WESTLOSANGELESCOLLEGE

DENTALHYGIENEPROGRAM
SPRINGSEMESTER2016
RISKASSESSMENTPROJECTREPORT
DH189
ANADELOURDESRODRIGUEZ
1724

TABLEOFCONTENTS

Outline.........................................................................page112
Discussion..................................................................page1314
Conclusion...................................................................page1516
Summary.....................................................................page17
References..................................................................page18
APPENDICES.
1.Copyofthetreatmentconsentform
2.CopyoftheMedicalHistoryform
3.CopyofthePlaqueIndexform.
4.CopyofthethreedayFooddiarybeforeadvisingandafteradvising
5.CopyofthenutritionalanalysisprintoutfromComputersoftware
6.CopyofCarbohydrateanalysisform
7.CopyofProcessevaluationformofOralhygieneinstructions
8.Copyofpreandpostphotographsofnondisclosedteeth(1stappointment)
9.Copyofpreandpostphotographsofdisclosedteeth(3rdappointment)
10.Copyoffullmouthprobing.
11.Copyofprobingprocessevaluationform
12.CopyofCAMBRAProcessevaluationform.
13.CopyofCAMBRAformforpatientrecommendation
14.Copyof8Humanneeds
15.Copyofalljournalsarticles
16.GradingRubric


Rodriguez,Ana
DH151
April,2016
#1724
RISKASSESSMENTPROJECTREPORT

1.PERSONALPROFILE
a.Age:48

b.Sex:Female
c.Race:Hispanic

d.Occupation:Telemarketing

e.MaritalStatus:Married
f.weight:195pounds
g.height:56
i.Chiefcomplaint:MygumsbleedandIfeelmymouthalittledry,andsometimesmyteeth
aresensitive
2.MEDICALHISTORY
PastMedicalHistory:2006Diagnosedwithcervixcancer
Treatment:Receivedradiotherapyforafewweeks
Hadahysterectomy
uterus.ovariesandfallopiantubesremoved
2008Acquiredfungusinfectiononfeet
Treatment:Antifungalmedication.
Hospitalizations:2006Hysterectomy,hospitalizedfor4days.
Nocomplicationsaftersurgery

Pastmedicationordruguse:Cancertreatment:Patientdoesn'trememberthenameof
themedications.
Fungalinfection:DoctorrecommendedLamisil,patientwas
allergic,physicianchangemedication,patientdoesn't
rememberthename.
FamilyHistory:MothersMother:Diedofstomachcanceron1991.
MothersBrother:Diedofprostatecanceron2007.

MothersNiece:Diedofbreastcanceron2010.
Reviewofsystems:Patientdeniedanyneurological,psychological,functional,
respiratory,cardiovascular,dermatological,gastrointestinal,
sexual,hematologicaland,immunologicalconditions.

Theendocrinesystemwasaffectedbecauseofthe
hysterectomysurgeryon2008,patientstated,afterthesurgery,Ieat
sweetsmorethanusedIto.Inaddition,thepsychologicalsystemwasaffectedsincethepatient
wasobservedexpressinghowthecancersurgerychangedherlifesinceshedidnothaveanykids
andfeltfrustrationanddesiretobecomeamother.
CurrentMedication:None
VitalSigns: a.P:64

b.BP:120/80mmHg
c.R:16
ASAClassification:

PatientisallergictoLamisil(antifungal),accordingtotheASA
classification,allergiestoamedicationclassifiesthepatientasASAII.

3.DENTALHISTORY
Pasthistoryofdentalexam,treatmentandhygienevisits
a.LastFMX:December2014
b.Lastdentalexam:December2015
c.Lastdentaltreatment:ProphylaxisDecember2015
d.Dentalhygienefrequency:Onceayear
e.ScalingRootPlanning:
f.Existingrestorations:June2010
g.PeriodontalMaintenance:Patientstatesnobodytoldmeaboutit,justIhavetocomeback
forcleaningonceortwiceyear
h.Periodontalsurgery:None
i.Restorations:Amalgamrestorations:1O,3O,12DO,15O,
Compositerestorations:2B,3OB,4MO.5DO,14B,15B
PFMcrown:13donein2005.
Teethextracted:#17,18,19,29,30,31.
Partial removable denture: Patient states started to used it on December 2015, but she lost it,
patient also mentioned that when she was wearing the partial lower denture she felt more even
biteandlesspressureonthefrontteeth.

4.EXTRAORALANDINTRAORALEXAMINATION

ExtraOralExamination:WNL
Occlusion,TMJandoralhabits:
a)Angle'sArchRelationshipClassification

RightMolar:Unclassifiable

LeftMolar:Unclassifiable

RightCanine:ClassI

LeftCanine:ClassI

Overjet:3mm

Overbite:4mm

MaximumOpening:45mm

Openbite:none

Crossbite:none

Patientprofile:Mesognathic
b)TMJ:
Nonedeviation,clickingorpopping.
c)Oralhabits:
Signsofattritiononmandibular&maxillaryanteriorteeth,abfraction21
Intraoralexamination:WNL.
Patientpresentagrayishflatlesionofasize3x3mm,aroundthe
buccalandpalatalgingivaltissueoftooth13,whereshepresentsa
PFMcrown,patientstateshadanextensiveamalgamfilling
previouslytothecrown.Tomyopinionthelesionmaybebean
amalgamtattoobasedonthecharacteristicsandantecedentsof
thelesion,butIwouldliketomentionthatanyorallesiontheonly
waytogiveanaccuratediagnosticisthroughahistologicalstudy
whichIdon'tconsiderisnecessaryonthiscasesincepatients
statesisbeingonhermouthformorethan20yearswithno
changes.

