By: Noor Hasan Feb.

28
th
,
2014
Introduction
Name: Ron
Age: 46 years old
Gender: Male
Race: African American
Patient Background
Speaks fluent English
Referred to Carrington College by a
colleague from work
Motivated and grateful to receive dental
hygiene care


Medical History
Weight: Approximately 185 lbs
Blood Pressure: average of 136/82
Pulse: 82 beats per min
Respiration: 18 breaths per min
ASA: II (controlled Type II diabetes)
Medical History (cont.)
Diagnosed with Type II Diabetes in 2003
Used to consume alcohol daily with meals;
now consumes it occasionally
Average recorded blood sugar level : 119
Currently maintains diet and exercises daily
Medications
Metformin: oral diabetes medicine
that helps control blood sugar
levels
Takes it 2 times/week
Lisinopril: ACE-inhibitor to treat
high blood pressure and other
heart problems
Plays a role in protecting a healthy
vascular pressure in the kidneys
Takes it 3 times/week

Dental/Dental Hygiene History
Never had his teeth cleaned
Had tooth extracted due to severity of
periodontal disease 3 months ago
Last dental exam: 3 years ago
Dental concerns: sensitivity and pain on LR
Social History
Married
2 children: 1 boy & 1 girl
Car sales man at Infinity dealership
Works 11 hours/day; 6 days/week
Hard to get days off due to family & financial
obligations
Chief Complaint
Sensitivity & pain between #29 and #30

Amalgam
Current Oral Hygiene Status
Appointment Score Rating
Initial Appointment 2 Poor
#2 1.5 Poor
#3 1.6 Poor
#4 1.3 Fair
#5 1.0 Fair
Re-evaluation 1.0 Fair
Patient Goal
Get his teeth cleaned
Improve his oral hygiene
Learn new oral hygiene methods
Oral Hygiene Instructions
Initial appointment: Modified Bass TB
method
Appointment #2: Flossing tight contacts
on mandibular anteriors
Appointment #3: End-tuft brush for the
distals of the last molars
Appointment #4: Interdental brush for
the interproximals of the posterior teeth
Supplemental Findings
Initital Gingival Description:
Color: Generalized dark pink and pigmented
Margin: Generalized red marginal band and rolling
Contour papilla: Generalized recession with localized
blunting on the maxillary and mandibular anterior teeth
Consistency/tone: Generalized slightly spongy
Texture: Generalized smooth with a shiny appearance.
Periodontal Assessments
Dental Charting: Few restorations and missing teeth-
3
rd
molars and #15 missing
Amalgam restorations on #2, #3 & #18
Occlusal resin composite on #14
PFM w/ root canal therapy on #30
Calculus Detection: Gen. heavy sub-gingival and supra-
gingival ledges
Probe Measurements: Gen. 3-6 mm & loc. 7-8 mm w/
gen. BOP and class I furcations on #2, #3, and #30.
Recession: Gen 1-3 mm
Occlusion: Class I classification
Radiographs
Radiographs (cont.)
CAMBRA
Moderate overall caries risk due to:
Hyposalivatory medications
Visually inadequate saliva flow
Exposed roots
Visibly heavy plaque on teeth
Saliva pH: 6.7 (risk for root demineralization)
Protective factor: Brushes w/ fluoride toothpaste daily.
Recommendation: Biotene
Unmet Human Needs
Freedom from Health Risks
Caused by: Diabetes and multiple medications
Evidenced by: Medical health history form
Freedom from Head & Neck Pain
Caused by: Intra-oral sensitivity & pain by #29
Evidenced by: Lack of oral hygiene care
Freedom from Stress
Caused by: Long hours at work
Evidenced by: Patients statement
Unmet Human Needs (cont.)
Skin & Mucus Membrane Integrity of the Head & Neck
Caused by: Lack of oral hygiene at home
Evidenced by: Gingival inflammation, BOP, and probing depth
7-8 mm
Responsibility for Oral Health
Caused by: Poor oral hygiene
Evidenced by: Poor DI-S score and heavy ledges of calculus
Periodontal Diagnosis w/ Initial Prognosis
AAP Classification: IIb
AAP Case Type: 4
Diagnosis: Generalized Chronic Active Severe
Periodontitis
Initial prognosis: Questionable because:
o 40-50% attachment loss
o Class I furcations
o Risk factors are present
o Proper maintenance is allowed but difficult
Planned, Managed & Performed DH Care
Appointment Number 1 2 3 4 5 6
FMX
OH-I
SRP 4 or more teeth per quad Gross
debridement
LR UR UL LL
Anesthetic: Lido w/ 1:100,000 epi
Gingival Irrigation
Gingival Curettage
Root Desensitization
Reevaluation
Fluoride Treatment
Coronal Polish
Chemotherapeutic Agent
Adjustments or Modifications
Root Desensitization:
Originally, was not in treatment plan but later added
due to patients discomfort post-scaling procedures.
Post-scaling root desensitization preformed with Colgate
Pro-Relief Paste

Re-evaluation
Before Treatment After Treatment
Re-evaluation &
Recommendation
Probing Depths:
Before treatment: Gen. 3-6 mm & loc. 7-8 mm w/ gen. BOP
After treatment: Gen. 3-6 mm & loc. 7 mm w/ sl-BOP
Recommendation: placed chemotherapeutic agent (Arestin) in 2
pockets: #5 Distal and #6 Mesial
Calculus Detection: Loc. spicules on distals of molars, loc. supra &
roughness
Recommendation: scaled remaining calculus deposits before polishing
and fluoride
Debris Index:
Before treatment: 2.0-poor
After treatment: 1.0-fair
Recommendation: Dental clearance needed for urgent dental care
Reflection
This was the first time treating a diabetic patient who
had never received dental hygiene care before. It was a
nice learning experience to be able to emphasize the
importance of oral health care and the connection to
the overall body. Also, through assessments and oral
hygiene instructions, I was able to show my his before
and after treatment and see how happy and thankful for
the work I provided for him. It showed him that
adequate home care is extremely important to help stop
the progression of his disease.
References
Wilkins, E. M. & Wyche, C. J. (2013). Clinical
Practice of the Dental Hygienist. 11
th
ed.
Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.
Price, T. (2013). How to care for patients with
diabetes. The Journal of Professional Excellence:
Dimensions of Dental Hygiene, 11 (1), pp. 62-65.
Retrieved from:
http://www.dimensionsofdentalhygiene.com
All pictures from Google Images