RAP

PROJECT
SPRING
2016
Mendez Jose #1714

Table of Contents
Personal History1
Medical History.2
Dental History...2
Extraoral and Occlusion Examination..3
Caries and Dental Examination ...3
Intraoral and Periodontal Examination4-5
Oral hygiene Evaluation..6
Nutritional Analysis.7
Fluoride Analysis.8
Caries Risk Assessment8
Oral Hygiene Instruction and Plan.9-12
Post Instruction Status.13
Discussions14-16
Conclusions16
References..17
Appendices.18

I)

Personal History
1) Age: 37 Years Old
2) Sex: Female
3) Race: Hispanic
4) Occupation: House wife
5) Marital Status: Married

II)

Medical History
1) Past Medical History:
a) No history on medical conditions.
2) Past Medication or Drug Use:
a) No drugs or medications
3) Family History:
a) Mother has a history of diabetes and high blood pressure.
b) Father has a history of high blood pressure.
4) General:
A) As of today the patient is in great medical conditions.
5) Review of Systems (Neurological, Psychological, Functional,
Respiratory, Cardiovascular, Dermatological, Gastrointestinal,
Sexual, Hematological, Endocrine, Immunological):
6) Current Medication:
a) No medications.
7) Baseline Vital Signs:
(a) During the first appointment the baseline vitals were taken and
determined to be within normal limits.
(1)BP: 118/78
(2) P: 74
(3) R: 18
8) ASA Status with Rationale:
(a) ASA I: Due to patients health status, Patient did not have any
health conditions or allergies and is currently taking no
medications.

III)

Dental History:
1) Past History of dental exam, treatment, and hygiene visits:
a) Previous dental exam was done two years ago 6/30/14.
b) She had two carious lesions restored and dental prophylaxis
done.
2) Present Status:
a) Patient currently has most maxillary molars restored.

b) Patient needs a dental hygiene appointment for full mouth

prophylaxis especially anterior maxillary and mandibular
sextants.
IV)

Extra Oral and Occlusion Examination

1) Extra Oral Examination:
a) Upon extra oral examination patient presents everything within
normal limits.
2) Occlusion, TMJ, and Oral Habits:
a) Patient presents with class I on right moral and canine
relationship as well as class II on left moral and canine, no
observable open, edge to edge or cross bite
b) Upon TMJ assessment patient presented with sings of bruxism
on the mandibular anterior teeth #s 22, 24, and 25. Patient
mentioned that she was clenching her teeth at night so she was
advised to go see a DDS for a night guard due to tenderness on
her jaw in the mornings, there was no clicking, popping.
c) There was hyperkeratinization of the left cheek which may
implicate cheek biting due to clenching. The patient was not
aware so therefore it indicates that she has been doing it in her
sleep or subconsciously

V)

Caries and Dental Examination

1) Identification of Decalcification, Possible Caries, and Defective
Restorations:
a) Patient presented with no decalcification and no observable
white spots were seen, however roughness was noticed. This
may be due to poor oral hygiene, having a buildup of dental
plaque biofilm on the surfaces on the teeth.
b) Upon oral examination, Possible Carious lesions were seen on
teeth numbers 1O, 2O, and 8DF. After discussing with her she
was advised to see a dentist to have those carious lesions
examined.
c) Teeth numbers 2O, 3O, 8DL, 9DLf, 14O, 15O, 18O, 19O,
29O, 30O, 31O, and 32O had previews restorations that were
done.
2) Quality of Restorations Evaluated:
a) All Maxillary and mandibular molars restorations seem in
excellent condition, with no overhangs, chips, or any
deformity.

3) Caries Location and Type Evaluated:

a)
4) Caries Index (DMFT) Recorded and Evaluated:
a) D
(1) 3
(a) Patient presents with class I on all maxillary and
mandibular molars and class III on maxillary centrals.
(b) Class I possible recurrent caries on #2 and class III on
#8.
b) M
(1) 0
c) F
(1)12
d) DMFT=3+0+12=15
5) Address Radiographic Findings Noted on FMX and Panoramic
Image:
a) Not available
VI)

