Oral hygiene instruction case study Jesika knitter

Medical/dental History 82 year old female Takes multivitamins Recent surgery includes cataract repair Irregular dental care – last prophylaxis 2+ years ago Chief concern: # 29 had a broken filling (since repaired at LCC), general sensitivity Medical/dental History

First appointment Motivation: low to moderate. OHI instruction: Soft picks – especially maxillary posterior, C shaped flossing, sulcular brushing with OralB 30 tooth brush. Plaque index: 68% plaque / 32% plaque free Goals: reduce tissue inflammation and root sensitivity

First appointment chart entry Risk factors: moderate supramarginal biofilm, xerostomia, crowded anteriors, slight – moderate CAL, bleeding, moderate sugar consumption. Deposit: 2/2 Periodontal case type: generalized II, localized III Statement of inflammation: generalized slight, localized moderate marginal and papillary inflammation

First appointment - High plaque areas -

Second appointment Motivation: moderate to high. Patient noticed previously debrided area (L/L quad) felt better and tissue was less irritated. As a whole – she noticed a decrease in bleeding and sensitivity. OHI revisions: patient likes using floss better than softpicks because “it covers more area” so I had her demo C shaped flossing in the posterior and anterior. Modification: wrap floss around tooth and create a more exaggerated “C”. I also recommended keeping the softpicks in her purse for easy access after meals “on the go”. Plaque index: 32% plaque / 68% plaque free Goals: our goal of reducing inflammation and root sensitivity was achieved via diligent homecare and fluoride varnish application.

Second appointment chart entry Risk factor: slight supra biofilm, frequent sugary snacks Periodontal Case type: generalized II, localized III Statement of inflammation: generalized slight marginal and papillary inflammation. OHI compliance: great compliance, tissue is responding to daily biofilm removal

Second appointment - High plaque areas -

Way to go Ruth! First appointment Second appointment Tissue: generalized slight and localized moderate hyperemia, enlargement, and edema; slight to moderate inflammation Bleeding: generalized moderate when probing, exploring, and especially scaling. Lots of food chunks  Tissue: generalized slight hyperemia, edema, and enlargement; slight inflammation Bleeding: localized slight when scaling. I didn’t see a single food chunk !

My thoughts on Changing patient behavior My recommendations worked! I was able to see a significant change in Ruth’s inflamed tissue, mild sensitivity, and low motivation. I would change one thing though…I should have showed Ruth the before and after pictures side by side! I know she could see and feel the difference in her mouth as her dental health gradually improved, but it would have been neat for her to see where she started and how much she improved. I wouldn’t change how often I showed her the food that was stored interproximally! I also liked the softpicks, C floss, and sulcular toothbrushing techniques and thought they worked great for her. My thoughts on Changing patient behavior And Personal reflections…

One patient down…thousands to go!