Virginia Commonwealth University

School of Dentistry
Dental Hygiene Program
Treatment Planning Exercise #1
Develop a sequenced treatment plan for the patient below. Also in the space provided
write out the educational needs of the patient. Determine the need and type of any
radiographs that may need to be taken.
22 year old African American female presents to clinic for a dental exam. She currently
works for StarBucks as a Barista trainee. After reviewing the medical history the RDH
finds there are no medical problems and the patient does not take any medications.
Patient states she is not in pain today and just wants her teeth cleaned. The RDH
carefully examined the radiographs taken today and after the oral examination finds the
following:
PERIO:
Probings between 2-3 mm with no bleeding on probing/ light supra/subgingival
calculus and light generalized plaque
FINDINGS:
#2 O decay
#3 MO decay
#4 DO decay
#8 MIL decay
#14 decayed and broken off at the gingiva (unsalvageable)
#15 missing
#19 MOD decayed
#20 DO decay
#30 O decay
#31 O decay
Medical/Dental/Social History:
Medical History: Medical history reviewed and updated. No medical conditions or
contraindications for treatment.
Dental History: Here for cleaning, No CC. Patient is at high carries risk. Radiographs
needed: FMX 18.
Social History: Starbucks employee as a Barista trainee.

Treatment Plan:
Seq.
1

Tooth/Quad
All quads

2
3
4
5
6
7
8
9
10
11

#14
#2
#3
#4
#8
#19
#20
#30
#31
#1, 16, 17,
18, 32
#15
#14
All quads

12
13
14

Surface
All
surfaces
N/A
O
MO
DO
MIL
MOD
DO
O
O
Pits and
fissures
N/A
N/A
All
surfaces

Treatment
D1110- Adult Prophylaxis & Fluoride Varnish
Extraction
Amalgam filling
Amalgam filling
Amalgam filling
Composite filling
Amalgam filling
Amalgam filling
Amalgam filling
Amalgam filling
Sealant
Implant/bridge/partial denture
Implant/bridge/partial denture
4 month DH recall & Fluoride Varnish

Rationale of Treatment Plan:

This patient presented to clinic with no chief complaint and no contraindications
for treatment. Due to the patient stating that she has no pain, we will begin in the oral
disease control phase and complete a D1110. Scaling and root planing is not necessary
as this patient has no bleeding on probing, her probing depths are within 2-3 mm, and
she only has light subgingival and supragingival calculus deposits. The next phase of
our treatment plan will include the extraction of #14, as it is hopeless and unsalvageable.
The next phase of treatment will include restoring all of the salvageable decayed teeth
with composite and amalgam fillings. Composite filling will be used in the anterior for
esthetic reasons, and in order to save as much tooth structure as possible. Furthermore,
composite material has the ability to be repaired if the patient is not compliant and
secondary caries form. Amalgam fillings will be used in the posterior teeth, as it is
stronger and better at resisting fractures caused by excessive force. After the oral
disease control phase is complete, we will bring the patient back in for evaluation. Due to
the previous extraction of #14, and #15 already missing, we will discuss options with our

patient regarding her missing teeth. We will explain to her that if she has sufficient bone
in that area, an implant is the best option. However, it is extremely costly, so we will give
our patient more affordable options such as a bridge or a partial denture. Due to the
high caries risk, the patient will be put on a four month recall. This will ensure to have the
patient gain a healthy environment to sustain the restorative work as well as to receive
the proper OHI at each appointment.
Educational Needs, Specific Patient Instructions, & Oral Health Aids:
This patient is considered to be a high caries risk due to the presence of several
caries. Therefore, providing this patient with oral hygiene instructions is the upmost of
importance. Our first step will be to go over the patients brushing technique, as her perio
exam revealed light supragingival and subgingival calculus, with light generalized
plaque. The patient will be disclosed to obtain a plaque free score, and to aid the patient
in identifying plaque accumulation. We will demonstrate the circular brushing technique,
along with brushing at a 45 degree angle towards the gingival margin using a mouth
model and toothbrush. The patient will be instructed to implement this brushing
technique at least twice a day. An electronic toothbrush would be suggested if money is
not an issue. If she already has an electronic toothbrush, we will ask her to bring it to her
next appointment to ensure that she is using it correctly.
Flossing would then be discussed, as this patients clinical exam has shown
several mesial and distal (interproximal) caries. We would enforce the patient to focus on
flossing at least once per day, focusing mainly at night. We will demonstrate the Cshape flossing technique to her, and have her demonstrate the technique back to us
using a patient mirror. Furthermore, we would explain the importance of flossing to her.
This patients social history revealed that she works at StarBucks as a Barista
trainee. This implies that nutritional counseling is extremely crucial with this patient as

well, as it could be one of the main contributors to her high number of caries. We will
explain to this patient that coffee is very acidic, and it can easily weaken the enamel of
the tooth structure. This can ultimately result in an increase of caries and erosion. We
will explain to her that we are more concerned with the frequency of her coffee intake,
and not so much the quantity. It would be very beneficial to try and drink her coffee in
one sitting, rather than sipping on it throughout the day. To help balance the pH of the
oral cavity, we will suggest to swish with water after drinking coffee, and to refrain from
brushing her teeth for thirty minutes after drinking her coffee to avoid further abrasion.
Swishing with water will additionally help reduce the amount of staining caused by
coffee. To further elaborate on her dietary intake and what it can do to the oral cavity, we
will send her home with a three day dietary intake.