Intra Oral and Periodontium Examination

1) Intra-Oral Soft Tissue are Assessed and Correlated:
a) Intra-Oral examination was within normal limits except for a
notable observation on the left cheek. The patient presented
with linea alba of the left oral mucosa and after discussion, we
concluded that the linea alba was from clenching her teeth at
night.
b) Noted a 2mm x 2mm traumatic lesion from a toothbrush stated
by the patient on the mucogingival junction of tooth #23.
2) Gingival Description and MBI:
a) Maxillary Gingiva:
(1) Free Gingiva: Generalized pink with localized
Erythematous, soft, scalloped papilla
(2) Attached Gingiva: Generalized Pink, Firm, with stippling.
b) Mandibular Gingiva:
(1) Free Gingiva: Generalized pink, firm, knife-edged papilla.
(2)Attached Gingiva: Generalized pink, Firm, with stippling.
3) Full Mouth Probing, Recession, Furcation and Mobility
Assessment:
a) Full Mouth Probing
(1) Generalized 2-3 mm pocket depth, localized 4mm of
posteriors

(2) 2mm recession on facial of teeth #20 &21

(3) No furcation
(4) No mobility
(5) Other findings: Exostoses noted on maxillary and
mandibular right side alveolar bone and around teeth #24 &
26.

4) Periodontal Disease Etiology:

a) Periodontal disease is caused by the interaction of the bacteria
in dental plaque biofilm with the host. With this interaction,
there is inflammation of the periodontium, and through time it
will result in the destruction of the alveolar bone and
connective tissues. Bacteria are the main cause of most
periodontal disease, systemic and local factors contribute to the
progression of the disease.
5) Periodontal Perpetuating Factors:
a) Patient has never had a dental hygiene appointment, therefore
she has not been taught the right techniques on how to brush or
floss properly. Oral hygiene education was implemented, so
that would be the greatest contributing factor on her
periodontium. The way that the patient was brushing, circular
motion, and not having a brushing sequence was not effective
for dental plaque biofilm disturbance. Also, the fact that she
was not flossing at least once per day to disrupt the bacterium
contributed to the localized 3-4mm pockets that was noted
above.
b) Patient has parafunctional havits (primarily bruxism) which
can alter the anatomy of normal tooth structure and
periodontium causing occlusal wear, damage the supporting
structures, and TMJ pain and dysfunction. Patient experiences
jaw tenderness in the mornings and acknowledges the wear of
mandibular anterior teeth.
6) Radiographic Interpretation for Periodontium and Oral Pathology
a) Not available.
7) AAP Classification
a) Patient was classified as AAP: Generalized Moderate Chronic
Periodontitis due to the localized 3-4mm on the molars, as well
as the 1mm recession on the facial of the mandibular left
premolars #20 and 21.
VII) Oral Hygiene Evaluation
1) Plaque Control Index Recorded and Evaluated:
a) The patients initial plaque index was at 87.5% on 3/08/16.
Main areas of concern were interproximal and facial areas
since patient was not flossing and brushing properly prior to
oral hygiene instructions. However, plaque index did show
dental plaque biofilm on almost all surfaces of her dentition.

After oral hygiene instruction, the patients plaque index

dropped to 39% on 3/25/16, which was a 48% decrease,
showing improvement as well as compliance from the patient.
The patient did improve on plaque control on most of her teeth
but we still had to work on the C-shaped technique due to the
patients incorrect and aggressive form of flossing.
2) Patient Skill Level:
a) While doing oral hygiene instructions, the patient had some
knowledgeable on how to properly do things but did not had a
sequence on how to do it she was all over the place. Once the
patients was shown, and given a chance to try it for herself, she
was able to do the technique properly, with some trouble in the
beginning. Grasping the skill to floss correctly took a bit of
instruction, but the patient seemed motivated, especially with
the modified bass technique. Patient was a fast learner
however, and she was able to developed proper skills to
incorporate the different techniques into her oral hygiene.
3) Patients Knowledge and Awareness of Dental and Periodontal
Disease
a) Patient was not educated in the aspect as to how the mouth
correlated to systemic issues. The patient explained that
Gingivitis was only bleeding of the gums, and did not know
that more damaged could be done if there was no periodontal
maintenance of her gums.