Alsoduringthesalivaryglandsassessmentitwasnoticedavery
lowsalivaryflow,andpatientstatesIoftenfeelmymouthdry,and
thisgotworseaftertheradiotherapyon2008.

5.CariesandDentalExamination
a.Identificationofdecalcification,possiblecaries,anddefectiverestorations
Mostofthepresentrestoration(amalgamandcomposites)
Abfractiononbuccalof#20

Amalgamrestorations:1O,3O,12DO,15O,
Compositerestorations:2B,3OB,4MO.5DO,14B,15B,haveopenmargins
b.Carieslocationandtypeevaluated
Noneclinicalcavityobserve,FMXisnotavailabletogiveamoreaccurateevaluation.

c.CariesIndex(DMFT)recordedandevaluated

a.D=9,M=6,F=0

b.DMF:15

6.PeriodontalEvaluation
Gingivaldescription:

a.MaxillaryFreeGingiva:reddish,blunted,rolled,smooth.

b.MaxillaryAttachedGingiva:pink,smooth,shiny,stippled.

c.MandibularFreeGingiva:rolled,blunted,edematous,shiny,

d.MandibularAttachedGingiva:reddish,shiny,smooth,edematous,lackof
Stippling.
Fullmouth:BOP,Probing,Recession,FurcationandMobilityAssessments
BOP:
a.Baseline:23sites=14.74%
b.Final:13sites=8.33%
Probingdepths:
Baseline(03/04/16):Generalized4mmsand5mmspocketdepths
withlocalized6mmon#2D,3D.

Onmandibularanteriorteethprobingwasnotdoneduethe
presenceofsupragingivalcalculusagrossdebridementwouldbenecessaryforamoreaccurate
measurementoftheperiodontalpockets.

Recession:
#1B:3mm#2B:5mm#3B:4mm#14B:4mm#15B:3mm#16B:2mm#16P:6mm#15P:6
mm#14P:5mm#3P:2mm#21B:2mm#22B:2mm#20L:2mm#21L:2mm

Furcation:

Bucca#l2:ClassII#14:PalatalClassII#Palatal15:ClassIII#Palatal16:ClassII
Mobility:
+1:teeth#8,9,23,24,25,26,2,3,16
+:teeth#7,10

CAL:Recession+pocketdepth:
Buccal#18mm,28mm,37mm,149mm,158mm,
167mm,205mm,215mm,225mm
Palatal#37mm,1410mm,1511mm,1611mm

ToothExtrusion:
Dueofthemissingposteriorteethonthemandibulararch.
#3,4,14,15

PrimaryEtiology:
Plaquebiofilm
ChronicPeriodontitisisconsideredamultifactorialdisease,wherethebiofilmplaysthemain
etiologicroleforthedevelopedandprogressionoftheperiodontaldiseasedestroyingsupporting
structuresofthetoothsuchasbone.
PeriodontalPerpetuating(Contributing)factors:
Somefactorscontributingtothedevelopmentoftheperiodontaldiseasewere:
Themissingofmostofmandibularposteriorteethcontributedtothedecreaseofthevertical
dimension,addingpressuretotheanteriorteethduringmastication,causingmobilityon
maxillaryandmandibularanteriorteeth,(+1on8,9,23,24,25,26,and+on9,10).becauseallthe
frontteethhavetodoachewingfunctionwhichisdesignedtobeperformedbymolars.
Anotherfactor,thepoorlycontouredcompositesrestorationsonthebuccalofmaxillarymolars
(2,3,14,15)arecausingplaquetraps,leadingtoincreaseofgingivalinflammation.
ThePFMon#13it'scausingbiofilmaccumulationduetheopenmarginsandalsowhenitwas
preparedthebiologicalwidthwasn'tpreserved,theinflammationcanbeobservedaroundthe
toothandpatientbleedeasilywithlightprobing.
Thepatientsufferedfromxerostomiawhichdecreasedtheoralph,contributingtothe
accumulationofbiofilmandthepossibilitiestodevelopdentalcaries,becausemanyofthe
bacteriasrelatedtoperiodontaldiseaseanddentalcariesproliferatefasterinanacidic
environment.
FMXandPanoramicimage:

Noneavailable

AAPClassification&Rationale:
GeneralizedSevereChronicPeriodontitis
Duethegeneralizedpocketsdepthsof4mmsand5smm,recession
between4mm6mm,CAL6mm10mmmeaningasevereboneloss,also

thisprocesswasdevelopedthroughoutalongtimeperiod.

