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Copy of Case Study A - Maya Patel

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Amelka Em

on 2 February 2014

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Transcript of Copy of Case Study A - Maya Patel

Case Study A:
Maya Patel
Health History:
-Female
-9 years old
-Height: 4'5'', Weight: 70 lbs.
-Asthma
-Several Visits to the ER for difficulty breathing (none in past 5 years but still keep inhaler on tray, semi supine position)
-ASA II
Medications:
-Montelukast Sodium (Singulair) - Selective Leukotriene receptor antagonist (pg 902 of Mosby's Dental Drug Reference - 10th Edition)
Uses - prophylaxis and chronic treatment of asthma
Dosage - for 6-14 years - one 5mg chewable tablet once a day in the evening

-Albuterol (Proventil HFA) - bronchodilator inhaler - Adrenergeic B2 agonist (pg 81 of Mosby's Dental Drug Reference - 10th Edition)

Assess salivary flow as a factor in caries, periodontal disease and candidiasis
Rinse mouth after each dose, frequent sips of water.
Asprin/sulfite preservatives in vasoconstrictors containing products
can exacerbate asthma
Dental History:
-6 months appointments
-Gag reflex
-Mouth breather
-Impressions indicated for Occlusal evaluation
-Nervous about dental treatments
History/Vitals:
-Blood Pressure: 100/60 mm Hg
-Pulse Rate: 110 bpm(70-100)
-Respiration: 20 rpm
Patient History Synopsis
1.Generalized Marginal plaque with slight bleeding on probing
2. Slight supragingival calculus on lingual surfaces of the mandibular anterior teeth
3. Slight generalized brown stain
4. Slight tongue thrust
5. Slight gingival sensitivity distal to the mandibular left permanent canine
6. Maxillary left primary first molar is mobile
Biopsychosocial Characteristics
Physical-Physiological
Characteristics:
(of a later childhood: 7-12 years)
-Must watch occlusion problems (size, location, and alignment of newly erupted teeth, as well as space allocated for anticipated permanent teeth).
-Hormonal changes - including estrogen and progesterone in the blood stream, which can affect the gingival tissue.
-Child is taking responsibility for oral care habits - developing coordination, motor skills, and motivation
-Independent and active children are at risk for oral trauma (playing or organized sports).
Psychologic-Behavioral
Characteristics:
-Children begin to understand and use simple logic as they gain understanding of relational concepts. Will listen to hygienist and work to keep healthy mouth to impress elders.
-Counseling of substance abuse and oral piercings.
-Bright/healthy smile or esthetics for social interaction
-Constant reassurance of accomplishments in dental appointments
LaShawnda Cunningham, Zuzana Guider,
Ula Sokolowski, Aga Szatko, Nirali Vora
Planning
Social History:
-9 year old female
-Lives with both parents and 5 year old brother
-Both parents work - middle class family
-Moved to United States 6 years ago from India
-Hindu - significances in diet and culture
-Patient in 4th grade - likes math and poetry.
Assessment
Diagnosis
Implementation
and Evaluation

Instrumentation
-The most appropriate instrument for subgingival deplaquing for a pediatric patient with gingivitis is the universal curette.
rounded toe
curved back
complex shank
-These characteristics allow for better adaption near the gingival margin and when necessary, subgingival instrumentation in shallow sulci, throughout the entire mouth without having to stop and change instruments when progressing to different regions.

-Also, consider using mouth block
Sealants
-Dental sealants are thin plastic coatings that are applied to the grooves on the chewing surfaces of the back teeth to protect them from tooth decay
Most tooth decay in children and teens occurs on these surfaces
Sealants protect the chewing surfaces from tooth decay by keeping germs and food particles out of the grooves.
Home-Use Fluoride
-The use of xerostomia-causing medications and mouth breathing puts this patient at an increased risk for carries. A self-applied home-use fluoride should be recommended
-Although Chlorhexidine is more effective at reducing bacterial plaque, its adverse effects of irritation to soft tissues and change in taste sensations may be compounded by the taste changes and xerostomia this patient experiences as a side effect of her medication.
Professional Fluoride Treatment
Used to promote remineralization of tooth surfaces
Applied based on the patient's need.
Patient has an increased risk for caries so she should have a topical fluoride treatment applied.
Due to reduction of salivary flow, a neutral sodium fluoride is the agent of choice.
review all info from the histories
identify the presence and severity of infection, and the risk factors for oral health
utilize data to rate the extent of the needs and provide a baseline for continuing comparisons
determine obstacles:does the patient show willingness and readiness to learn? How may cultural values and beliefs promote or block the patient's response and application of home care recommendations?
GINGIVITIS-an inflammation of the periodontum that is confined to the gingiva resulting in damage to the gingival tissue that is reversible.
Bacteria causing gingivitis: Actinomyces, Streptococcus, and Fusobacterium.
H.P, D.P, Vitals, medications research, ASA status
EOIO, gingival description
BI, Probing Depths, Periodontal Classification
Subgingival Exploring, Deposit Assessment
Caries detection, Contributing Factors
Coated Tongue
Caries detection - Patient presents with a history of interproximal caries , existing MO amalgam filling on #I,
Staining - Suspicious staining on D of #H and around an existing filling on #I
Active Caries on #B
Eruption of mandibular 1st premolars
Anterior Overjet
Dietary factors
Medications
Systemic disease
Patient presents with mixed dentition
All teeth are developing within normal range in accordance with patient's age
Panoramic radiograph, intraoral pictures:
Abnormalities: both mand. canines have 2 roots.
Both, her medical condition and ineffective self care proves that patient is in a higher risk in developing a dental disease.

