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Oral Hygiene Instructions

By: Trisha Ferguson DH2 LCSC

First Appointment
Check-in appointment
Patient is rated a 2/2.5 and is a
Case Type III with generalized
moderate periodontitis
Generalized moderate
papillary/marginal inflammation
Generalized severe spontaneous

Plaque Index

Patients current home


care
Sometime brushes daily
If brushing, brushes in the morning.

Intraoral photos

OHI discussed at first


appointment
Patient qualified for an amazing program
that we have at the dental office, which
gives them an electric toothbrush.
Showed patient how to properly use the
electric toothbrush with the advice to
brush for at least 2 minutes twice a day.

Second Appointment
Patient is non-compliant with OHI, patient wanted me
to discuss the use of electric toothbrush again.
Discussed use of electric toothbrush and went over
use of electric toothbrush again.

Third Appointment
Patient is using electric toothbrush once daily.
Went over stimu-dent picks to aid in cleaning
interproximal. Patient had already explained she does
not like using floss.

Final Appointment
Patient non-compliant with use of stimudents, but is still brushing with electric
brush once a day.
Patient does not use electric brush for 2
minutes, but knows she needs to work on
brushing more often.
Patient has generalized moderate

Plaque Index at final


appointment
After patient brushed with manual toothbrush in the
clinic
Plaque Free 69 %
Areas with plaque- mostly interproximal

Patients current home


care
Brushing once a day with electric
toothbrush
Patient is trying to brush for the
recommended 2 minutes.

Intraoral photos

OHI discussed at final


appointment
Explained to patient that her gingival margin plaque had improved and
stressed the importance of brushing twice day for the recommended
amount of time, to help with the removal of all biofilm.
Discussed the need to disrupt the bacteria/plaque from interproximal,
and showed patient these were the areas mostly missed.
Showed patient how to use proxy brush. Patient has wide enough
embrasures that the proxy brush easily fit.
Explained the importance of brushing twice daily and removing the
interproximal plaque to prevent decay, and the progression of her
periodontal disease. This seemed to motivate patient, since she had
already had 4 appointments for her cleaning and was beginning to
understand the ramifications of getting behind on her oral care.

Patient Motivation
Originally the patient was motivated to come to the
clinic because of areas of sensitivity.
Home care did not seem to be much of a priority for
patient.
By the final appointment the patient was much more
motivated to improve her oral hygiene.
After seeing how many appointments her NSPT took,
the patient started to understand that her oral
hygiene played an important role in her future
hygiene appointments.

Observation/Reflection
I was surprised that the patient was not motivated earlier in the treatment.
The patient had a microscope slide, which was one part of explaining her
periodontal disease. Then I also discussed periodontal disease by showing the
patient pictures and discussing what Case Type she was rated. I explained to
the patient that periodontal disease leads to bone loss, and showed the
patient her Class III mobility on #31.
I thought getting an electric toothbrush would be very motivating for the
patient. But as the patient said it was just hard for her to incorporate her oral
hygiene in her daily routine.
I think after having to spend the 4 days at the clinic, plus a few days for
restorative work the patient started thinking more about her oral health. So I
am very happy that the patient needed many appointments because I think if
her cleaning had been done at one appointment she would not had started to
care about her oral health.
I think the only way I could had altered home care was to stress the
importance of her oral health by using words that showed how severe the
situation was, and that the oral cavity effects the whole body. Maybe if I could
had shown her how much time on her part it was going to take to get back on

Observation/Reflection Cont
I felt that this patient was a hard patient to get motivated.
There are many patients like this that I have seen and I have
learned to just give them the recommendations, and encourage
and motivate them.
I also try to listen to the patient and see where they are currently
at with home care and try to move them in the right direction
without overloading them with information. When I had first
started I feel that I probably overloaded many of my patients.
I am also learning that some patients will probably never floss,
and to try to find a different aid that will work for them to clean
interproximal areas.

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