7.OralHygieneEvaluation
Plaquecontrolrecord,indexrecordedandevaluated:

03/04/16BaselinePFI10%

03/29/16FinalPFI40%
Thesecondappointmentwason03/11/16,thepatientreceivedacomprehensiveoral
hygieneeducationthatincluded:brushingandflossingtechnique,dentalaidsinformation,
recommendationsofuseofmouthwash,prescribedtoothpaste,nutritionalanalysisand
recommendationsbasedontheresults.
Patientseemedveryinterestedandmotivatedtolearnmoreaboutoralhealth,andeventhough
thisprojectallowsonlytodoanassessmentandpreventivedentaltreatmentaseducationand
fluoridevarnishapplication,itwasgreattoobserveagoodimprovementindentalplaque
control,whichwillbemorebeneficialforthepatientaftershehasdoneadentalprophylaxisor
SRPdependingonherneeds.
Assessedpatientsdentalhomecareandskill:
Patientplaqueremovalskill
Patientwasusingacircularbackandforwardmotion,whichisinadequate,patientmissedallthe
gingivalmarginarea,themandibularlingualanteriorteethandallthemaxillarypalatalarea.
Patientstatedshedidnotusedentalflossregularlyjustwhenshefeltfoodbetweenherteeth.She
alsohadneverreceivedanoralhygieneeducationfromadentistordentalhygienistonhervisits
toherpreviousdentalappointments.
Patientsknowledgeandawarenessofdentalandperiodontaldiseases:
Patienthadaminimalknowledgeaboutwhatisperiodontaldiseaseandtheiretiological
factors.Patientdescribedgumdisease,Whenthegumsbleed
8.NUTRITIONALANALYSIS
1.Carbohydrateintake:
Pt.carbohydrateintakeincreased:
a.First3daysdietjournal(03/11/1603/13/16)233.33minutesofexposure

b.Second3daysdietjournal(03/25/1603/27/16)253.33minutesofexposure
2.AnalyzeBMI
a.Ptweight:190pounds
b.Ptheight:56
c.BMI:31.5,
OBESITY

3.ActivityAnalysis

a.Activities:Cleanshouseonceaweek
Nowalking
b.Activitylevel:Sedentary

4.NutritionalCounseling

a.Patientmets90%oftarget

b.Pt.notdeficientinmacronutrients

c.Pt.deficientin:Ca,K,Fe,Mg,VitA,k,DandCholine

d.Advisedpatientto:

IncreaseH2Ointaketo2000g/day(8cups)

ObtainCafromCheese,Milk,sunflowerseeds,soybeans

ObtainPotassiumfrompotatoes,beets,squash.

ObtainIronfrommeat,beans,nut,sunflowersseeds.

ObtainMagnesiumfromGreenleafyvegetables,suchasspinach,

andwholegrains.

ObtainVitaminAfromsweetpotatoes,carrots,darkleaf.

ObtainVitaminKfromfrozenkale/spinach

ObtainVitaminDfrom15minsunexposuredailyandfattyfish.

ObtainVitaminCholinefromcereal,eggs,garlic.

9.FluorideAnalysis
a.CurrentUse:CrestWhiteningplusScopeanticavity0.243%NaF2x/day
b.WaterFluoridation:0.6ppm
Recommendation
IncreaseTopicalfluorideuse,basedontheCAMBRAresultswhichdeterminedthepatienthasa
HIGHCARIESRISK.

10.CariesRiskAssessment
a.CAMBRAassessment:patientwasdeterminedtobea
HIGHRISK
forcavities.
b.Recommendation:
ContinueusingCrestwhiteningplusscopeanticavity0.243%NaFat
morning,andstartusingbeforebedtimePrevident5000ppmtohelpto
remineralizetheteethandalsodecreasethesensitivitythepatienthaswithall
theseveralrootexposure(recommendingtopatientdonotremovecompletely
thepaste,toincreasethebenefitsthroughthenight).
StartusingListerinezero,whichdoesnothaveanyalcohol(patienthas

xerostomia,avoidanyproductwithalcohol)
ChewXylitolgum5minaftersnacks35/day,fordrymouth.
5%NaFVarnish(atthelastdentalapptofSRP)

EducationonCariesControl
Patientwaseducatedontheetiologyandprogressionofdentalcaries,andhowimportantitisto:
Decreasethefermentablecarbohydratesfromthediet.
Thebacteriainbiofilmorplaquepresentinthepatientsmouth,consume
sugarsandproductsacidswhichdestroythetoothstructureofsusceptible
tooth,reasonwhyisimportanttohaveplaquecontrol.
Understandtheimportanceoffluoridesabilitytoremineralizeteethinordertoreducetherisk
ofcaries.

Prognosis
OriginalOverallPrognosis:
Poor,duepatientsdiet,(highinfermentablecarbohydrates)lackofappropriate
brushingandflossingtechnique,lackoffluoridemouthwash,thesevereroot
exposureincreasingtheaccumulationofbiofilm.

Theproposedpatientscariespreventionplanisverydifferenttothecurrentoralpatientscare,
becausethenewrecommendationincludedtheuseofPrevident5000toothpaste,mouthwash
withoutalcohol,xylitolchewinggum,inofficeNaF5%varnishateveryappointmentandalsoto
reducetheintakeoffermentablecarbohydrates.Ifthepatientfollowsalltherecommendations
theprognosiswillbeimprove.

