Leah Flickinger, Teri Tomkins, Eshraga Badry, Melanie Hunger

TREATMENT PLAN ASSIGNMENT​ #1

I. Assessment

A. Patient Interview

1. 70 year old, male, white caucasion, 5’8”, 200 lbs, and retired insurance salesman

2. Chief complaint is that he is way overdue for his dental checkup

B. Medical History

1. Cigar smoking, hypothyroidism, Parkinson’s disease, frequent bronchitis, GERD, occasional

angina. Basal cell carcinoma removed from under his right eye 5 years ago.

2. Medications

a) (Simvastatin) Zocor

b) (Metoprolol succinate) Toprol

c) (Levothyroxine) Synthroid

d) (Lisinopril) Zestril

e) (Levodopa) Sinemet

f) Aspirin (81 mg)

C. Dental History

1. In years prior, the patient received 6 month recalls and regular dental care.

2. Brushes 2x daily with medium bristled brush

3. Unless food is impacted between teeth he rarely flosses

4. Burning sensation when using his daily mouthrinse

5. History of burning dry mouth contributed to by medication.

D. Social History

1. Smoked cigars for 20 years weekly, but now smokes 1 pack of cigarettes weekly.
 E. Vital Signs

1. BP 138/88.

F. Intra Oral Examination

1. Recession #9 with mobility noted. Extrinsic stain GEN light ,heavy Localized on maxillary anterior

lingual and mandibular anterior lingual. Nicotine stomatitis noted on palate . gingiva GEN color red

, Marginal gingiva: rounded rolled . papillae: blunted.

2. Extra Oral Examination

Bilateral clicking/popping in TMJ, facial tremors mild and inconsistent, tenderness in submental,

submandibular, and deep cervical chain nodes.

G. Periodontal Exam

1. Generalized 4mm or less pockets throughout the mouth

2. Localized 5-7 mm on 5, 9, 14, 15, 18, 25, 28, 30

3. Bleeding Index (55%), BOP in most areas

H. Radiographs

1. Full CMS made and intra oral pictures made prior to treatment and 6 weeks post treatment.

Generalized horizontal bone loss noted throughout. Noted areas of isolated vertical bone loss

around #25 and #9. Radiolucency noted at apex #20.

II. DH Diagnosis

A. Level of Health

1. Not having had routine dental care for a few years and only having two areas of decay on the

occlusal, he has a low caries risk. Patient is at high risk for periodontal infections due to tobacco use

and behavioral factors. He is also at risk for oral cancer due to the tobacco use..

B. Diagnosis

1. Periodontal Disease- Slight to moderate chronic periodontitis

b) Mobility #9

III. Plan

A. Consultations Necessary

1. Perio Consultation

a) #9 mobile, due to localized areas of 5-6 mm probing depths and vertical bone loss,

recommend perio consult.

b) Possible Endo referral needed upon testing of #20 due to apical radiolucency

2. Smoking- Discuss smoking cessation. Offer 1-800 quitline.

B. Treatment Goals

1. To eliminate the progression of bone loss.

2. Reduce the depth of periodontal pockets.

3. Improve the health status of the gingiva and teeth.

4. To increase the patient’s motivation for behavioral oral health changes.

C. Addresses Phases of Treatment

1. Initial visit for assessment and to review health history. Take any radiographs if needed. Take any

intra oral pictures if needed. Discuss treatment plan and goals.

2. Begin initial treatment with removal of calculus and plaque.

3. Scaling and Root planning all quads. May need multiple appointments.

4. Restorations on occlusal surfaces of 3 and 31

IV. Implementation

A. Appointment #1

● Consultation:
​
 o​ H
​ is present smoking habits discussed, seemingly oblivious to their harmful oral and systemic

effects. He learned that smoking increases his risk for oral cancer; specifically, the risk of lungs,

and oral cancer grows, monitored for oral cancer and periodontal disease as they are linked to

tobacco use and the brown stain provides a segue to introduce home care. Inform him that the

appointment takes longer than usual due to his medical issue he was given breaks.

● Medical History Review

● Vital Signs

● Extra/Intraoral Exam

● Restorative/Hard Tissue Charting

● Complete Periodontal Evaluation

● Scaling & Root Planing

○ Ultrasonic/Caviron

○ Hand scaling instruments were used:

■ a subgingival periodontal explorer 11/12 for calculus detection.

■ specific Curets; Gracey 1/2 for anterior and premolar surfaces and interproximal areas,

Gracey 11/12 for mesial proximal and 13/14 for distal proximal surfaces of molars. Two

quadrant completed. Heavy calculus and brown stains from tobacco were removed by

scaling.

● Anesthesia:

○ No Anesthesia Necessary.

● OHI :

○ BASS method toothbrushing is introduced.

stain, Floss pikes were introduced if C-shape flossing be a problem.

○ using a 5000-ppm fluoride toothpaste and chlorhexidine (CHX) mouth rinse is recommended

Based on his risk of periodontal disease.

○ Recommend using an alcohol free mouth rinse due to burning sensation. Also recommend using

Biotene for dry mouth.

·​ Prescriptions:
​

O​ Using a 1.1% prescription strength sodium fluoride toothpaste daily for the management of
​

periodontal disease is suggested for two weeks.

B. Appointment #2:

● Medical History Review (Update)

● Vital Signs

● Extra/Intraoral Exam (Update)

● Charting (Update)

● Limited Periodontal Evaluation

● Scaling & Root Planing

○ Ultrasonic/Cavitron

○ Hand scaling with the same instrument. Two quadrants completed. presented with moderate supra-

and subgingival calculus and heavy plaque. and generalized moderate interproximal calculus was

tenacious

● Complete Polish to remove the brown stain from tobacco.

● No Anesthesia Necessary

● OHI: "C" shaped flossing demo

● A six-week reassessment appointment is scheduled.

V. Evaluation

● Visual inspection for redness, swelling

● Charting

● Radiographs

● Patient feedback

A. Follow up charting

● Probing depths - Whole mouth

● Gingival bleeding index - Whole mouth

● Plaque score

● Mobility index - specifically for #9 where mobility was already detected make sure bone loss is halted

B. Radiographs

● The follow-up photographs and study models indicate that the tissue in the anterior area responded well to thorough

debridement

C. Patient OH behavior change

● The patient can demonstrate an adequate technique for brushing and flossing. He effectively removes plaque and

values his newly acquired skills and the appearance of his tissue.

● Ceased smoking

Will continue with treatment and be on six week call back

❏ Wilkins, E.M., Wyche, C. J., & Boyd, L. D. (2017). ​Clinical Practice of the dental hygienist (12th ed.).

Philadelphia: Wolters Kluwer

❏ Wynn, R. L., Meiller, T.F., & Crossley, H. L. (2018). ​Drug information handbook for dentistry: including

oral medicine for medically compromised patients and specific oral conditions (24th ed.). Hudson, OH:

Lexicomp/Wolters Kluwer.