Looking at the data, the probe depths range between 1 to 3 mm. Also slight, generalized bleeding was noted. Therefore, her perio status would be classified as Gingivitis.
Contributing factors:
Treatment planning is a part of ADPIE:
ADPIE is an acronym for:
Assessment
Diagnosis
Planning
Implementation
Evaluation
Examination:
Examination (cont.):
What to Assess?
Polishing:
Marginal Plaque/Dental Plaque Biofilm
Light generalized brown stain
Extrinsic stain range from tan to dark brown in color and occur over broad, smooth tooth surface and in pits and fissures. Occurs on the external surface of the tooth and may be removed by procedures of toothbrushing, scaling, and/or polishing.
 Scaling is an effective method of removing stain, when power-driven polishing contraindicated for the patient exhibiting signs of respiratory difficulty.
Use a Soft bristle toothbrush with a mild abrasive toothpaste
Method of patient management: Show-tell-do is the simplest and most effective way to ease apprehension in all patients who appear nervous of treatment procedures. Must use Baby Steps!!! Do not overwhelm patient
Disclosing agent: Make plaque biofilm visible
Use of a soft bristle toothbrush or electric toothbrush
Modified Bass technique: good plaque biofilm removal from gingival margin and sulcus.
Floss: (waxed) help to prevent trauma to soft tissue. May consider using a floss handle if patient lacks dexterity due to young age.
Self Care:
The amount and frequency of eating fermentable carbohydrates has the greatest potential for decay and may be a factor in cultural food preferences and eating habits.
Understanding the risk potential for caries and explaining the importance of a well-balanced diet from all food groups would be important nutritional counseling information to share with the preparer of child’s food.
Vegetarianism is commonly associated with the Hindu diet
May not consume any animal products such as any meats or even milk
Choose other calcium sources (help build and maintain strong teeth and bone) such as fortified foods and beverages (dark green vegetable: collared greens, spinach, etc)
Protein (helps maintain healthy skin, bone and muscles): beans, peas, nuts, lentils, soy, and seeds
Vitamin B-12 ( necessary to produce RBC and prevent anemia)
Vitamin D ( role in bone health)
Nutrition:
Includes the provision of inform consent for all procedures
Keep inhaler near by
Includes all components related to instrumentation principles and procedural techniques while maintaining infection control practices throughout the patient care session (Angulation, Activation, Adaption)
Polish/Stain Removal
Fluoride Application
Also includes Counseling (nutrition, dental and periodontal disease)
Implementation:
Evaluation:
Act of measuring to which extent the goals specified in the plan of care have been achieved and the need for modification, setting new goals and a continuous plan for improving or maintaining oral health.
Evaluation is always on-going and underlies all phases of care
What are we looking for with Maya?
Natural eruption of permanent teeth
Less/No Caries due to proper self care (proper brushing techniques, flossing, mouth rinses)
Less staining
Less bleeding and continuous smaller pocket depths
Reduce gingivitis to state of health
Less coating of tongue
Reduction of Tongue thrusting (or consideration of Ortho treatment)
References:
Analysis and utilization of patient needs and clinical findings (including radiographs and other diagnostic tests) in the synthesis of patient data. This data culminates in a summarization of the patient's actual or potential oral health problems or deficits that are able to be treated through dental hygiene care.
Self Care (2):
Tongue brushing: Brush the tongue with toothbrush
Improvements for the patient who has xerostomia, coated tongue
Tongue cleaning with tongue scraper
Non-alcoholic rinses (Biotine)
Daily Habits - Tongue Thrusting (orthodontic treatment)
Daniel, Susan J., Sherry A. Harfst, and Rebecca Wilder. Mosby's Dental Hygiene: Concepts, Cases and Competencies. Edinburgh: Elsevier Mosby, 2007. Print.

Jeske, Arthur H. Mosby's Dental Drug Reference. 10th ed. St. Louis, MO: Elsevier Mosby, 2010. Print.

Thomson, Evelyn M. Case Studies in Dental Hygiene. 2nd ed. Upper Saddle River, NJ: Pearson Prentice Hall, 2009. Print.
Diagnosis:
Maya's Diagnosis:
Maya's Diagnosis:
ADPIE:
Tongue thrust
Mouth breathing
Calculus
Anticipatory Guidance:
Preparation to help relieve fear and anxiety of an event
Explain each procedure to the patient and the parent
Early appointments help with anxiety
Likes math/poetry - find ways to incorporate into discussion while working on patient
-Stickers/Sticker Chart
-Reward system during 6 month recall
-Parental involvement
-Gross Book
Motivational Techniques:
Dental Impression
-A mold taken of the teeth or jaw and used in the fabrication of dental appliances to be used in restorative dentistry or orthodontics.
Have patient breath in and out nose
Direct patient to hum favorite song while tray is being placed.
Decide on impression material
Select correct tray size
Full transcript