11.OralHygieneInstructionandTreatmentPlan
Goals
:Tobeachievedin3weeksperiodbetweeninitialappointmentand
Reevaluation.
a.ImprovePFIbyminimum20%
b.DecreaseBOPsitesby40%
c.DecreasePDby12mm(CouldbemoreafterpthasdonetheSRP)
Brushing
:
a.Currentregimen:manualtoothbrush,0.243NaFCresttoothpaste,circular,
backandforwardmotiontwiceaday.
b.Recommendation:Demonstratedmodifiedbasstechnique,withmanual

brushandsuggestedelectrictoothbrush,continuetoothpastetwiceaday
addingPrevident5000toothpaste,Mouthwash(alcoholfree),Xylitolchewing
Gum.
Flossing:
Currentregimen:None
Recommendation:twiceperday,seesawwithcshapedtechnique.Ptwas
showedandpracticehowtouseit,advisedtospendenoughtimeduring
Flossing.
Mouthrinse:
Currentregimen::None
Recommendation:ACTAnticavity0.05NaF(alcoholfree)

13.PostInstructionsStatus
a.E/I:NoChanges
b.GingivalTissues:
.MaxillaryFreeGingiva:pink,blunted,rolled,smooth.
.MaxillaryAttachedGingiva:pink,smooth,shiny,stippled.
.MandibularFreeGingiva:rolled,blunted,edematous,shiny,
.MandibularAttachedGingiva:reddish,shiny,smooth,edematous,lackof
Stippling

PeriodontalReevalution:03/29/16
a.Probing:Mostofperiodontalpocketswerereducedatleast1mmormaintainthesame.
b.Recession,Mobility,Furcation:NoChanges
c.PFI:40%(30%improvement)
d.OHICompliance:Ptclaimstohavefollowedalltheinstructions,andseemshappytofeeland
seethedifferenceonhergums,evenwithouttheSRP,Pt.startedusinganelectricaltoothbrush
andflossingeverydayatleastonceperday.
e.NutritionCompliance:Ptcarbohydrateliquidexposuresdecreasesfrom100minutesto53.33
daily,mainlysodaintake,butthesolidexposureincreasedfrom133.33to153.33
ProposalDentalTreatment
FullMouthScalingandRootPlaning(Fourappointments)
DuetheamountoftediouscalculusthepatientpresentIwillrecommendonequadrantofScaling
RootPlaning(onehourperappointment).
Firstappointment
Recordofvitalsigns

10

ExtraoralandIntraoralExamination
PeriodontalExamination(withallrecordsofgingivaldescription,probingdepth,calculus
code,BOP,CAL,recession,furcation).
ScalingRootPlaningUR(onehourperquadrant)withtheproperanesthesiagiventopatient
tomakethetreatmentmorecomfortable.
ComprehensiveOralHygieneeducation
Toothbrushmethodrecommended:ModifiedBassduetheseveralrecessionandalsoforthe
plaquecontrol.
Toothbrushrecommended:Soft,small,tuftedalsogivetheoptionforanelectrictoothbrush.
Educationabouthowusedentalflossing,interproximaltoothbrushes,etc
RecommendedaNaF1.1%toothpastetwiceaday,tohelptoremineralizealltheteeth
especiallythemultiplesrootexposureduegumrecessionandreducethesensitivitypatientfeels.
Recommendedtheuseoforalmouthwashwithoutalcohol,becauseofpatientsxerostomia.
Recommendeduseofxylitolgumaftereatingsnacks34x/day(dietanalysisrevealedpatient
eatssnackfrequently),alsothexylitolwillhelpwithxerostomiathepatientpresents.
NextappointmenttocontinueSRPforLRquadrantasaporaccordingpatientsavailability.
Secondappointment
Recordofvitalsigns
ExtraoralandIntraoralExamination
PeriodontalExamination(withallrecordsofgingivaldescription,probingdepth,calculus
code,BOP,CAL,recession,furcation).
ScalingRootPlaningLR(onehourperquadrant)withtheproperanesthesiagiventopatient
tomakethetreatmentmorecomfortable.
ReevaluateOHIintraorallyandalsowithpatient,incaseisnecessaryreinforce.
NextappointmenttocontinueSRPforULquadrantasaporaccordingpatientsavailability.
Thirdappointment
Recordofvitalsigns
ExtraoralandIntraoralExamination
PeriodontalExamination(withallrecordsofgingivaldescription,probingdepth,calculus
code,BOP,CAL,recession,furcation).
ScalingRootPlaningUL(onehourperquadrant)withtheproperanesthesiagiventopatientto
makethetreatmentmorecomfortable.
NextappointmenttocontinueSRPforLLquadrantasaporaccordingpatientsavailability.
Fourthappointment
Recordofvitalsigns
ExtraoralandIntraoralExamination

11

PeriodontalExamination(withallrecordsofgingivaldescription,probingdepth,calculus
code,BOP,CAL,recession,furcation).
ScalingRootPlaningLL(onehourperquadrant),withtheproperanesthesiagiventopatientto
makethetreatmentmorecomfortable.
Reevaluateifthepatientisfollowingallthepreviousrecommendationsaboutoralhealth,and
ifthereisanythingthepatientismissingordoesn'tunderstandcompletelyreinforce.
NaF5%Varnishapplicationattheendoftreatment
Scheduleafollowupappointmentin46weeks.