VIII) Nutritional Analysis

1) Carbohydrate intake: Patients Carbohydrate intake decreased but
she is still over the recommended RDA of carbohydrates.
2) Vitamin intake: Patients Vitamin intake increased.
a) 1st 3-day diet journal- 173 minutes of sugar exposure
c) 2nd 3-day diet journal-120 minutes of sugar exposure
3) Analyze BMI:
a) Patients weigt:135lb
b) Patients Height: 52
c) BMI: 24.7 She is (normal weight)
4) Activity Analysis:

a) Activities: house cleaning 3-4 times a week,2mile run 3times a

week
b) Activity Level: High
5) Nutritional Counseling:
a) Patient met 78% of targets
b) Patient is not deficient in micronutrients
c) Patient deficient in: vitamin C, D, K, potassium & iron, and
water.
d) Advised patient to:
1) Increase H2O intake to 2,000g/day (8-9 cups)
2) Get vitamin C from leafy green veggies, broccoli, tomatoes,
and berries.
3) Get vitamin D fatty fish, eggs fortified cereals.
4) Get vitamin K from frozen kale/spinach.
5) Get iron from meat, beans, nuts, sunflower seeds.
IX) Fluoride Analysis:
1) Current Usage of Fluoride:
a) Type
(1) Col gate Total dentifrice.
(2) ACT Mouth rinse.
b) Amount
(1) Colgate Total: 0.243% NaF 2x daily.
(2) ACT: 0.02% NaF 2x daily.
c) Supplement
(1) N/A
d) Water Concentration
(1) Water Concentration in the city of Los Angeles is 0.7ppm.
2) Identification and Rationale of Fluoride Focus:
a) Due to the possible carious lesions presented on mandibular
molars, and recent restorations of the maxillary molars, the
patient is high at risk for caries. Implementing fluoride would
be beneficial to the patient to help protect her dentition from
decay.
X)

Caries Risk Assessment

1) CAMBRA Assessment:
a) After evaluation of CAMBRA, the patient is at High risk for
carious lesions due to several factors, but the main ones being
visible cavitations and having caries within the last 3 years.
2) Provide recommendations Based on Patients need:

a) The patient should be using Prevident 5000 Plus and use it 2x

daily, as well as using a Chlorhexadine 0.12% rinse for one
week once a day, and discontinue for 3 weeks. While on
Chlohexadine, make sure that the patient is not using ACT
mouthwash, but may resume once Chlorhexadine is not in use.
3) Provide Education and Written Information on Caries Control and
Management:
a) The patient was informed that carious lesions are due to acidity
and fermentable carbohydrates that are in the mouth that the
bacteria feed on, thereby decaying the enamel surface of the
tooth. Saliva does help neutralize the acidity and repair.
Therefore the patient should pay attention and make sure that
she is not experiencing dry mouth, as well as watch what she
should eat and limit snaking between meals and limit the
amount of sugar fermentable carbohydrates. She should also be
using fluoride products, such as toothpastes and mouthwashes,
and make sure she is getting adequate plaque removal while
brushing and flossing. She could also supplement with xylitol
gum, which is an anticarogenitc, meaning that the bacteria
cannot ferment the sugar, thereby not being able to decay teeth.
4) Caries Risk Prognosis and its Rational:
a) The patient is at high risk for caries for multiple reasons:
(1) Generalized plaque.
(2) Visible cavitation.
(3) Cavity within the last 3 years
(4) Regular soda.
XI) Oral Hygiene Instruction and Plan
1) Designed to Meet Patients Needs:
a) Before suggesting anything to the patient, considerations
needed to be made as to what the patients capabilities were.
From speaking with the patient, she did not floss properly, and
was not brushing more than 30 seconds two times daily not
having a brushing sequence. Dentifrice was chosen based on
either price or whitening, and regular dental visits were nonexistent. Taking all the information into consideration,
developing on oral hygiene plan to work with her capabilities
and what she liked to do as well had to be implemented.
2) Developed Goals with Patient During OHI:

