Archie McCoy

Tang Blanton
Alejandro Garcia
Kamibayashi, DH 100
December 2, 2015

Case Study Written Report: Case #20

1. Medical Assessment and ASA status

a. Patient vital signs are not available
b. Patient is a smoker.
c. Patient has a slipped disc in his neck
d. Patient is currently not taking any medications.
e. Patient does not report any allergies, recent surgeries, recent hospitalization, or visits to a doctor.
f. ASA II
2. Dental Assessment (Caries, defective restoration, need for prostheses)
a. Patient radiographs need to be updated. Most recent FMX was from over 4 years ago
b. No active caries
c. Amalgam restorations overhanging on MD#30, DOL#19 potentially etiologic. Refer to DDS for
evaluation.
d. Restoration on #3 is questionable due to lack of tooth structure and restorative margins at biologic
width
3. E&I findings from intraoral photographs
a. Patient shows tight, pink, blunted free gingiva and attached gingiva.
b. patient exhibits dark brown stains on maxillary and mandibular incisors: #7-10 and #23-26. Stains are
more prominent on lingual/palatal surfaces.
c. Right intraoral image is missing
4. Occlusal Classification
a. Left Canine: Class I
b. Right Canine: Class I
c. Left first molar: unclassifiable due to extracted #14-16.
d. Right molar: cannot be determined, intraoral image of maxillary right is not available.
5. Periodontal assessment
a. Patient radiographs need to be updated. Most recent FMX was from over 4 years ago.
b. 2 - Light calculus. Patient exhibits subgingival calculus deposit on mesial of tooth #15
c. Probing: Shallow pockets throughout: 1-3 mm pockets. 4 mm pocket on #4 Distolingually
 d. Gingival description: Generalized 2-3 mm recession, Tending 3 mm recession in posterior teeth.
Attached gingiva and free gingiva are pink, tight, and appear firm with blunted interdental papilla.
e. Extensive horizontal bone loss. Low probing depths are inconsistent with radiographically evident
bone loss. Suggest re-evaluation of pocket depths with anesthesia.
f. No mucogingival involvement
g. Class I furcations: Buccal #3, lingual #18, lingual and buccal #19, lingual and buccal #30;
h. Class II furcation: Buccal #18, buccal and lingual #31
i. No tooth mobility observed
j. Radiographs require update. Periodontal charts lists #15 as missing, though it is present in the
radiographs
6. Dental Hygiene Diagnosis (AAP classification)
a. Generalized moderate periodontitis tending advanced localized periodontitis in second molar region
ULQ, LLQ, LRQ, (#1-2 missing): Generalized 2-3 mm recession, tending towards higher values in posterior teeth,
furcation involvement, and advanced horizontal bone loss.
i. Localized severe periodontitis in posterior teeth. Radiographically evident bone loss is
present in furcation areas, corroborated in periodontal chart.
ii. Generalized moderate periodontitis with radiographically evident horizontal bone loss.
7. How many appointments needed? Plan each appointment in detail in a correct sequence.
a. 6 appointments. Quadrant scaling performed over 4 appointments.
i. E&I, FMX, Evaluate full mouth periodontal and dental condition (general assessment,
periodontal assessment, restoration assessment), treatment plan, selective polishing
ii. E&I, Plaque index, SRP ULQ with anesthesia (radiographically evident calculus #15M),
selective polish, OHI and smoking cessation
iii. E&I, plaque index, SRP LLQ with anesthesia (most severe furcation involvement),
selective polish, OHI and smoking cessation
iv. E&I, plaque index, SRP LRQ with anesthesia (less severe furcation involvement),
selective polish, OHI and smoking cessation
v. E&I, plaque index, SRP URQ with anesthesia, selective polish, OHI and smoking
cessation
vi. 3-4 weeks later: Evaluation of periodontal condition. Rescale residual calculus, plaque
index, OHI and smoking cessation, selective polishing
vii. Maintenance: 3 month recall due to smoking and xerostomia-elevated caries risk. Oral
prophylaxis, OHI, and smoking cessation.
8. What treatment would you provide for this patient?
a. Quadrant scaling and root planing
b. Selective polishing to remove stains from anterior teeth

