Krista Vogel

July 2016

Special Needs Treatment Plan

I. Assessment
A. Patient Interview-
Female 49-year-old patient presenting with plaque and

calculus. Patient is unhappy, and seems to be in some

pain throughout her body.

B. Medical/Dental History
Patient suffers from fibromyalgia, anxiety, and depression.

All of these require medications.

Medications:
Gabapentin (Neurontin) 800mg daily unlabeled use for

fibromyalgia, side effect is xerostomia

Milnacipran (Savella) 50mg three times daily

antidepressant used for fibromyalgia. Caution using

vasoconstrictor because interferes with norepinephrine.

Side effect is xerostomia. Increased risk of bleeding

especially if used with NSAIDs.

Temazepam (Restoril) 30mg daily-benzodiazepine,

xerostomia as the side effect.

Trazodone (Oleptro) 300mg daily. Caution with

vasoconstriction due to elongated QT interval and possible

norepinephrine/Seratonin interaction. Side effect is

significant xerostomia.
 Levetiracetam (Keppra) 250mg three times daily

anticonvulsant off label use for fibromyalgia. No significant

precautions or side effects.

No known allergies
Dental History: Patient has root canals on mandibular

lateral teeth. Patient has been coming in about every 7

months for recall appointments.

C. Special needs implications
Patient requests a neck pillow. Patients shoulder seems to

be painful and I offered a towel to put under it. Patient

needs frequent breaks to stretch. Patients depression and

anxiety required me to speak calmly to not worry her about

anything. Also, speaking upbeat and not dwelling on

anything bad. Patient has very dry mouth due to

medications and requires frequent rinses.

D. Social History: Smoker-Half pack per day
E. Vital Signs: Blood Pressure 117/82
F. EO- WNL
IO- Tongue coated, attrition to anteriors, medium to heavy

extrinsic staining, Occlusion class I with an overjet of 2

mm. Gingiva is pink and wnl. Light spontaneous bleeding.

Calc Type B. No plaque score at this apptointment, but

previous plaque scores around 10%.

G. Perio Exam: Probing Depths- Generalized under 3 mm,

localized 4mm on #17, 18,32

Furcations-Class I on teeth #3,14,15,17. Class II on

#18,19,30,32

Recession- Generalized recession to full mouth

 H. Oral changes based on special needs- Drink a lot of water

due to xerostomia and try products like Biotene.

I. Radiographs: BWs and Periapicals of #22-27 in November

2015 show slight bone loss with no obvious decay and no

visible calculus.
II. DH Diagnosis
A. Level of Health: Fair
B. Relate special needs to diagnosis gingivitis/perio/caries.

Very little bleeding (no gingivitis), slight (to moderate in my

opinion for perio case type), no active carious lesions,

which is good due to dry mouth. Shoulder and other body

pain dont seem to limit patients ability to brush or floss.

Generalized slight (Barely any bleeding and patient has

pretty clean teeth and has good homecare, so Christy

categorized as slight. I would classify as a slight with

localized moderate due to patients furcations)

III. Plan
A. Consultations Necessary: None
B. Treatment Goals: Remove plaque and calculus. Apply

fluoride varnish to full mouth. Keep patient coming in for 6

month recalls. Keep patients dry mouth comfortable with

Biotene and other dry mouth products. Apply Super Seal

to recession or other sensitive areas as needed like #19.

C. Addresses phases of treatment *pg. 353
Preliminary phase- looked over patients chart and received

patient new information

Phase I- More preventative measures for xerostomia,

polish, hand scale

 Outcomes of phase I-Conclusion of probing depths, no

inflammation, low plaque score, good patient homecare

Phase II surgical- Not needed at this time
Phase III restorative- Not needed at this time
Evaluation of overall outcomes- Not needed for

restorations.
Phase IV maintenance- 6 month recall, patient has good

homecare with low plaque score and uses BASS technique

and flosses
IV. Implementation
Narrative- No consultations, used hand scaling instruments

including Graceys and Universals, no anesthetic, no

prescriptions, patient uses waxed floss and soft bristle brush

C. Identify alterations to implementation based on special

needs:
Patient needs a neck pillow, and possibly a folded

towel/blanket for shoulder. Patient needs frequent breaks

to stretch shoulder. Patient needs frequent rinses for dry

mouth.
V. Evaluations
A. How will you evaluate care? 6 month recall appointment
B. Follow up charting:
Plaque Score, probing depths, recession, calculus detect,

furcation involvements
C. Radiographs: BWs every year, possibly vertical bitewings
PAs as needed
D. Patient OH behavior changes
Compare plaque scores, and perio chart for recession and

furcations. This patient has good homecare and already

flosses daily and uses BASS technique. Make sure patient

 doesnt start to ignore or change these good habits due to

shoulder pain.

References

Wilkins, E. M. (2013). Clinical practice of the dental hygienist.

Philadelphia, PA: Lippincott Williams and Wilkins.

Wynn, R. L., Meiler, T. F., Crossley, H. L. (2014). Drug information

handbook for dentistry. Hudson, OH: Lexi Comp, Inc.