FOLLOWUP
Nextappointment46weekstoreevaluate.
Ifthedentaltreatmentitwassuccessfulschedulethepatientforaperiodontalmaintenancein3
months,ifnotwillbenecessarytoreevaluatetofindout,whereitwasthefailureandcorrected
it(maybemisunderstandingofpatienthowtomaintaingoodoralhygiene,willbenecessaryto
reinforce.)
IncasethereisstillcalculusredotheSRPontheareaswherebenecessary.
SelectiveCoronalPolishing:Itispreferedtodoitatthisappointment,because,thetissuewill
belesstender,soreandinflamed.
Referthepatientwiththegeneraldentist:
Foracomprehensiveoralevaluation,takingofFMXtoevaluatethepossiblereplacementof
somefillingsandthePFMon#13
Patientisinterestingtogetanewlowerpartialdentureandobtainsomeinformationregarding
dentalimplants.
PatientwillbereferwiththePeriodontistforacompleteperiodontalassessmenttodiscussed
thepossibilitytoplacesomeimplantsonthemandibularposteriorarea.

12


14.Discussions

Overall, the patient met the goals set on the first appointment.The Plaque Free Index was

improved by 30% (goal was 20%),theBOPsitesdecreasedby55%,mostofpocketsdepthwere

decreasedatleastby1mm.Alsoherconsumptionofcarbohydratesdecreasedby
The patient understood the oral hygiene education and the importance to maintain a healthy
mouth, and all the factors that contributed to obtain it.The patient had several problems on her
oral mouth through the years, suchearlylossofteethdueeconomicissueswhichdidn'tletherto
get them fixed,ending with extractingaffectedteeth,causingalsoextrusionof theopposingteeth
and loss of the vertical dimension and interocclusal space, making more difficult to rehabilitate
due ofthelackofappropriateinterocclusalspace,addingextrapressuretotheanteriorfrontteeth
during the mastication forces due the lack of most mandibular posterior teeth. Making all these
factors even worse after, the radiotherapy she had on 2006, according to the patient caused
xerostomiaincreasingtheriskofcavities.

The patientmadeacommentaboutherpreviousdentist.Thepatientexpressedherdesiretodo

something about to rehabilitate her mouth, but unfortunately the dentist told her, You would
have to invest thousands of dollarsinordertorestoreyourmouth,because,ithasalotproblems,
and also you have medical, which mainly willcovertoothextractions,reasonwhyit'sbetterfor
you, just keep your mouth ascurrentlyit is,andjustcometo do prophylaxisevery612months.
The clinician could not believe what the patient told her about this dentist, it was very
unprofessional, disrespectful, and irresponsible. The patient mentioned, after she talked to this

13

dentist she felt very sad and hopeless about to rehabilitate her mouth.The clinician explained to
the patient, that the bad experience she had with that dentist should not stop her desire to
improve her oral health,and that is the reason why it is so important to have a good oral health
bycontrollingthedentalplaque accumulationandalsohavingalowcarbdiettodecreasetherisk
of tooth decay, if she can establish a good management of all these factors it wouldhelpher to
haveagoodperiodontalfoundationnecessarytorehabilitateandmaintainheroralmouth.

At the CAMBRA and nutritional assessment, it was given to the patient an Oral B Electric

Toothbrush,and some Glide dental floss, the patient seemed veryinterestedandmotivatedabout

everythingthatwasexplainedontheappointment.

At the last appointment the patient expressed how happy she was about the electric

toothbrush,thatherteethfeltsmoothand clean,andhergumswerenotbleedingasmuchandalso
that she started chewing the xylitol gum ,and how she wasputtingmoreattentionaboutthetype
offoodsheateandifthefoodwasstickyshebrushedherteethafter.
The clinician felt excited abouttheoverallimprovementofthepatientcamethroughtheprocess,
and how effective can a goodandmotivationaloraleducationforpatientsbe, andhowclinicians
should never assume that an economic situation will put a patient away have a good dental
treatment .The oral care professionals have a responsibility to educate and offer all the options
available to the patient, leaving an impact on patients as part of theprocess,and,afterreceiving
all necessary information, patients will be able to make the best decisions according to their
personalsituations
.

