Oral Hygiene

Case Study Presentation

Presented by Mindy Duran, DH2

First Appointment

Completed periodontal charting

Disclosed patients mouth and charted plaque index
Observed the microscope Sample
Patients overall motivation
Discussed Oral Hygiene Instructions

Periodontal Charting

At the first appointment, I recorded information regarding the

patients overall oral health status. With this information I was able to
identify tissue descriptions and identify areas deeper pocket
measurements.

Visualizing plaque

(using disclosing solution at 1st appointment)

First, I applied Vaseline to the patients lips to keep from coloring them purple,
I then thoroughly dried (a quadrant at a time) the teeth and applied a liquid
disclosing solution using a cotton swab.
Once I applied solution to the entire dentition, I rinsed the patients mouth.
I was now able to see the areas that had plaque remaining (areas that remained
purple/pink) and utilized an assistant to document the plaque index.
The calculations showed that this patient had 34% plaque free.

Intraoral Photos at First Appointment

Intraoral Photos at First Appointment

Intraoral Photos at First Appointment

Intraoral Photos at First Appointment

Utilizing the Microscope

Utilizing the periodontal chart, I obtained

samples from areas with the greatest
pocked depths.
The sample showed Cocci, gliding rods,
Spirochetes, and a few Trichomonads.

I described to the patient what the

different roles each bacteria played and
how they contribute to periodontal
disease.

Patient Goals and Motivation

After observing his microscope sample and I explained the causes and
risks of periodontal disease; this patient realized that that he was definitely
needing to improve his home care.
He wanted to identify ways he could improve what he was already doing
and find ways to fix the things he was not already doing.

Oral Hygiene instructions

Giving the patient the hand held mirror, I showed the patient how to
properly do the following:
Sulcular brushing using the Bass Method:
Spending 3 seconds on each tooth surface

Flossing using a floss holder:

Creating a C-shape to hug each tooth

Second Appointment

OHI compliance
Differences noticed by patient and/or Clinician
Plaque index after utilizing oral hygiene instructions at the
appointment
Revisions/modifications to Oral Health instructions
Patients new motivation and/or goals

OHI Compliance

At the second appointment, scheduled 11/24/14 (about 2 weeks later),

this patients oral health conditions had an amazing improvement.
After asking how he was maintaining his home care, the patient stated
that he had been really focusing on brushing with his electric toothbrush
at least two times per day (morning and night); and flossing, using the
floss aide, a couple times per week.

Changes to Oral Tissue

The patient had shown great signs of improvement. He said that he

noticed less bleeding and irritation while brushing and flossing at home.
Looking at the patients oral health from a clinical standpoint. The color,
contour and consistency of his tissues all showed improvement, changing
from severe in some localized areas at the first appointment to moderate
in all locations at the second appointment. The marginal and papillary
inflammation was reduced.

Visualizing plaque

(using disclosing solution at 2nd appointment)

At the beginning of the appointment, I had the patient brush and floss their
teeth using the methods we had discussed at the previous appointment.
Again, utilizing an assistant, I documented the areas which had plaque
remaining.
This appointment showed that the patient was 62.5% plaque free.

Intraoral Photos at Second Appointment

Intraoral Photos at Second Appointment

Picture on the left and previous slide:
shows improvement of OHI

Picture on the right: Shows areas that

needing improvement with
modifications shown.

Revisions/Modifications to OHI

I discussed the use of an electric toothbrush since this is what he started

using at home, focusing on the areas he had been missing (lingual of the
mandibular molars). I also discussed the importance of C-shaped flossing
and trying to improve the amount he flossed, aiming towards every evening
before bed.

Patients motivations
(After Plaque Free % and Modifications)

After realizing how much his plaque free percentage improved, this
patient was very proud of the steps he had taken towards bettering his
oral health.
After making modifications to his Oral health instructions, he kept his
enthusiasm towards making improvements and kept interest in the things
he can do to keep his teeth for a long period of time.

Reflections
I enjoyed completing this assignment and was pleased to see how working with
the details of this assignment helped make an impact on the patient. Seeing the
pictures and the improvement of his plaque index, was like a reward and kept him
wanting to make improvements. Normally, I get so caught up getting the
assessments completed and completing patient treatment, this helped to verify
what was working instead of just assuming that there was an improvement.
When there are improvements in a patients oral health, I do notice; however,
without actually using the intraoral camera, I am unable to actually visualize
improvements made. This gives evidence of improvement for myself since
sometimes there can be weeks between the start and completion of patient care.
It also gives me evidence to show the patient which allows them to actually
visualize the accomplishments made.

Reflections (Continued)

I know that sometimes patients are not as willing to comply with the OHI. I always
try to involve the patient, specifying techniques to the individual patient (adding
the floss aid or showing a different homecare device that more specifically meets
their needs).

Pictures Cited

Lane Community College Bacteria Picture

Microsoft Clip art