1. Oral hygiene instruction case study
Jesika knitter

2. 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

3. 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

4. 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

5. First appointment
- High plaque areas -

6. 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.

7. 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

8. Second appointment
- High plaque areas -

9. 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 !

10. 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…

11. One patient down…thousands to go!