14


15.Conclusions
TheoverallOralhealthofthepatientwaspoor,duetomanyfactorssuchaslackof
knowledge,properprofessionalinformation,economicissues,butitwasprovedthroughthe
projectthepatientsimprovementandmotivationtorecoveragoodoralhealth.
Oneofthemajorproblemthepatienthadandcontributedtotheacceleratedprogressofthe
periodontaldisease,wasthelackofmostofposteriorteeth,whichhadcausedaseverelossofthe
verticaldimensionandtheinterocclusalspace,makingmoredifficulttorehabilitatewithpartial
lowerdenture,bridgeorimplants,andalsowascausinganocclusiontraumatothepatients
mouth,because,allthemasticationforcesaredirectedtoanterior,reasonswhyitwasimportant
tocreateanevenmasticationforcesforthepatientsmouth.
Ithasbeenreportedthroughstudies,thatocclusaltraumacanaffecttheperiodontium
negativelyinthepresencepresenceofplaqueandcalculusbyacceleratingtheprogressionof
periodontaldisease.Thepurposeofthisstudytoinvestigatetheeffectsoftheocclusaltraumaon
periodontaldestruction,particularlylossofattachment.
Theconclusionofthestudywas,
Wheninflammationwascombinedwithocclusaltrauma,immunecomplexeswereconfirmedin
moreexpandingareasthanintheareaoftheIgroupwithoutocclusaltrauma,andlossof
attachmentattheonsetofexperimentalperiodontitiswasincreased.Damageofcollagenfibers
byocclusaltraumamayelevatethepermeabilityoftheantigenthroughthetissueandresultin
expansionoftheareaofimmunecomplexformationandacceleratinginflammatoryreaction.

15

TheperiodontaltissuedestructionwasthusgreaterintheT+IgroupthanintheIgroup.
(Nakatsu,S.,Yoshinaga,Y.,Kuramoto,A.,Nagano,F.,Ichimura,I.,Oshino,K.Hara,Y.2013)
Therehasbeenmanystudiesabouttheimportancetoreplacemissingteeth,tryingtoimprovethe
health.Thisstudywasdoneabouttheprostheticreplacementofmissingteeth:
Prostheticreplacementofmissingteethaimstoimprovehealth.Thiscanbeachievedby
improvingthepatient'swellbeingandqualityoflifeandbyrestoringthebiologicalbalancein
termsofocclusalandmandibularstabilityintheocclusalandtheorofacialsystem.Inocclusal
systemswithacompleteanteriorregionand'satisfactory'premolarandmolarregions,prosthetic
replacementofmissingteethisnotindicatedgenerally.Incaseofarestrictednumberofmissing
teethintheanteriorregionand/oranot'satisfactory'premolarregion,fixeddentalprostheses
maybeindicated.Incaseofanincompleteanteriorregionandno'satisfactorypremolaraswell
asmolarregions,removabledentalprosthesesareusuallyindicated.Theseguidelinesare
presentedintheabsenceofsufficientscientificevidence.Therefore,inclinicaldecisionmaking,
thequestionwhetherprostheticreplacementofmissingteethissensible,andifso,bywhichtype
ofdentalprosthesis,canonlybeansweredafteradialoguewithmutualrespectbetweencare
providerandpatient(NedTijdschrTandheelkd.2014)
InConclusion,thisprojectshowshowperiodontaldiseaseisgivenandallfactorsinvolved
andfortheirprogress.Alsoshowsasoralcarehealthproviderswehavetheresponsibility,to
acquiretheprofessionalknowledge,toabletoeducatethepatientsandguidethemtoobtainand,
maintainagoodoralhealthandtheimportanceofthepreventionintheprocessofHealth.

16

16.Summary
Duringtheproject,Ididchallengemyselfintwoimportantaspects:Theabilitytomotivatethe
patientabouttheimportancetomaintainagoodoralhygiene,andalsotheskilltodevelopan
efficienttimemanagementduringpatientstreatment.IfeltverypleasedthatIwasabletogive
thecorrectoralhygieneinstructionstothepatientand,thepatientunderstooditandpracticed
resultingandaconsiderabledecreaseofthedentalplaque,decreasingtheinflammationandgum
redness,evenwithoutperformingadentaltreatment.Mylearningishowpowerfulisthedental
hygienistsroletoeducateourpatientsandtohelpthemtoachieveagoodoralhealth.Wehave
abigresponsibilitytoobtainallthelatestknowledgeaboutbrushingtechniques,typesofdental
aids,typesdentalbrushes,typesofdifferenttoothpastes,etc.inordertorecommendedthe
appropriatedentaltoolsforeachpatientandhis/herspecificneeds,withtheultimategoaltohelp
tohaveandmaintainahealthyoralcavity.

17

References
Nakatsu,S.,Yoshinaga,Y.,Kuramoto,A.,Nagano,F.,Ichimura,I.,Oshino,K.,...Hara,Y.
(2013).Occlusaltraumaacceleratesattachmentlossattheonsetofexperimental
periodontitisinrats.
JournalofPeriodontalResearchJPeriodontRes,

49(
3),314322.
doi:10.1111/jre.12109

NedTijdschrTandheelkd.(2014).Prostheticreplacementofmissingteeth.Indicationsfor
fixedandremovabledentalprostheses.121(1):4556.

Xerostomia.(n.d.).RetrievedMay28,2016,from
http://www.oralcancerfoundation.org/complications/xerostomia.php.

