Treatment Plan Assignment 2

Kylie Hill

Kirkwood Community College

I. Assessment

a. Patient interview: Patient goes to The College of Dentistry for all of her
dental needs/concerns. The patients last prophy was in December 2017.
The patients main concern is plaque and calculus but reports, “my upper
left feels weird”. Patient drinks diet mt. dew every morning and snacks on
“junk food” between meals. She also has started drinking “fizzy” water,
which is flavored, carbonated water.
b. Medical concerns: Currently has no major health concerns, but patient
recently gave birth to her 3rd child in September and is currently
breastfeeding. She is allergic to penicillin/amoxicillin and her reaction if
exposed is hives. Patient is currently not on any medications. Dental
history: Patient brushes with a manual toothbrush and brushes 2x daily
with either Colgate or Sensodyne toothpaste. Patient reports that she
occasionally flosses only when she noticeably feels something stuck in her
teeth and does not use any mouth rinses.
c. Social history: Patient does smoke or chew and does not drink regularly.
d. Vital signs: First visit: Blood pressure was 126/78 and pulse was 80.
Second visit: Blood pressure was 122/78 and pulse was 67.
e. Extra-oral exam: within normal limits. Intra-oral exam: Within normal
limits, chapped lips, bite mark and her left cheek, bilateral mandibular tori,
palatal tori, slight fissured tongue, #10 peg lateral, attrition generalized to
her maxillary and mandibular anteriors, areas of erosion/abfraction on the
buccal of mand. # 18, 19, 30 and 31 and all 3rd molars have been
removed.
f. Periodontal case type: Generalized healthy with localized gingivitis to
teeth # 14,18, 19 and 22 where bleeding was present while probing.
Patient has generalized 1-3 mm probing depths with localized 4 mm
depths on teeth # 3,18, 19, 28 and 31. I was unable to get a plaque score
on the first appointment due to time restraints, but her plaque score was
30% on the second appointment.
 g. Radiographs: Patient had 4 horizontal bitewings last taken in January
2017. Patient has never had a CMS at the College of Dentistry but after
Dr. Harris did her initial assessment she approved to update her bitewings
since it has been two years and requested a periapical of teeth #4 and 15
due to very deep pulpal caries and patient saying is feels “weird”. After I
took x-rays and Dr. Harris did her exam decay has occurred on teeth # 13,
14,15 and very deep pulpal caries that were asymptomatic on tooth #4.
Dr. Harris requested a consult with Dr. Cavalcanti in the Endodontic
department.
II. Dental Hygiene Diagnosis

a. Level of health: Mild systemic disease, ASA II. Patient is allergic to

penicillin/amoxicillin making her level of health jump up to ASA II.
b. Generalized healthy patient with localized gingivitis on teeth # 14,18,19
and 22 due to bleeding while probing. She is at risk for caries because she
drinks diet mt. dew every morning and only occasionally flosses. She has
had fillings in the past, which means caries are always going to be present
in her mouth and currently has decay on teeth #2, 13, 14 and 15.
III. Plan

a. Consult: Operative for restorative work, Endodontic consult and Perio for
crown lengthening after her root canal.
b. Treatment goals:

 Have patient continue to brush 2x daily using the bass method

and to develop a daily flossing routine.
 Reduce plaque score.
 Keep areas of 4 mm probing depths from progressing.
 Put patient on a 6-month recall.
c. Preliminary Phase: information was gathered at assessment, the patient
isn’t in pain but on tooth # 4 there is very deep pulpal caries. Endodontist
Dr. Cavalcanti determined a root canal is needed on tooth #4 before my
patient’s prophy appointment.
Phase I (Therapy):

