Comprehensi ve Care Patient Amber Carey 4272020 Case
Comprehensi ve Care Patient Amber Carey 4/27/2020
Case Selection Rationale No significant medical risk factors Last physical approximately 2006 Recommend for patient to have physical Very low dental knowledge Heavy smoker Infrequent re-care appointments Only seeks dental care when in pain Poor oral hygiene Moderate motivation to improve home care Diet high in sugar
Medical History ASA II 32 year old male Brushes once per day, Flosses never No medications Last prophylaxis unknown Allergy to cats and Ceclor Only seeks dental care when in pain Ceclor makes him severely ill Smokes one pack or more of cigarettes per day Dental History Somewhat interested in quitting Drinks 5 alcoholic beverages per week Last dental visit in 2015, limited exam focused on #15 Teeth 2 and 15 extracted due to extensive decay in 2015 RCT #31 Radiolucency around apex #31, asymptomatic Diet high in sugar
Odontogram
Radiographs Radiographic Analysis: Generalized slight-moderate bone loss.
Intraoral Photos
Periodontal Chart
Initial Assessment Plaque Index: 70% Bleeding Index: 67% Calculus Analysis: Generalized Class III Gingival Description: Generalized moderate-severe red, marginal, edematous, spongy, loose, rolled, pyramidal, hypertrophy
Initial Assessment Caries Risk Nutrition Drinks 1 -3 sodas per day High Caries Risk Frequently snacks throughout day Diet high in sugar Diet high in carbohydrates and sugar Active decay Frequently eats fast food Inadequate brushing frequency Inadequate flossing technique and frequency Infrequent routine dental visits High plaque indices Generalized severe demineralization
Periodontal Risk Factors Heavy smoker Infrequent dental care Poor home care: Brushes once per day, does not floss at all Two molar teeth extracted due to extensive decay Class III calculus High Periodontal Risk Assessment
Periodontal Diagnosis and Prognosis Generalized Severe Chronic Periodontitis Good Prognosis if: -Disease treated -Improved home care - Maintains re-care appointments -Quits tobacco use
Treatment Plan Appointment # Length &Intervals between appts Plan for Treatment and Services Appointment #1 Procedures: 1. Comprehensive Evaluation 2. FMX 9/19/19 3. Caries Risk 4. OHI 5. Tobacco Cessation 6. Nutritional Counseling Appointment Procedures: #2 1. IPT UR quad 2. OHI 10/18/19 - skills 3. Tobacco Cessation test 4. Nutritional Counseling. Plan for Education and Counseling 1. Demo bass brushing 2 xdaily with electric TB for 2 min. 2. Demo c-shape flossing once per day 3. Discuss oral systemic link 4. Nutritional counseling 5. Tobacco cessation 1 month 1. Evaluate home OH improvement 2. Discuss disease progression 3. Tobacco cessation 4. Nutritional counseling 5. Demo bass brushing with electric TB 2 xdaily for 2 minutes 6. Demo c-shape flossing
Treatment Plan Appointment #3 10/25/19 Appointment #4 11/1/19 Procedures: 1. IPT LR quad 2. OHI 3. Tobacco Cessation 4. Nutritional counseling 1 week Procedures: 1. IPT UL quad 2. OHI 3. Tobacco Cessation 4. Nutritional counseling 1 week 1. Evaluate healing of UR quad 2. Evaluate plaque indices 3. Evaluate home OH 4. Demo bass brushing with electric TB 2 xdaily for 2 minutes 5. Demo c-shape flossing 6. Tobacco cessation 7. Discuss oral systemic link 1. Evaluate healing of right side 2. Evaluate plaque indices and home care 3. Demo bass brushing with electric TB 2 xdaily for 2 minutes 4. Demo c-shape flossing and use of soft picks as needed. 5. Tobacco cessation 6. Nutritional Counseling 7. Discuss oral systemic link
Treatment Plan Appointment #5 Procedures: 1. IPT LL quad 11/8/19 2. OHI 3. Tobacco Cessation 4. Nutritional Counseling 1 week Appointment #6 1 month 12/6/19 Procedures: 1. 1 month evaluation 2. OHI 3. Caries Risk 1. Evaluate healing of previous 3 quads 2. Evaluate home care and plaque indices 3. Tobacco cessation 4. Demo bass brushing with electric TB 2 xdaily for 2 min. 5. Demo c-shape flossing and soft picks as needed 6. Tobacco Cessation 7. Discuss oral systemic link and importance of keeping good OH 8. Antiseptic mouthrinse to reduce bacterial load 1. Evaluate healing of tissues 2. Evaluate home care and plaque indices 3. Evaluate tobacco use/Tobacco cessation 4. Demo bass brushing with electric TB 2 xdaily for 2 mintues 5. Demo c-shape flossing 6. Recommend antiseptic mouthrinse 7. Nutritional counseling 8. Discuss oral systemic link
Treatment Plan Appointment #7 3/6/19 Procedures: 1. SPT 2. Periodic evaluation 2. OHI 3. Caries Risk 3 months 1. Evaluate home care and plaque indices 2. Demo bass brushing with electric TB 2 xdaily for 2 minutes 3. Demo c-shape flossing and soft picks as needed 4. Tobacco cessation 5. Nutritional counseling 6. Oral systemic link
