OHI Case Study

Presentation
COURSE: DH 220A CLINICAL DENTAL HYGIENE IV
BY: BETHANY MONIZ - DH2
11/29/14

Informing the Client

Disclosing agent that temporarily stains plaque biofilm so that it can be

observed and measured.

Client is provided a hand mirror to identify areas where stained deposits

exist.

Intraoral photos taken for additional visual aid for both clinician and
client. Photos saved in client computer record.

Educational aid for both client and clinician to teach and motivate
clients how and where to improve their self-care effectiveness.

Process implemented and observed over two separate clinic

appointments for comparison.

1st
Appointment

51% Surfaces with Biofilm

49% Plaque Free Index

Current Home Care:

Client brushes only 1x/day.

Client does not like to floss.

OHI STRATEGIES
Tell, Show, Do
MECHANICAL REMOVAL: Specific Tooth
Brushing - Bass method: Bristles directed
apically at a 45-degree angle; insert
bristles into sulcus with gentle vibratory
strokes.

DURATION: Goal of 2 minutes. (30

seconds per quadrant).

INTERDENTAL BRUSH: 90-degree angle

to tooth surface, using an in-and-out
motion.

MOUTH RINSE: Recommended Fluoride

ACT brand.

DENTIFRICE: Crest 3D White Luxe

toothpaste provided in home care bag.
(Removes up to 90% of surface stain).

Client Motivation:

Reduce STAIN, Gingival

Sensitivity

RISK FACTORS:

Smoking
Cigarettes

Xerostomia

Medications

Sleeps with CPAP Machine at

night

CHART ENTRY

CHIEF CONCERN: Sensitivity in

Gingiva, Reducing Stain

HOME CARE INSTRUCTION: 45 degree

sulcular brushing for 2 minutes,
2x/day with use of interdental
brushes. Referred ACT mouth rinse
and Biotene lozenges/chews for
xerostomia.

PLAQUE FREE: 49%

RISK FACTORS DISCUSSED:

Xerostomia, Stain increased by
smoking, Moderate plaque

HARD/SOFT DEPOSITS: Moderate soft

plaque, with fine grainy calculus.

MEDICAMENTS: Fluoride Varnish 5%

placed on mandibular teeth due to
gingival sensitivity.

2nd
Appointment
o

39% Plaque Index

61% Plaque-Free Surfaces

12% Improvement from

First Appointment at 51%
Plaque Index.

Client Motivation:
stain reduction.

Satisfied with visible

CLIENT COMPLIANCE:
Good
CLIENT HOME CARE
MODIFICATIONS:

Client increased brushing to

2x/day.

Client did not care for wide

bristled toothbrush Provided
client with narrow bristled
tooth brush.

Client liked interdental

brushes.

CHART ENTRY

CLIENT COMPLIANCE WITH OHI:

Adequate compliance. Does not care
for wide-bristled toothbrush.
Provided client with a narrow-bristled
toothbrush.

HOME CARE MODIFICATIONS: Roll

Stroke Technique with tip of brush
pointed apically and rolled vertically
towards occlusal surface in
interproximal areas. This
recommendation due to majority of
disclosing solution in interproximal
areas.

RISK FACTORS DISCUSSED: Increased

risk of caries due to xerostomia.
Encouraged patient to acquire ACT
mouth rinse for caries prevention.

HARD/SOFT DEPOSITS: Reduction in

plaque, with areas of fine/grainy
calculus.

Comparison:

Improvement on Maxillary
Anteriors (Lingual view)

1st Appointment

2nd Appointment

Comparison: Facial View

1st Appointment

2nd Appointment

OBSERVATION

Patient motivation remained the same during both appointments.

Effectiveness of OHI Instruction: Adequate.

Patient showed improvement by 12% on 2nd Appointment.

Significant reduction in plaque reduction at 2nd Appointment.

At both appointments, disclosing solution was greatest interproximally.

Client showed improvement on lingual mechanical removal of plaque at

2nd Appointment.

Patient did not acquire Mouth Rinse or Biotene lozenges/chews, as

recommended.

REFLECTION

As a clinician, this was my first client-care appointment using the

intraoral camera. Personally, I felt this was an effective visual aid to
reference at chairside during home care instruction.

Although there was improvement with the mechanical toothbrush, I feel

a power toothbrush would be a more effective device for this client to
increase efficiency. Patient is tired often before bed, and does not
usually spend a full two minutes brushing.

Gingival sensitivity deters client from brushing into sulcular areas.

Dentifrice was noticeably effective in stain reduction.

REFLECTION
MODIFICATION: In addition to the Bass Method, I also incorporated the Roll
Stroke Method. Tell, Show, Do Demonstration: Angled tip of toothbrush
interproximally with a roll stroke; directed apically and rolled occlusally in a
vertical motion.
CHANGES

1st Appointment:

None. I would keep the same recommendations and risk factor discussions.

2nd Appointment:

After seeing continued significant areas missed interproximally with

disclosing agent, I would have referred a power toothbrush and/or Perio-Aid
to access those areas.

References

Darby, Michele Leonardi, and Margaret M. Walsh.

"Toothbrushing;
Mechanical Oral Biofilm Control." Dental
Hygiene: Theory and Practice. St. Louis, MO: Saunders/Elsevier,
2010. 390-416. Print.

Darby, Michele Leonardi. "Mechanical Plaque Biofilm Control."

Mosby's Comprehensive Review of Dental Hygiene. 7th ed. St.
Louis, MO: Mosby Elsevier, 2006. 604-10. Print.

THE
END