 Biofilm control: Plaque score, oral hygiene routine

 Additional Preventive Measures: Fluoride
 Calculus Removal: Hand scale
 Corrective Restorative Irritants: #13 had MO caries with a defective
distal.
 Restorative Caries Control: Needed on teeth # 2, 13, 14, and 15.
Outcomes Evaluation of Phase I:
 Probing Depths: probing depths remained stable
 Clinical Signs of Inflammation: decreased areas of bleeding while
probing
 Dental Biofilm Control: lowered plaque score
 Patients Participation: daily oral hygiene flossing daily using the C-
shape method.
Phase II (Surgical): Endodontic treatment was needed on tooth #4. Root
canal was successfully completed and following Endo treatment patient
was sent to Perio department for crown lengthening of tooth # 4.
Phase III (Restorative):
 Final restorations: restore carious lesions
 Fixed/removable prostheses: N/A
Evaluation of Overall Outcomes: restorations are not mobile, no pain,
no recurrent carries around the restorations, and the root canal does not
fail.

Phase IV (Maintenance):
 Appointments for continuing care and supervision: 6-month recall
for DHYG, 2 week follow up in PERIO for crown lengthening.
 Refining biofilm control technique: continue to brush 2x daily using
the bass method and to floss multiple times a week.
IV. Implementation

a. After reviewing medical history, dental history, intra-oral exam, extra-oral

exam and collecting data; go over OHI and dietary consult.
 Brushing: Patient does a good job use a manual toothbrush by
brushing in circular motions and angling the toothbrush 45
degrees towards the gumline. Recommend an electric toothbrush
to help reduce her plaque score.
 Flossing: Stress the importance of flossing 1x daily. Demonstrate
the proper technique by wrapping the floss in a C-shape around
each tooth and to gently seesaw the floss between the contacts
so no damage is done to the gums. Then have the patient demo
flossing for you and critique if necessary. By using the “Tell-Show-
Do” process the patient should feel more confident in flossing at
home.
 Gingivitis: Explain to patient that while I was probing there were
a few areas of bleeding that occurred and that this is a sign of
gingivitis. Talk about how flossing daily will remove the plaque
and bacteria from between her teeth and in return reduce
bleeding, which will then reverse her gingivitis.
 Dietary consult: Patient would benefit from a diet consult. In
between meal she snacks on “junk food”, drinks diet mt. dew or
“fizzy” water every morning. Explain to the patient how these
drinks and foods play a role in the caries process.
(Sugar+Bacteria from plaque= Acid, Acid+ healthy tooth=Decay)
Recommended taking sips of water after drinking her pop or “fizzy
water to help neutralize her mouth.
b. No anesthetic needed during her cleaning appointment, but during her
endo and perio appointments anesthetic is needed.
c. Scale full mouth by hand.
d. Polish full mouth with fine grit prophy paste because patient has minimal
staining and light-moderate plaque score.
 e. Floss full mouth with unwaxed floss.
f. Fluoride varnish due to moderate caries risk. Post operative instructions:
can eat and drink right away, no alcohol for a couple of hours, don’t eat
excessively hot or cold items such as soup, coffee, or ice cream. Wait to
brush teeth for six hours or brush the next morning.
g. General dentist will examine patient’s oral cavity and consult patient about
restoring her carious lesions. Endodontist will come in for an endo consult
on tooth# 4.
h. Make appointment for restorations on teeth #13,14, 15.
V. Evaluation
a. How will/did you evaluate care: Would evaluate care with comparing
charting, radiographs, and improvement of oral hygiene.
b. Follow up charting: Charting full mouth, probing, bleeding while probing,
and plaque score to see if any improvements, stabilized, or worsening of
gingivitis has occurred.
c. Radiographs: Horizontal bitewings in 2 years. Patient has never had a
CMS at the College of Dentistry. CMS are supposed to be done every 3
years. OP200 are supposed to be taken every 5 years.
d. Patient oral hygiene behavior changes: continue to brush 2x daily using
the bass method, floss multiple times a week, lower bleeding while
probing and lower plaque score.
 References

Boyd, L., Wilkins, E., Wyche,C. (2017). Clinical practice of the dental hygienist.

Philadelphia, PA: Wolters Kluwer. (12) 398, 409, 440.

Crossley, H., Meiller, T., Wynn, R. (2018). Drug information handbook for dentistry

including oral medicine for medically compromised patients & specific oral

conditions. Hudson, OH: Lexicomp. (24)