Stefanie Fischer

Dental Hygiene Treatment Plan #3

1. Assessment
a. The patient is a Caucasian male, 70 years old. Patient had yellow jaundice as a
child. Hearing impaired.
b. Patient is taking aspirin which affects bleeding, tamsulosin which can cause
orthostatic hypertension and tooth disorder, docusate which can cause throat
irritation, glucosamine which has no dental effects, acyclovir which has no dental
effects, and fluoride toothpaste which may cause staining of the teeth. Patient
says he experiences sensitivity to cold and hot. He sees a dentist regularly, about
every six months. He has been hospitalized for his gall bladder, prostate and a
hernia. Patient states he uses an electric toothbrush and Close Up toothpaste,
which does contain fluoride. He does not floss his teeth and did not seem
interested in being compliant regarding flossing. He does consume tap water and
uses fluoride toothpaste. He snacks occasionally between meals, but not
c.
d.
e.
f.

frequently.
This patient is considered special needs because he is hearing impaired.
Patient does not use drugs and does not use alcohol excessively.
BP: 110/72
Extra oral exam was within normal limits. Intra oral exam: small cheek bite on the
left buccal mucosa. Exostosis on the mandible. Small bilateral mandibular tori.
Twenty-nine total teeth. Attrition localized to anterior teeth. Generalized light
brown extrinsic stain. Class 2 occlusion on the right and left. Overjet of nine mm.

Moderate overbite.
g. Generalized probing depths less than 4mm.

h. Hearing impairment doesnt directly affect the oral cavity; however, if he is

unable to hear oral hygiene instructions correctly, he may not be able to
appropriately take care of his teeth.
i. Five bite wings were taken on 5/30/14.
2. Diagnosis
a. The main concern for this patient is slight periodontal disease. His hearing
impairment doesnt directly relate to his dental hygiene diagnosis. However, his
slight periodontal disease may be related to how well he understands oral hygiene
care. If he is unable to accurately hear oral hygiene instructions, and does not ask
questions to clarify, he may be caring for his teeth insufficiently.
3. Plan
a. Consultation with an endodontist was required due to sensitivity. Patient was
referred to major operative for restoration of interproximal caries.
b. Treatment goals: remove bacteria from plaque and calculus, reduce any gingival
inflammation, and give oral hygiene instruction, particularly regarding flossing.
c. Preliminary phase refers to assessment data collection, see part 1 named
assessment. Phase one is the therapy phase. This will involve dental biofilm
control, discussing preventive measures and calculus removal. Dental biofilm will
be assessed using the plaque score. Dental biofilm will be removed through
scaling, polishing and flossing. Preventive measures will be introduced. A fluoride
varnish will be applied to the teeth. Interproximal brushes will be given to help
introduce a flossing habit. Calculus will be assessed using calculus detection of
the Ramford teeth with an explorer. Calculus will be removed using a sickle,
Gracey , Gracey 11/12, and Gracey 13/14. The outcomes of the therapy phase to
be evaluated are clinical signs of inflammation, bone loss, dental biofilm control
and patient participation. Phase two is the surgical phase, which this patient does
not need. Phase three is the restorative phase. If the patient chooses to schedule in

minor operative, his decay will be restored. The evaluation of overall outcomes
will be evaluating periodontal response to restorations. Phase four is the
maintenance phase. This involves further appointments for continuing care and
supervision as well as reviewing and practicing proper oral hygiene. His level of
bone loss will need to be checked at every appointment to determine the status of
his periodontitis. We need to discuss and review the C shaped method for flossing.
He outright dislikes flossing so I will provide him with samples of interproximal
brushes for the purpose of interproximal cleaning in hopes that he will choose to
do some interproximal cleaning.
d. My role as a hygienist is to provide my patient with the best possible care and
treatment during our appointments. I will accomplish this through OHI, hand
scaling, polishing, and fluoride varnish. My patients role is to comply with OHI
given to him: flossing once daily and brushing with a soft bristled tooth brush
using the BASS brushing method.
4. Implementation
a. Sickle, Gracey , Gracey 11/12, Gracey 13/14, explorer.
b. Hand scaled full mouth, polished full mouth with fine prophy paste, flossed full
mouth, applied fluoride varnish.
c. Homecare aids: floss, floss picks, and interproximal brushes.
d. No anesthesia was given.
e. No prescriptions were written.
5. Evaluation
a. In October 2013, preventive clinic noted his Plaque Index at 1 with slight plaque
on multiple sites. This appointment his plaque score was 32% which is more than
just a slight amount of plaque, as previously noted. Periodontal probing depths
generally remained the same.
b. Since bitewings were completed on 5/30/14, he does not need radiographs at the
next appointment.

c. Sensitivity has decreased very slightly; however, it is still present and bothers
him. There is still heavy bleeding of the gums during treatment. He is using a soft
bristled electric tooth brush and using the BASS brushing method. However, he
still is not compliant with flossing.
References:
Wilkins, Esther. (2013). The dental hygiene care plan. Clinical Practice of the
Dental Hygienist. (351-360).
Crossley, H.L, Meiller, T.F. & Wynn, R.L. (2013). Drug Information Handbook
for Dentistry.