a) At each appointment, there were goals that were set to start

implementing the different aspects to improve her oral
hygiene. The first appointment, the patients chief complaint
was that her teeth did not feel smooth and that they were too
yellow. This was also noted while probing and exploring, so
something had to change at the time. During second
appointment, interproximal health was addressed as well as
fluoride treatments to go along with CAMBRA that was done
during that time. At the last appointment, a review of
everything that had been talked about was done, and any
additional questions that the patient had were answered.
3) Oral Hygiene Instruction and Rationale:
a) The patient experienced some tooth sensitivity, especially
around the premolar areas, and there were signs of recession.
Since the patient did experience the sensitivity, education on
5% potassium nitrate was done. The patient was using listerine
Antiseptic which in itself is good, but for this patient Colgate
Total, the abrasives on the dentifrice were too large, and just
the fluoride was not doing the job for sensitivity relief.
Therefore, the patient was introduced to Sensodyne, hoping to
alleviate sensitivity.
b) Observable recession was noted, and the patient demonstrated
how she brushed her dentition. Patient was using circular
method, and generally used a medium to hard bristled tooth
brush. Because of this modified bass technique was taught as
well as recommending the use of a soft bristle tooth brush.
Patient understood the reasoning, and was happy for the
change.
c) Dental floss was the next project for the patient. The patient
had some knowledge but was not flossing regularly, but when
she did, she did not use the C-Shaped technique, she used the
up and down technique, which was too aggressive for her
gingiva so it was stressed to the patient and she had to start
flossing at least twice a day on a more gentle technique and
also the C-Shape was shown.
d) When the patient returned for her next appointment, she was so
excited of implementing the techniques that were taught that
she was a little too aggressive on using her brush and floss, so
she had to be reminded on being gentler with her flossing and

brushing techniques. So the patient understood and said she

would try to be gentler from there on.
e) Patient was recommended to use ACT mouthwash, which is a
good idea for the patient because she is at high risk for caries
under CAMBRA, so the importance of implementing the
mouthwash was stressed and the use of 1.1% NaF toothpaste
would be recommended.
f) During the initial intraoral examination there were no signs of
xerostomia or salivary flow problems.
4) Smoking Cessation Program Recommendation:
a) N/A
5) Preventive Recommendations:
a) Fluoride varnish every 3 months
b) 1.1% NaF toothpaste
6) Possible Implications of Systemic Conditions:
a) The patient does not have any systemic conditions. As
discussed prior, possible carious lesions were observed as well
as the presence of plaque biofilm. Both of these issues are
interrelated, and affect the patients oral health. As a result, it
was stressed to the patient the importance of oral hygiene and
not to ignore the effects of the plaque biofilm, since it can
affect periodontium no matter how well her oral hygiene is.
7) Rationale for the Treatment Plan and Patient Needs:
a) First Appointments Treatment Plan was (3/08/16):
(1) Initial Periodontal Assessment, Intra-Oral photos,
Disclosing, Plaque Index, Post Disclosing, Intra-Oral
Photos and provided the patient with the 3 day diet journal.
a) Initial periodontal assessment was done to establish a
baseline that could be compared when patient came back
for reevaluation. Disclosing and plaque index were also
done at the initial appointment, again, so that there was
something to look and see how their oral health improved.
Provision of the diet journals was done at this appointment
as well, so that the patient could keep track as to what they
were eating, and determine alternatives, as well as assess
carbohydrate analyses and assess CAMBRA status.
The second appointment consisted of (3/15/16):
(2) Disclosing, OHI, CAMBRA, Nutritional Counseling, and
Carbohydrate Analysis, also another set of diet journals
were given.

a) Disclosed the patient at the second appointment so that

OHI could be done, and it would be easier for the patient
to see what they were missing when they were brushing
and doing their own oral hygiene. Once the patient was
disclosed, OHI was done, and shown how effective
simple alternatives can be. Nutritional counseling and
carbohydrates analysis was also done, in conjunction
with CAMBRA, to see what they could improve in their
diet, and to show them how their eating habits can cause
carious lesions. Another set of diet journals was also
given so the patient can either implement what they had
learned, and see the difference from the previous 3-day
diet journals.
Final appointment, 2 weeks after (3/25/16):
(3) Periodontal Evaluation, Disclose, Introral Photos, and a
review of her OHI and Nutrition.
8) Goal and Objectives of the Dental Hygiene Treatment:
a) The goals and objectives for the dental hygiene treatment were
for the patient to improve on their oral hygiene and drop down
on the plaque index score. As hygienists, we want our patients
to have a plaque index score. As hygienists, we want our
patients to have a plaque free index of at least 80% so this was
the main concentration of the scheduled appointments. Another
goal was to assess what the patient had going on from the start.
She had never had a hygiene appointment, and was not
consistent with going to the dentist, so this was a good eye
opener for the patient, and to take care of something most
individuals take for granted. Finally, the most important goal
of the treatment plan was to implement all the information that
the patient obtained from the first two appointments, and have
an overall improvement in their oral health.
9) DDS Referral, MD Referral and Specialty Referral
a) Suggested that the patient go see a dentist for possible carious
lesions, night guard for the bruxism, and have a hygiene
appointment, since ultrasonic scaling was not done recently.
No MD or specialty referral was given.
XII) Post Instruction Status
1) E&I Examination:

