Dental Hygiene TREATMENT PLAN 2

I.

HEATHER WILHELMI, APRIL 2015

ASSESSMENT
A. Patient: 41 yr. old male, unhappy with appearance of teeth, occupation is welder,
breathes in the weld dust
B. Social History: Smokes 5 cigarettes/day, for 15 years, has cut back from 1
pack/day, drinks socially 2x/week
C. Diet: Mostly healthy diet, lots of protein, except regular consumption of pop and
energy drinks throughout the day, snacks on popcorn in the evening
D. Medical History: Regular check-ups with family physician, no current or recent
illnesses. No hospitalizations. No allergies or medical conditions. Normal blood
pressure and cholesterol level.
E. Medications: 15 mg. meloxicam 1x/day, 5-325 hydrocodone as needed for prior
injury to cartilage in ankle, 10 mg. ambien 1 x/night for sleep (Xerostomia)
F. Dental History: No regular dental check-ups due to lack of insurance. Last
hygiene visit approximately 2000, last exam for extraction of broken teeth and to
check into orthodontic options 2013, radiographs done 2013.
G. Oral Hygiene Habits: Brushes 2x/day with a medium bristle toothbrush, Crest prohealth dentifrice, and Listerine mouthwash. Flosses, but not often because it is
too hard to get floss between teeth and when does uses the floss in holder.
H. Vitals: BP 124/82
I.

Intraoral Exam: Fibrotic non-resilient gingiva, papilla necrosis, no other oral

lesions or pain, some generalized recession (1mm), bilateral linea alba, extrinsic
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staining, visible tenacious calculus, class C, multiple areas resembling

demineralization, Missing molars #1, 14, 16, 17, 19, 30. Molar #3 amalgam filling.
Maxillary and mandibular anterior crowding with canines almost directly behind
laterals. Plaque score 70%.
J. Extraoral Exam: General appearance WNL. No irregular palpations. TMJ WNL.
K. Periodontal Exam: Multiple probing depths ranging from 5-7mm, furcations on all
remaining mandibular molars, inconsistent bone levels, no BOP, no loose teeth.
L. Radiographs: Dated 2013, due to cost patient declined new radiographs. Visible
sub-calculus, bone loss of varying levels, #3 may have recurrent decay around
filling and other areas of possible decay.

II.

DIAGNOSIS
A. Overall health: Good
B. Periodontal Case Type: Generalized Advanced Periodontitis
C. Severity Level: Moderate Severe
D. Calculus Level: Class C

III.

PLAN
A. Consultations: Periodontist regarding periodontitis, prescription for chlorhexidine
from Dentist, smoking cessation programs provided 1800#, caries restorations
with Dentist

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B. Treatment Goal: Arrest bone loss through removal of plaque/calculus, reducing

risk factors, and personalizing oral hygiene techniques thus improving
inflammatory response and gingival health. With good homecare and follow-up
prognosis is good.
C. Treatment Phases:
a. Preliminary: Assess data and complete diagnostic statement.
b. Therapy: Educate and OHI, chlorhexidine, cavitron, hand scale, root plane,
fluoride application, polish.
c. Evaluate: Check for success of therapy and progress of oral health.
d. Surgical/Restorative: Refer to periodontist for further assessment and
treatment of periodontitis and diagnosis/restorations of caries with
general dentist.
e. Re-evaluate: 3 months and with increased oral health status can schedule
maintenance for 6 months.

IV.

IMPLEMENTATION: 1st appointment(s) = education and cavitron. Discuss plaque

score of 70% and explain the formation of biofilm to plaque to gingivitis leading to
periodontitis. Motivate the patient by explaining that the bone loss is permanent and
if it progresses could lead to tooth loss and more severe bone issues. Discuss how
OHI can be personalized to help improve health and stop the bone loss. With
prescription of chlorhexidine from dentist provide brushing instructions to use soft
bristle brush in small circular motions angled toward the gingiva to stimulate and
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clean under gingiva, use chlorhexadine 2 xs daily to brush and swish, no toothpaste.
Give flossing instructions and explain why wrapping it around the tooth will clean the
areas under the gingiva better that using the premade flossers, recommend super
floss for getting into the tight contacts. Medications may cause xerostomia which
plays a role in acid level in mouth. Describe how this along with the sugary drinks can
increase caries risk. Recommend rinsing with H2O, not bottled since it may not have
fluoride, throughout the day and to lessen intake of energy drinks and pop to help
balance pH between brushing. Recommend chewing Trident with xylitol to
supplement use of chlorhexidine and assist in production of saliva. Explain the
effects of smoking on his oral health and recommend smoking cessation programs.
Break up calculus with cavitron, offering anesthesia if uncomfortable. Based on
patients comfort level, split cavitron scaling into 2 appointments starting with the
arch having the most plaque first. Before next appointment explain to patient that
they need to focus on hygiene and toughening tissue by flossing 2x/day, and rinsing
with salt water 1x/day. This is to help tissue toughen between appointments to
lessen bacterial introduction into the bloodstream.
V.

2nd appointment(s) = scaling, root planing, and fluoride application. Schedule for a
couple weeks after initial appointment(s). Scale and root plane by quadrant, offer
anesthesia and break into more than one appointment, if appropriate based on
patients comfort level. Apply fluoride varnish focusing on exposed roots to help with
sensitivity and help with areas of demineralization. Recommend patient continue
with OHI and make adjustments if needed. Allow patient a month to practice new
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hygiene techniques and to utilize chlorhexidine. Next appointment in one month reevaluate condition of tissue, biofilm, probing depths and healing progress. Revisit
OHI and adjust if necessary. If tissue has healed, polish using fine grit and reapply
fluoride varnish, since not using dentifrice with fluoride. Refer to periodontist for
further assessment and treatment of disease and to get restorations for caries. Next
appointment in 3 months to re-evaluate treatment and confirm oral health response
is positive. Check condition of gingiva, plaque score, and probing depths. Discuss
status of smoking and diet changes. Adjust OHI if needed and reaffirm the
importance of keeping the bone loss arrested. Hand scale, polish and apply fluoride
varnish. If patient cooperated and participated in improving oral health then it is time
to schedule for maintenance recall appointment in 6 months at which time we will
reassess condition and review techniques.

VI.

EVALUATION: When complete with ultrasonic, hand scaling, and root planning at
each appointment use the explorer and floss to confirm sub-gingival calculus has
been broken up/removed. Check supra-gingival calculus removal using air. At each
appointment review the oral health including intra and extra oral examinations,
probing depths by charting, plaque score index, and radiographs as prescribed to see
if treatment has been successful and that patient has maintained good hygiene habits
using initial assessment data as a baseline. Review OHI, status of smoking,
medications, and diet changes. Make adjustments if needed. If successful then put
on a 6 month recall maintenance appointment schedule.
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WORKS CITED
Clark, Shaunda (2015). Dental Hygiene II, Kirkwood Community College.
Wilkins, E. (2013). The professional dental hygienist. In Clinical Practice of the
Dental Hygienist (11th ed., pp. 6-9 & 351-359). Philadelphia, PA: Lippincott
Williams & Wilkins.

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