DH 100 Tx Plan Kamibayashi 2013

 9. Plan oral hygiene instruction and home care therapy. What would you recommend?
a. Advise regarding oral health benefits of tobacco cessation. Assess interest regarding smoking
cessation. If interested, assist with smoking cessation and monitor progress during maintenance appointments.
b. Educate patient on the need for daily interproximal cleaning at home to control accumulation of oral
bacteria, dental plaque biofilm, and calculus formation. Educate on proper flossing technique and present
alternative interdental aids such as interproximal brushes.
c. Recommend daily 0.05% fluoride dentifrice (ACT) to mitigate caries risk
d. Recommend fluoride dentifrice that does not contain sodium lauryl sulfate, as it may irritate oral
mucosa in xerostomia patients.
10. Which quadrant to scale first? In what order? and why?
a. ULQ, due to radiographically evident subgingival calculus
b. LLQ, due to severe horizontal bone loss and furcation involvement
c. LRQ, due to horizontal bone loss and furcation involvement
d. URQ, as it is the least periodontally involved area
11. What type of fluoride treatment?
a. No active caries, overall fair oral hygiene, xerostomia renders patient at moderate caries risk
b. Daily 0.05% fluoride mouth rinse, 10 ml for 60 sec
c. Continue using twice-daily fluoride dentifrice not containing sodium lauryl sulfate so as not to
aggravate xerostomia symptoms.
12. Polishing
a. Selective polishing performed at each appointment to remove stains from patients anterior teeth.
13. Specialist referral
a. refer to prosthodontist for evaluation of restoration on tooth #3. Prognosis is questionable due to lack
of tooth structure and restorative margins at biologic width
b. Refer to a DDS for evaluation of potentially etiologic overhanging amalgam restorations on MD#30,
DOL#19
14. Diet counseling? Tobacco cessation?
a. smoking cessation
i. Ask patient for more information regarding his smoking history and habits.
ii. Assess patient interest on smoking cessation.
iii. Advise on oral health benefits of smoking cessation and how smoking exacerbates
xerostomia and periodontal disease.
iv. Assist patient with cessation program, including quit date and replacement therapy, if
desired.
v. Arrange follow-up visits to monitor progress.

DH 100 Tx Plan Kamibayashi 2013

Multiple Choice Questions
1. The patient is a smoker, which classifies him as ASA II. The patient also has a slipped disc in his neck which
elevates him to ASA III.
a. Both statements are true
b. Both statements are false
c. The first statement is true and the second statement is false
d. The second statement is true and the first statement is false

2. A dentifrice containing pyrophosphate would help to remove the stains on the patients anterior teeth.
Pyrophosphate is considered a therapeutic ingredient.
a. Both statements are true
b. Both statements are false
c. The first statement is true and the second statement is false
d. The second statement is true and the first statement is false

