The Dental Hygiene Process of Care
(Wilkins, 2009)
Assessment:
Medical and Dental History:
Medications:
Blood Pressure: 118/78
Pulse: 100
Oral Inspection:
Permanent Teeth Present- 3, 7, 8, 9, 10, 14, 19, 22, 23, 24, 25, 26, 27, 30
Diagnosis:
Planning
Implementation:
This is the phase where the dental hygiene services are performed. The special accommodation’s that were implemented were shorter appointments because the patient presented to the clinic anxious. Also, instead of a child sized cuff, an adult cuff was used when taking the blood pressure due to the obesity of the patient. The ultrasonic scaler was not used due to the primary dentition that was still present.
Evaluation:
Since Alex had generalized plaque and carious lesions, it was recommended that he should have three month recare appointments. At every appointment with Alex, his home care should be assessed to ensure that the proper technique for brushing and flossing is used to remove plaque on a daily basis. Another recommendation is that fluoride should be given at every appointment. The benefits of fluoride should be discussed with Alex and his mother. The carious lesions present should be discussed with Alex and his mother and restorative procedures should be scheduled.
Medical and Dental History:
- Alex is currently under the care of his primary physician for nutritional counseling and behavioral issues.
- He sees an endocrinologist for growth hormone treatment to increase his growth, decrease his body fat, and improve his muscle tone.
- He is on a strict and well-balanced diet that includes healthy foods that are proportioned throughout the day.
Medications:
- Somatropin injection- growth hormone
- Testosterone- sex hormone to help with the development of sex organs
- Clotrimazole- treatment of candidiasis
Blood Pressure: 118/78
Pulse: 100
Oral Inspection:
- Xerostomia
- Thick and sticky saliva
- Plaque Index- 84%
- Candidiasis is present on the palate
- Gingival color- generalized red
- Gingival consistency- smooth and shiny
- Gingival contour- generalized thickness and rolled
- Gingival shape- generalized bulbous and flaccid
- Position of gingival margin- generalized coronal to CEJ
- Carious lesions are clinically visible on every tooth
- Generalized severe attrition
- Generalized enamel hypoplasia
- Generalized moderate plaque build up
- No evident bone loss
- Based on the radiographs and clinical evaluations the patient is in mixed dentition state.
Permanent Teeth Present- 3, 7, 8, 9, 10, 14, 19, 22, 23, 24, 25, 26, 27, 30
Diagnosis:
- The xerostomia is caused by the patient’s systemic disease, medications, and his decreased salivary flow. By increasing his water intake and recommending him xylitol mints, this may produce an increased salivary flow thus decreasing his risk for caries.
- The candidiasis that is present on his palate is caused by the xerostomia and his condition. He is currently prescribed Clotrimazole to treat the candidiasis.
- His gingival tissues appear red as a result of his decreased salivary flow, poor home care, and the excessive plaque present throughout his dentition.
- The carious lesions that are present on every tooth are caused by the patient’s decreased salivary flow and his frequent carbohydrate intake. Since he is currently seeing a physician regarding nutrition the patient’s caries risk should decrease.
Planning
- Appointment 1: The medical and dental history was assessed. Intra/extra oral inspection was completed. A plaque index was completed. A panoramic and four horizontal bitewings were taken. Patient education was discussed and the Modified Stillman’s Method was recommended and demonstrated to the patient and the guardian. The proper flossing technique was demonstrated to both patient and guardian.
- Appointment 2: The medical and dental history was reassessed and intra/extra oral inspection was performed. A plaque index was completed to see if the patient had improved with his home care. Patient education consisted of evaluating the patient’s brushing and flossing techniques and a reiteration of the proper technique was demonstrated with the guardian present. The use of fluoridated toothpaste was introduced and discussed. The patient was hand scaled and selectively polished in all four quadrants. A five percent neutral sodium varnish was applied to the entire dentition with post-operative instructions.
Implementation:
This is the phase where the dental hygiene services are performed. The special accommodation’s that were implemented were shorter appointments because the patient presented to the clinic anxious. Also, instead of a child sized cuff, an adult cuff was used when taking the blood pressure due to the obesity of the patient. The ultrasonic scaler was not used due to the primary dentition that was still present.
Evaluation:
Since Alex had generalized plaque and carious lesions, it was recommended that he should have three month recare appointments. At every appointment with Alex, his home care should be assessed to ensure that the proper technique for brushing and flossing is used to remove plaque on a daily basis. Another recommendation is that fluoride should be given at every appointment. The benefits of fluoride should be discussed with Alex and his mother. The carious lesions present should be discussed with Alex and his mother and restorative procedures should be scheduled.