Zanardi,P.R.,Santos,M.S.,Stegun,R.C.,Sesma,N.,Costa,B.,&Lagan,D.C.(2015).
RestorationoftheOcclusalVerticalDimensionwithanOverlayRemovablePartial
Denture:AClinicalReport.
JournalofProsthodontics.
doi:10.1111/jopr.12351

18

APPENDICES

1.Copyofthetreatmentconsentform
https://drive.google.com/file/d/0B5sYslz7G_7b0RuVUxhaUR2ZTU1T3ZsT3N5b09kekY4RHow/
view?ts=574bd0ef

2.CopyoftheMedicalHistoryform
https://drive.google.com/file/d/0B5sYslz7G_7MEdhZ2JBZjhpTDJIaHZ3LUY5Rm44dGlheERJ/vi
ew?ts=574bd210

3.CopyofthePlaqueIndexform.
https://drive.google.com/file/d/0B5sYslz7G_7Tm1fTFBiVGV0RmdSMXlfWHgxam5hb2dFUnVj/v
iew?ts=574bdbcd

4.CopyofthethreedayFooddiarybeforeadvisingandafter
https://drive.google.com/file/d/0B5sYslz7G_7OE9YTHppNjk0Qm95WDlKTkI3MHhvTEctNmZJ/
view?ts=574bd6bb

5.Copyofthenutritionalanalysisprintoutfromcomputersoftware
https://drive.google.com/file/d/0B5sYslz7G_7aGptbXhtTkswMlBJTGFKd2hfZVZEOGp5dFo0/vi
ew?ts=574be4ec

6.CopyofCarbohydrateanalysisform
https://drive.google.com/file/d/0B5sYslz7G_7RVBmWTJUM3NaTnpkU3RCMGpkb1VhMUNZVl
hJ/view?ts=574be08e

7.CopyofProcessevaluationformofOralhygieneinstructions
https://drive.google.com/file/d/0B5sYslz7G_7ak0xQVpmTUs5M0ZxcXFjYjNoVW96WnkxXzFF/
view?ts=574bf90e

8.Copyofpreandpostphotographsofnondisclosedteeth(1stappointment)
https://docs.google.com/document/d/16BRIeaif40gNNy6S4KvQvabOAQLiKbOcDXDS9lAjI/edit
?ts=574b9

9.Copyofpreandpostphotographsofdisclosedteeth(3rdappointment)
https://docs.google.com/document/d/18u9hir_E9_iAi3zfRDsgwVeO6ZASVAK9gF35De8Rm4E/e
dit

10.Copyoffullmouthprobing

19

https://drive.google.com/file/d/0B5sYslz7G_7MGR4cmItZVpZTFpZdVN2U2dodGVSZ1dGVnJz/
view?ts=574bd5b7

11.Copyofprobingprocessevaluationform
https://drive.google.com/file/d/0B5sYslz7G_7d08tdU9XWTlhM3Nma0xvaWVxQVdwV1RLeGV
B/view?ts=574bf58f

12.CopyofCAMBRAprocessevaluationform
https://drive.google.com/file/d/0B5sYslz7G_7Q084cnpGQ0RIaGNmLWVLd2ptRHR1YnNJYnA
w/view?ts=574bf6ce

13..CopyofCAMBRAformforpatientrecommendation
https://drive.google.com/file/d/0B5sYslz7G_7bHhHWk1pVHh0YXYtQUNJTXpsRmtjUDBfM3Fn/
view?ts=574be570

14.Copyof8Humanneeds

HYGIENEDIAGNOSISANDCAREPLAN

DentalHygiene
HumanNeeds

PatientsNeeds

GoalandCarePlan

Evaluatio
n

ChiefComplaint

Mygumsbleedand
Ifeelmymouthalittle
dry,andsometimes
myteetharesensitive

RefertoDentistfora
ComprehensiveEvaluation
withanewFMXandpossible
referraltoPeriodontist.

Nospecialmodification
needed.

ProtectionfromHealth Patientdoesnothave
risks,anxiety,fear,and anydentalfear.
stress

WholesomeFacial
Image

Patientisconcern
RefertoDentistand
aboutbleedingand
Periodontistandalso
replacedmissingteeth. Prosthodontist.

20

SkinandMucous
Reduceprobingdepths GoodOHI,dentalfloss,usedof
MembraneIntegrityof andbleeding.
dentalaidsasproxabrushes
HeadandNeck
speciallyallthegumrecession
presentsmainlyonthe
posteriorteeth.Educated
patientregardingperiodontal
disease,andalsoimportant
roleofdietinOralhealth.
Biologicalsoundand
functionaldentition

Patientpresentslackof Refertogeneraldentistand
bilateralocclusion
periodontistandpossible
withseveralextruded prosthodontist.
teeth.

Conceptualizationand
problemsolving

Patientmustimprove
oralcareandalso
nutritionalhabits.

Explaineffectsofcalculusand
dentalplaqueonperiodontal
diseaseprocess,explainthat
inflammationandbleedingare
deceasedwithagoodoral
hygiene.Alsoevaluatethe
patientbyshowingthe
techniqueisusingtobrushher
teethandreinforceasneeded.

FreedomfromHead
andNeckPain

Pt.experiencenopain
inheadorneck,E/I
examinationWNL

Nogoalneeded,butcheck
everyappointment,specially
sincethepatienthadcervical
cancerinthepast.

ResponsibilityforOral Patientshouldmake
Health.
thetimetovisitthe
DentalHygienistevery
threemonthsand
improvedherOHand
LowCarbdiet.

AftercompletionSRPTxvisit
hygienistevery3months
.Explainetiologyand
progressionofperiodontal
disease,encouraged
meticulousOHandsetgoals
tocontrolPlaque.