DH 100 Tx Plan Kamibayashi 2013

 WEST LOS ANGELES COLLEGE
DEPARTMENT OF DENTAL HYGIENE
DENTAL HYGIENE DIAGNOSIS AND CARE PLAN
Student Name: Tang Blanton, Archie McCoy, Alejandro Garcia_______
Patient Name: _[Name Redacted]______________________________
I. Medical Assessment:
Smokes one pack of cigarettes daily, drinks 2-3 alcoholic drinks weekly, slipped disc in neck 10 years ago, shoulder pain when
reclined for long periods. No stated medications, hospitalizations, or recent surgeries.
II. Dental History:
a. Caries: No active caries
b. Periodontal: Periodontal charting September, 2014
Advanced horizontal bone loss in second molar region of all 4 quadrants.
Class I and II furcations in all molars
c. Last dental visit:___9/2014__Reason:______Oral Prophylaxis_____
d. Last radiographs: FMXs____2010___________
BWs___2010_________PA;s__2010____________Other________
III. Oral Assessment:
a. Extra/Intra Oral Exam Findings:_TMJ crepitus on right side with no pain. Facial symmetry,lips, skin, pharynx,
were within normal limits.___________________
b. Occlusal Classification (I, II, and III): Rt C:_I_Rt M:_N/A_Lt C:_I_Lt M:_Not classifiable_
Overbite_N/A_Overjet_N/A_Crossbite:_premolars, left-side mid-arch crossbite_
Maximum Opening____N/A____
TMD_Crepitus-right side_______
c. Special Dental Prostheses (Dentures, Implants etc.)_None_________
e. Caries Risk Assessment/Defective Restorations:_Moderate caries risk; overhanging restoration margins
MD#30, DOL#19__
f. Periodontal Assessment: Advanced horizontal bone loss in second molar region of all 4 quadrants. Class I
and II furcations in all molars. Radiographs indicate previous advanced periodontal disease that has since resolved.
Gingival description (Color, Consistency, Contour, Texture)
Maxillary Free Gingiva:___Tight, Pink, scalloped_____________
Maxillary Attached Gingiva:_Tight, Pink, blunted___________
Mandibular Free Gingiva:__Tight, Pink, scalloped____________
Mandibular Attached Gingiva:_Tight, Pink, blunted__________
MBI, Probing, BOPs and Exduate_N/A____________________________

DH 100 Tx Plan Kamibayashi 2013

 Recession and mucogingival involvement:_generalized 2-3 mm recession, with greater recession in posterior teeth. No
mucogingival involvement
Furcations:_Class I: Buccal #3, lingual #18, lingual and facial #19, lingual
and buccal #30; Class II: Buccal #18, buccal and lingual #31_________
Mobility:_None____________________________________________________
Periodontal Classification: AAP class_generalized moderate periodontitis tending localized severe periodititis in maxillary
and mandibular posterior, second molar regions_______________________________________________
WLAC Calculus Code:_2-Light, treatment plan as 5 medium-heavy______________________________________

DH 100 Tx Plan Kamibayashi 2013


IV. Dental Hygiene Human Needs Assessment
Dental Hygiene Human
Needs
Chief Complaint
Protection from health risks, Shoulder pain while reclined
anxiety, fear and stress
Wholesome Facial Image
Skin and Mucous Membrane
Integrity of Head and Neck
Biologically Sound and
functional dentition
Conceptualization and
problem solving
Freedom from Head and
Neck Pain
DH 100 Tx Plan Kamibayashi 2013
DENTAL HYGIENE DIAGNOSIS AND CARE PLAN
Patients Needs
"I am very concerned about the stain
on my front teeth."
Stains on anterior teeth, patient is
curious about tooth whitening
Xerostomia
Class I and II furcations; prominent
staining lingual #7-10,#23-26; Missing amalgam restorations.
#1,2,14,15,16,17,32; overhanging
restorations MD#30 and DOL#19;
advanced horizontal bone loss in
posterior maxillary and mandibular
regions; questionable prognosis
regarding crown on #3
Does not floss regularly, tobacco use Emphasize benefit of regular flossing,
and oral health
Slipped disc causing shoulder pain
while reclined for extended periods
Goal and Care Plan Evaluation
Selective polish
Upright patient position, minimize
duration that patient is reclined
Selective polishing, inform about in-
office and at-home tooth whitening
options
Recommend alcohol-free 0.05%
fluoride mouthrinse and sodium lauryl
sulfate-free dentifrice. Recommend
saliva substitutes, sugar free gum, and
other non-cariogenic solutions for
xerostomia. Advise on effect of
smoking on xerostomia and
periodontal disease.
Refer to DDS to evaluate overhanging
Refer to prosthodontist to evaluate
prognosis for crown on #3
4 quad SRP with anesthesia.
Oral hygiene instruction.
3 months maintenance.
educate on oral health effects of
tobacco use, and question interest
regarding smoking cessation.
Sit patient upright during procedure.
Minimize duration that patient is
reclined.
Responsibility for Oral health Does not floss regularly, does not use Educate and motivate patient to floss
fluoride mouth rinse daily. Patient must maintain 3 month
recall schedule to monitor bone loss
and overall periodontal condition.
V. Appointment Plan:
Appointment Date/Interval Procedures:
1 E&I, FMX, Evaluate full mouth periodontal and dental condition (general assessment,
periodontal assessment, restoration assessment), treatment plan, selective polishing
2 E&I, Plaque index, SRP ULQ with anesthesia (radiographically evident calculus #15M), selective
polish, OHI and smoking cessation
3 E&I, plaque index, SRP LLQ with anesthesia (most severe furcation involvement), selective
polish, OHI and smoking cessation
4 E&I, plaque index, SRP LRQ with anesthesia (less severe furcation involvement), selective
polish, OHI and smoking cessation
5 E&I, plaque index, SRP URQ with anesthesia, selective polish, OHI and smoking cessation
6 3-4 weeks Evaluation of periodontal condition. Rescale residual calculus, plaque index, OHI and smoking
later cessation, selective polishing
Maintenance 3 month Oral prophylaxis, OHI and smoking cessation
recall
Signatures:
Patient________________________Date________Faculty___________________Date_________Student________________ _