2)

3)

4)

5)

a) Extra Oral findings were within normal limits. Intra Orally, the
patient did have linea alba on the buccal mucosa of the left
cheek, so questions were asked to determine if anything could
be changed. The patient did say that she did bite her cheek
when she sleeps, and that is usually stressed induced.
Evaluation of Gingival Tissue:
a) Gingival tissue had improved after the oral hygiene
instructions. At the initial appointment the patient had
generalized soft, erythematic, scalloped with localized bulbous
papilla, with no anterior stippling. After OHI, at the
reevaluation, the patients gingiva had improved to generalized
firm, coral pink, generalized scalloped with localized to
bulbous papilla, and slight anterior stippling.
Periodontal Re-Evaluation:
a) At the periodontal re-evaluation the patient did have a lot of
improvement, with exception of localized 4mm pockets
depths. At the reevaluation the patient did improve on some of
the 4mm pocket depths, but not all had been resolved. Patient
still presented with light-plaque, as well as being classified as
generalized moderate chronic periodontitis. Recession levels
had not been changed, and the number of bleeding on probing
sites had decreased.
Patient Compliance with Recommended Home Care
a) Patient had followed all home care instructions by the book,
and did a very good job for the most part. Only issue was flossing,
but even attempting to floss was a big improvement. Only because
the patient used to floss holders, it was not a complete failure.
Hopefully, the patient will switch to regular waxed floss in the
near future.
Patient Compliance with Recommended Nutritional Diet
a) While going over the patients diet journals and doing the
carbohydrate analysis with her, the patient understood that
something needed to change. So the thought of changing her
habits were there; however, the patient had expressed later that
she had not been doing well with her diet, and did not follow
what had been told.

XIII) Discussions
Overall the treatment for this patient was very beneficial from the
tissue perspective. Since radiographs were not available, it is difficult to determine

whether or not the progression of periodontal disease has been arrested, still
progressing, or was never a progressive form to begin with at the initial periodontal
assessment because the progression of the disease it can only be determined by two
sets of x-rays taken at two different times. As far as the tissue is concerned, the
tissue did go from erythematic and spongy, to coral pink and firm. Just by those
signs, the gingival health had improved quite a bit just from the oral hygiene
instructions. The patient was not very knowledgeable as far as oral hygiene, and
demonstrated great interests in improving her at home care. She asked great
questions, and comprehended what was being told.
Once the nutritional analysis came around, the patient was already
very knowledgeable as to healthy and unhealthy foods. What she did not know was
what foods affect oral cavity. Once the first three-day diet journey was reviewed
with the patient, she started to understand what kinds of carbohydrates she would
be avoiding, and how often she should be eating. The difficult part for her was to
write what she ate, and to limit the snacking and to achieve her nutritional needs.
Besides these, the patient was very interested in the nutritional counseling, because
this was what she was interested in. During the second round of diet journals and
carbohydrate analysis, it was obvious that the patient understood what was taught,
and that she was making an effort to drop the exposure time, as well as achieve her
nutritional goals.
At the re-evaluation of the periodontal assessment, the patient did
improve with the original treatment plan of mainly nutritional guidance and oral
hygiene at home. It would have been interesting to see how much more the
patients oral health would have changed with the combination of ultrasonic and
hand scaling. As far as the patients treatment plan, introducing scaling would have
been very beneficial for her, and would have further improved her oral status.
Other than those factors, the original treatment was perfect for this patient, because
the patient did improve however slight those changes were. The tissue improved,
bleeding sites were reduced, as well as plaque index. Obviously, more
improvement would have been aspired, but without scaling, it is very difficult to
have reduction of pockets and have even less bleeding sites. The calculus that the
patient has is a great way for bacteria to adhere to, and creates more damage.
Therefore, without the removal of that, other issue could emerge.
Buccal exostoses are non-malignant lesions of little clinical
significance. The multiple masses in the maxilla are consistent with multiple
buccal exostoses, which are bony protuberances that arise from the cortical plates
in the maxilla and mandible. They usually occur in the late teens and early adult
years, and many continue to enlarge slowly over time. The etiology of the multiple
exostoses remains unknown, although it has been suggested to be the outcome of a