21

15.Copyofalljournalsarticles
http://www.ncbi.nlm.nih.gov/pubmed/24552072
http://www.ncbi.nlm.nih.gov/pubmed/26376203
http://www.ncbi.nlm.nih.gov/pubmed/23808820
http://www.oralcancerfoundation.org/complications/xerostomia.php

16.GradingRubric

RISKASSESSMENTPROJECTGRADINGFORM2016
ThisprojectwillbegoodevidenceforPLO#2(PatientCare)

StudentName:____________________
_
_________________________

DateSubmitted:

______________

Gradedby(InstructorsName):__________
_
EvaluationCriteria

1.PatientSelection
Qualificationofthepatientselectionwasverifiedbyan
instructorwithinstructor'ssignatureanddate

2.MedicalHistory

Overallpatientsmedicalhistoryissummarized(NOnameof
thepatientneeded)
Properpatientdatarecord
Listofallcurrentmedications(includeimplicationsand
dentalconcerns)
MedicalhistorycorrelateswithASAstatus

3.DentalHistory
Dentalhistorydiscussedandcorrelated
Frequencyofhygienevisitsanddentalexamandrestoration
history.

4.ExtraoralandOcclusalExamination
Extraoralexamcorrelated
Occlusion,TMJandoralhabitsareevaluated.

5.CariesandDentalExamination

22

Identificationofdecalcification,possiblecaries,defective
restorations
Qualityofrestorationevaluated
Carieslocationandtypeevaluated
CariesIndex(DMFS)recordedandevaluated
Radiographicevaluation(ifavailable)

6.IntraoralandPeriodontalExamination
th

(basedonevaluationcriteriaforDH108DueMay5
)
Intraoralandsofttissueisassessedandcorrelated
Gingivaldescription
Fullmouthprobing,recession,furcation,mobility
assessment
Periodontaletiologyisidentified
Periodontalperpetuating(contributing)factorsidentifiedand
recorded
RadiographicInterpretationforperiodontiumandoral
pathology(ifavailable)
AAPclassificationandrationale

7.OralHygieneEvaluation
Plaquecontrolrecordindexrecordedandevaluated
Assessedpatient'sdentalhomecareskilllevel
Assessedpatient'sknowledgeandawarenessofperiodontal
diseaseandcaries

8.NutritionalAnalysis
th

(basedonevaluationcriteriaforDH256DueMay4
)
Threedaydietaryanalysisarerecordedandevaluated(Attach
copiesoftheoriginalformsandthecomputerprintoutfor
bothbeforeandafteradvising)
Completeanalysisofcarbohydrateintake(Attachtheanalysis
table)
Identificationofnutritionalfocusandcounseling

9.FluorideAnalysis
Evaluateallavenuesoffluorideutilization(Currentusage,
typeandamount,concentrationoffluorideinwater(Lookup
waterfluoridationlevelsincitywherepatientresidesandany
additionalsupplemental)
Identificationandrationaleoffluoridefocus

10.CariesRiskAssessment
CAMBRAAssessment

23

Providethepatientwithrecommendationsbasedonyour
clinicalobservationsandtheresponsestothequestionsand
Discussstrategiesforcariescontrolandmanagement.Give
thepatientthesheetthatexplainshowcarieshappensandthe
sheetwithrecommendations.
CariesRiskPrognosisanditsrationale

11.OralHygieneInstructionandPlan
Designedtomeetpatientsneeds
Smokingcessationprogramrecommendations
Preventiverecommendations(sealantapplication,fluoride,
etc)
Stategoalsandobjectives
Possibleimplicationsofsystemicconditions
Considerationofphysicaldisabilities
Dental/Medicalreferrals

13.PostInstructionsStatus
E&Iexamination
Evaluationofgingivaltissue
Fullmouthprobing,recession,furcation,mobility
assessment
Plaqueindexrecordedandevaluated
Patientcompliancewithrecommendedhomecare

14.Discussions
(Essayformat)
Discusstreatmentoutcomes
Evaluatethepatient'sunderstandingsonnutritionand
participationinthetreatment
Reevaluatetheoriginaltreatmentplanandassessments
Discusshowtohavebettertreatedpatient
Discussesifgoalsandobjectivesaremet

15.Conclusion
(Researchwritingformatatleast2pages)
Correlatetheconclusionswithatleast3current,primary
professionalrefereedjournalarticles
Statementoffinalprognosisforthept,usingresearch
findings

16.Summary
(Oneparagraph)
Concisesummaryofyourlearningexperiencewiththe
project

17.EvaluationofWrittenProject

24

Professionalterminologyused
Correctspelling
Correctgrammar
Developedindepththefocusoftheproject
Allformsandpicturesareincluded
Turnedinontime
Documentedtheminimumof3current(withinlastfive
years)articlesfromprofessionaljournals
Presentation:typed,doublespacedinabinder.

FINALSCORE
(Max.possible:51)

3=Thoroughlyaddressedissueandcorrelatedfindings
2=Adequatelyaddressedissueandcorrelatedfindings
1=Inadequatelyaddressedissueandcorrelatedfindings
0=Didnotaddressissueorcorrelatefindingsorcompleteassignment

25

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