Risk: High Perio Risk: High Cancer Risk: Low Inadequate personal oral hygiene:
. Plaque biofilm
. Calculus deposits

Diet:
. Poor dietary habits

Medications:
. Causing dry mouth

Hereditary pre-dispositon to disease (Diabetes)

Alcohol
. Sugar containing increasing glycaemic levels Risk Factors Referral Treatment Plan Apps in the morning

Appt 1

Appt 2

Appt 3

Appt 4 Supportive Periodontal Therapy Periodontal Chart If there appears to be disease recurrence in:

.disease is evident in multiple sites
. deep pocket progression
. BOP
. No improvement in inflammation
. In the presence of adequate patient self care

Then periodontal surgical therapy is indicated, I would recommend Dan see a periodontal specialist. Research evidence shows that periodontal maintenance should be performed every 3 months or less for the removal and disruption of subgingival periodontal pathogens (Nield-Gehrig & Wilmann, 2011). However..............
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