mild, chronic periosteal inflammation. The diagnosis of a buccal exostosis is based

on clinical and radiographic findings. An additional biopsy for diagnostic support
is usually not recommended.
Neither the torus nor the bony exostosis require treatment unless it
becomes large enough to interfere with function, denture placement, cause
recurring traumatic surface ulceration (usually from sharp food such as potato
chips or fish bones) or as used to get autograft as it is a potent donor site.7 When
treatment is elected, the bony mass may be removed using bone cutting bur or
chiseled off through the base of the lesion.
A major enzyme of saliva is salivary alpha-amylase, which catalyzes
the hydrolysis alpha bonds of polysaccharides. Therefore, with the secretion of
saliva, the human body also gets the protective properties from the salivary
amylase enzyme. The main issue is how salivary secretion and the secretion of
this enzyme affect those playing sports at a competitive level. According to an
article in the Journal of Sports Med, the act of exercising does not decrease the
rate of salivary flow, therefore increasing the amount of salivary amylase,
Physical exercise altered the 1D electrophoresis profile of salivary total protein
mainly by increasing the concentration of the polypeptide corresponding to SAA
[Salivary alpha-amylase] (Oliveira et al). This result seems unorthodox, since the
body goes through the sympathetic nervous system while doing strenuous activity.
However, knowing that salivary alpha-amylase can also be a protective barrier for
the oral mucosa, the body may have produced a biological role for the increase in
saliva, and the enzyme,
During exercise, sAA activity may provide a protective effect
against infection, since this enzyme has been shown to inhibit
bacterial attachment to oral surfaces [27]. This may be a
compensatory response to the lowering of immunoglobulin A (IgA)
after intense exercise as previously reported (Oliveira et al).
However, there is a catch with this enzyme. Even though it has
protective properties, and inhibits bacterial attachment to oral surfaces, salivary
alpha-amylase is one of the molecules that are associated with pellicle, salivary
macromolecules found in the pellicle, such as lysozyme and amylase (Bowen et
al). With the formation of pellicle over the tooth surface, generally within minutes
of excellent oral hygiene care, and salivary alpha-amylase breaking down
polysacharrides, this creates a great environment for bacterial attachment, mainly
Streptococcus mutans (S. mutans). The alpha-amylase hydrolysates the starch and
creates a starch derived glucan, which then initiates a glucan derived adherence.

This is particularly important with the current patient since she did show possible
carious lesions, and this may be due to the bacteria attachment of S. mutans acidic
properties, creating the decay.
VIV) Conclusion:
After doing all the research and re-evaluating my findings during the
appointments, I found out about the profession, and how we are the
investigators of the oral cavity. It troubling that we arent taught
much about the oral cavity during school, because of how important
it is, and how it opens the doors to the rest of our bodies. For
example, I would have never thought that when salivary glands
production of saliva is reduced it can lead to other problems in the
oral cavity. However, just by doing research and assuming that my
patient does not have these effects. I also learned the importance of
having radiographs, and how you cannot make, assume, or analyze
just by clinical observations. The best way I can describe this
profession is like being a detective. We as dental hygienists have to
look at something determine what we see clinically and radio
graphically, and then figure out what the problem is why its causing
what its causing. Its always a puzzle, there is always a learning
experience with every patient, no matter how small or big the
problem is periodontally.

Appendices:
1.

Copy of the treatment consent form

2.

Copy of the medical history form

3.

Copy of the pre and post oral hygiene progress form (PI)

4.

Copy of the pre and post oral hygiene progress form (PE)

5.

Copy of the nutritional analysis print out from Chronometer

6.

Copy of the food diary journal

7.