Dental Hygiene Diagnoses Interventions 1. Increased potential for inflammation related to inadequate flossing. 1. Educate about c-shape flossing due to knowledge deficit of flossing technique and frequency. 2. Increased potential for inflammation related to inadequate brushing frequency. 2. Educate about bass brushing with an electric toothbrush for 2 minutes twice per day due to knowledge deficit of proper brushing technique and frequency. 2. Patient will reduce plaque around gingival margin by 25% by next appointment and marginal inflammation will begin to subside. 3. Increased potential for continued bone loss, delayed wound healing, and poor vascularity within the gingiva related to heavy smoking habit. 3. Educate patient about the risks involved with tobacco use due to knowledge deficit of oral and systemic effects of continued use. 3. Patient will be educated about the effects of tobacco use and will begin to think about quitting. By the following appointment patient will be able to have set a quit date. 4. Educate patient about beginning stages of oral cancer due to knowledge deficit of effects of tobacco use. 4. Patient will know the signs of abnormal changes within his oral mucosa. He will understand the importance of tobacco cessation and will be able to establish a quit date by next appointment. 5. Educate about disease progression and the importance of recall visits due to knowledge deficit of restoring teeth when carious lesions are small rather than only going to dentist when in pain. 5. Patient will understand the importance of frequent re-care visits. Patient will no longer seek dental treatment only when he is in pain. He will understand disease progression and how together as a team, we can prevent carious lesions from becoming so large it causes the patient pain. 4. Increased potential for mucosal changes related to tobacco use. 5. Increased potential for decay/demineralization related to infrequent recare visits. Outcome Statements Realistic, specific, measurable, time bound 1. Patient will begin to start flossing 3 times per week and reduce interproximal plaque by 30%.
3 Day Food Diary Multiple exposures of soda/energy drinks
3 Day Food Diary Multiple exposures of soda/energy drinks Processed deli meats High in sodium
3 Day Food Diary Multiple exposures to soda/energy drinks Fast food High in sodium Empty calories
Nutritional Analysis Excess Deficiencies Vitamin C Sodium Iron Carbohydrates Fiber Sugar exposures Vitamin D
Nutrition Recommendations Increase Vitamin C Aids in healing of oral tissues Smokers require 35 mg more than RDA Citrus fruits such as oranges and pineapple Limiting soda to one per day or only at mealtime Reduces frequency of acidic exposures Chewing xylitol gum to raise p. H Avoid processed foods frequently found in fast food Reduces sodium intake Increase variety vegetables Fortified cereal Will increase fiber, iron, and vitamin D intake Limit snacking frequency Self cleansing snacks such as cheese and apples
Expected Improvements Periodont al Health Tobacco Cessation Nutritional Counselin g
Self Care Education Adjuncts Motivation Modifications • Electric toothbrush • Soft picks • C-shape flossing • Disease progression photos to educate • Oral systemic link • Motivational interviewing • Multiple appointments to reinforce tobacco cessation
Patient Involvement Always on time to appointments Very easy to work on Patient with long appointment times Had to reschedule multiple times due to work conflicts Treatment plan timeline delayed Scheduling conflicts
Successes of Program Patient ceased tobacco use within two weeks of comprehensive exam Patient increased brushing frequency to twice per day Patient increased flossing frequency using floss picks to approximately twice per week Patient reduced plaque indices Patient states wife has noticed a difference in his teeth
Opportunities to Improve Oral Health Patient had not yet scheduled appointment with family DDS for evaluation of caries and radiolucency on #31 Patient had not had physical from physician Continue to increase flossing frequency, ideally once per day
Conclusion Patient has made an improvement on his oral health Patient quit tobacco usage Patient increased brushing frequency to twice per day Patient increase flossing frequency to approximately twice per week Patient gained motivation to improve oral health since wife has noticed a difference Patient has not seeked treatment for carious lesions and suspicious radiolucency Afraid he will continue only seeking care when in pain
My Thoughts Pleased with the progress of my patient Tobacco cessation Improved home care Would have liked to have seen at one month evaluation Follow up on getting treatment for carious lesions and radiolucency Progress photos
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