Iggy Plan of Treatment

Kirkwood Community College

Ronda Parker

1. Assessment
a. Interview: Iggy is an 80 year old female. Her chief
complaint is I need my teeth cleaned and a regular
examination.
b. Medical: This person has GERDs disease, congestive heart
failure for which she was hospitalized for on February 14,
2014. She has an irregular heartbeat that is controlled
with a pacemaker and defibrillator, which was replaced in
November of 2013. Due to a kidney disease she only has
her left kidney her right was removed in 1980. She has
had 11 of her intestine removed due to diverticulitis in
1996. She also had a benign brain tumor removed on July

6, 2010. She also has high blood pressure that is

controlled by her medication Lipitor. Aside from Lipitor that
has no precautions, she is also on atenolol, calcium,
carvedilol, citalopram, omeprazole, moexipril,
spironolactone, furosemide, lorazepam, doxepin,
atorvastatin, and digoxin. Lorazepam and doxepin cause
xerostomia but have no other precautions. Digoxin causes
a sensitive gag reflux and caution is to be used when using
vasoconstrictors as it increases the risk of cardiac
arrhythmias. Omeprazole can cause taste perversion, dry
mouth, esophageal candidiasis, and mucosal atrophy.
Citalopram states to use anesthetics with caution
otherwise can cause xerostomia and abnormal taste as
well as increase the risk of bleeding and can cause bruxism
and involuntary muscle movements. Carvedilol can cause
postural hypotension and periodontal disease. She has a
drug allergy to Demeral and Duracef.
Dental: Though her last dental exam was in February of
2012, she usually receives regular dental examinations.
Patient brushes with a soft tuft manual tooth brush daily
and flosses daily. She uses Crest ProHealth and rinses with
Biotene mouth rinse for the dry mouth.

c. Special needs implications: Due to having the GERDS and

the possibility of postural hypostatic tension, it is
imperative that the patient be seated so that her head is
above her heart and is almost in a sitting position rather
than being laid back flat. This will help to reduce the
possibility of acid reflux or orthostatic hypotension, which
is fainting.
d. Social: Patient eats snacks throughout the day and is
usually fruits, vegetables, and nuts though sometimes will
eat chips.
e. Vital signs: BP 110/61
f. Extra Oral: All areas were WNL.
Intra Oral: WNL though has a white coating on her tongue
caused mostly by her medications. She has 26 teeth.
Plaque score: 38%. Calculus class B. Gingiva had areas of
recession and normal flat contour in posteriors and is
otherwise knife-edged and pointed and is generalized pink,
stippled, firm and resilient. Tooth #23 has rolled gingiva
and anterior lingual teeth have recession. Class I occlusal
on the left and class II with edge to edge on the right
posterior teeth.
g. Periodontal examination: Patient has pocket depths of
4mm to 5mm in the posterior teeth and 3mm or less in the
anterior teeth which have been maintained from the
previous probe readings with only one spot of bleeding.
She also had some areas of furcation class I on 15, 31, 19,

and the buccal of 30 and class II on teeth number 23 and

18.
h. Due to being on omeperazole, this patient can have some
oral and esophageal candidiasis. Being on Citalopram, this
can cause her to have bruxism which could cause attrition
and abfraction to her teeth. Carvedilol has been shown to
cause periodontal problems as well. With a majority of her
medications causing xerostomia, she has an increased risk
for cavities.
i. Radiographs: Horizontal bone loss in areas of molars
shown as well as restorations.
2. Diagnosis
a. This patient only had one area of bleeding and had pink
healthy gingival tissue.
b. Periodontal disease present: Generalized moderate and
due to maintained probing depths chronic.
c. Caries: No current carious lesions past caries have been
restored.
3. Plan
a. Consultations necessary: Needs to see dentist for regular
examination.
b. Treatment goals: Continue to maintain periodontal stage,
decrease plaque score.
c. Phases of treatment: Hand scaling in all 4 quadrants, root
planing, and debridement to help maintain disease.
Remove plaque and stain with prophy angle and nupro fine
prophy paste and floss full mouth. Apply varnish fluoride
treatment due to areas of recession.

d. My role is to help patient in the removal of the plaque and

calculus build up as well as to review with her how to
maintain her current level of periodontitis. Her role while
at the appointment is to comply with the treatment as well
as learn how to improve her oral health. She is to continue
with her current home oral hygiene using a few different
techniques and corrections.
4. Implementation
a. This patient can only be hand scaled due to her pacemaker
but this should be more than adequate as she has low
amounts of calculus. I will be udsasing the prophy angle to
remove the plaque that is on the teeth as well as any
stains on the outer surface of the tooth.
b. Counsel the patient in how to reduce the amount of plaque
at the gingival areas using the bass technique and angling
the tooth brush 45 degrees towards the gingiva. Also
discussing with patient using the brush vertically in the
anterior teeth. Discussed using a c shape to floss around
her teeth for best results and to continue with her current
habits with the small changes we worked on to improve her
oral health. Also discuss that she should rinse her mouth
out with water after eating meals or snacks and to wait at
least 20 minutes before brushing after eating or drinking
liquids other than water. Discussed using interdental brush
for larger spaces if there is food stuck.

c. Homecare aids recommended was the size 20 toothbrush

to be able to adequately get her anterior teeth where there
is more crowding.
d. No anesthetic given as patient reports no sensitivity at this
time.
e. No prescriptions written.
5. Evaluation
a. I was able to remove all of the calculus in the areas
addressed (maxillary and mandibular anterior teeth). I was
also able to polish the anterior teeth with no plaque left on
them. Only manual instruments were used to remove
calculus due to the light amount of calculus and the patient
having a pacemaker.
b. New radiographs could be made in the future to assess
whether or not patient is maintaining her level of
periodontal health as well as to continue to monitor any
areas of possible carious lesions.
c. Patient stated that she will continue to keep brushing and
flossing and using Biotene with her normal routine as it has
currently been working for her but that she will use the
minor adjustments in hopes to do an even better job. With
this I believe she will maintain her current periodontal
health and lower her plaque score.
Works Cited:

Wilkins, E. M. (2013). Clinical practice of the dental hygienist. (11th

ed.). Philadelphia, PA: Lippincott Williams & Wilkins, a Wolters
Kluwer business.
Wynn, R. L., Meiller, T. F., & Crossley, H. L. (Eds.). (2013). Drug
information handbook for dentistry: Including oral medicine for
medically compromised patients and specific oral conditions.
(19th ed.). Hudson, OH: Lexicomp. http://www.lexi.com