Eight Human Needs Classification for Dental Hygiene Process of Care

1. Protection from Health Risks

The need to avoid medical contraindications to dental hygiene care; includes the need to be protected from health risks
related to dental hygiene care.
Examples:
Evidence on health history for immediate referral to, or consultation with, a physician regarding
uncontrolled diseases.
Evidence of need for antibiotic premedication.
Evidence that client is at risk for oral injury (plays sports, poor dexterity)
Evidence that client is at risk for oral or systemic disease
Evidence that client is in a life-threatening situation

DH 100 Tx Plan Kamibayashi 2013

2. Freedom from Fear and Stress

The need to feel safe and to be free from fear and emotional discomfort in the oral healthcare environment
Examples:
Client fear
Client concerns about confidentiality, cost of care, disease transmission, fluoride toxicity, mercury
toxicity, radiation exposure, or dental hygiene care planned

3. Wholesome Facial Image

The need to feel satisfied with ones own oral-facial features and breath
Examples:
Client reports dissatisfaction with the appearance of his or her teeth, gingiva, facial profile, dental
prosthesis, or breath

4. Biologically Sound and Functional Dentition

The need to have intact teeth and restorations that defend against harmful microbes, provide adequate function, and
reflect appropriate nutrition and diet.
Examples:
Teeth with signs of disease, missing teeth, defective restorations, teeth with abrasion and erosion, teeth
with signs of trauma, ill-fitting prosthetic appliances, chewing difficulty

5. Skin and Mucous Membrane Integrity of Head and Neck

The need to have an intact and functioning covering of the persons head and neck area, including oral mucous
membranes and periodontium, which defends against harmful microbes, resists injurious substances and trauma, and
reflects adequate nutrition.
Examples
Presence of extraoral and intraoral lesions, tenderness, or swelling, gingival inflammation, bleeding on
probing, probing depths or attachment loss > 4mm, mucogingival problems, presence of Xerostomia, oral
manifestations of nutritional deficiencies

6. Freedom from Head and Neck Pain

DH 100 Tx Plan Kamibayashi 2013

 The need to be exempt from physical discomfort in the head and neck area
Examples
Extraoral and intraoral pain or sensitivity before dental hygiene care
Tenderness on palpation during the extraoral or intraoral examination
Discomfort during dental hygiene care

7. Conceptualization and Problem Solving

The need to grasp ideas and abstractions in order to make sound decisions about ones oral health
Examples
Client has questions, misconceptions, or lack of knowledge about oral disease
Client does not understand the rationale for daily oral self-care
Client does not understand link between some systemic disease
Client has misinterpreted information

8. Responsibility for Oral Health

The need for accountability for ones oral health as a result of interaction between ones motivation, physical capability, and
environment.
Examples
Inadequate plaque control
Inadequate parental supervision of childs daily oral hygiene regimen
Inadequate self-monitoring of health status
No dental examination within past 2 years

DH 100 Tx Plan Kamibayashi 2013