Copy of carbohydrate analysis form

8.

Copy of process Evaluation form of the Oral Hygiene Instruction

9.

Copy of pre and post photographs of non-disclosed teeth

10.

Copy of pre and post photographs of disclosed teeth

11.

Copy of radiographs (if available)

12.

Copy of full mouth probing print out

13.

Copy of full mouth probing (PE)

14.

Copy of CAMBRA process evaluation form

15.

Copy of CAMBRA form for patient recommendations

16.

Copy of eight Human Needs form

17.

Copy of all journals articles used for this project

Eight Human Needs

Chief Complaint:
The patients chief complaint was that her teeth felt rough and
dirty, she also had some sensitivity.
Goal and Care Plan:
Refer to DDS or Hygienist for SRP plus prophylaxis
Protection from health risks, anxiety, fear, and stress
Patient does not have any dental fear
Goal and Care Plan:
No special modifications needed
Wholesome Facial Image:
Patient is concerned about having rough and yellow teeth
Goal and Care Plan:
Refer to DDS or Hygienist for SRP plus prophylaxis and teeth
whitening
Skin and Mucous Membrane Integrity of Head and Neck:
Patient has BOP on numerous sites as well as plaque-induced
inflammation
Goal and Care Plan:
Meticulous OHI focusing on areas where patient revealed
presence of plaque. Demonstrate to patient these sites as well as BOP
sites.
Biologically Sound and Functional Dentition:
Patient presents with clenching
Goal and Care Plan:
Refer to dentist for night guard
Conceptualization and Problem Solving:
Patient must improve home oral hygiene for lifelong oral health
Goal and Care Plan:
Explained patient that inflammation and BOPs are reduced
when proper OH is implemented and with regular dental hygiene
visits. Explain patient of the effects of calculus and plaque on
gingival and periodontal health. Ask patient to demonstrate
techniques on brushing and flossing, modify techniques if needed and
have patient (tell, show, do), show patient areas of inadequate OH
with plaque Indices.
Freedom from Head and Neck Pain:
Patient experiences no pain in head and neck area and Extra
oral Examination is WNL

Goal and Care Plan:

No goals are needed but recommend regular visits to access
TMJ to make sure there is no pain.
Responsibility for Oral Health:
Patient should make regular visits to dental hygienist and
improve at home OH
Goal and Care Plan:
Refer to Dental Hygienist for regular visits. Revise OHI,
explain patient the etiology and progression of periodontal disease,
motivate patient on meticulous OH and set goals that can be
reevaluated at the next follow up appointment to show patient the
efficacy of the recommended OH regimen.
Appointment Plan:
1st Appointment (3/08/16)
Procedure:
RMH, Vitals, E&I, Periodontal Assessment, Plaque Index,
Intraoral Photos before and after disclosing, delivered Diet Journals
2nd Appointment (3/15/16)
Procedure:
RMH, Plaque Index, OHI, CAMBRA, Nutrition Analysis
3rd Appointment (3/25/16)
Procedure:
Reevaluation: RMH, Vitals, E&I, Periodontal Assessment,
Plaque Index, Intraoral Photos before and after disclosing, discussed
nutrition, reinforce OHI
Maintenance:
3 months recall

Work Cited:
Ficnar, T., Middelberg, C., Rademacher, B., Hessling, S., Koch, R., & Figgener, L. (2013). Evaluation of
the effectiveness of a semi-finished occlusal appliance a randomized, controlled clinical
trial. Head & Face Medicine, 9, 5. http://doi.org/10.1186/1746-160X-9-5

Medsinge, S. V., Kohad, R., Budhiraja, H., Singh, A., Gurha, S., & Sharma, A. (2015). Buccal Exostosis: A
Rare Entity. Journal of International Oral Health: JIOH, 7(5), 6264.

Moye, Z. D., Zeng, L., & Burne, R. A. (2014). Fueling the caries process: carbohydrate metabolism and
gene regulation by Streptococcus mutans .Journal of Oral Microbiology, 6,
10.3402/jom.v6.24878. http://doi.org/10.3402/jom.v6.24878

Stegeman, C. A., & Davis, J. F. (2015). Dental Hygienist's Guide to Nutritional Care (4th ed.). St. Louis, MO:
Elsevier - Health Sciences Division.