Patient Journals During Year One of Hygiene School

Cambria Curran
Journal Entry #1
Date: 4/20/15 Ruth
Background: Ruth is a 71 year old retired dental assistant
Initial Appointment Monday, April 20th
Assessment
Medical/Dental History: Has high blood pressure that is controlled with medication, some of her
medication causes xerostomia, has a latex allergy, had a hip replacement in 2007 and therefore
needs premedication. She has osteoporosis and arthritis. Has routine dentist but was referred to our
clinic by her sister who had a great experience and was seeking cheap care. Her vitals were normal.
Intra/extra oral exam showed palatal and maindibular tori but was WNL.
Dental: Has multiple gold crowns, porcelain fused to metal crowns, a couple gold foils, and
multiple composite restorations.
I took a FMX on her with indirect digital using the XCP. No caries or other dental problems were
visible on the films.
Assessment (Perio): Generalized slight marginal and papillary inflammation. The plaque was
moderate interproximally and at the gingival margin, especially around her crowns. Deposit
Evaluation: 1.5/1.5
Diagnosis:
DHD-Generalized Slight Periodontitis; Perio Case type II, with localized Moderate Periodontitis;
perio case type III. With her knowledge of dentistry from her background as a dental assistant Ruth
was very knowledgeable about all of the information that I gathered about her inflammation,
bleeding, probing depths, etc. She even taught me a thing or two. She was very receptive to me
going over my findings with her though. She had generalized slight bleeding upon probing and
exploring. For her age her gums and bone level are in great condition. She explained to me that she
loves eating sweets and hates flossing. I went over the importance of flossing with her and showed
her some plaque that came off onto my explorer from interproximally so she would see what she
was missing by not flossing. I also told her to brush after eating sweets, to which she said she
already does.
Plan:
After explaining the details of her dental hygiene diagnosis and the dental exam, we planned our
treatment. I told Ruth that we would complete the scaling by arch starting with the maxillary arch
and then the mandibular arch. After scaling, we would polish using the prophy cup and apply
fluoride varnish. I started hand scaling and completed the upper right quadrant, but was unable to
finish the maxilla due to time. I explained to Ruth I would complete scaling her maxilla then move
on to her mandible at our next appointment.
OHI: Demonstrated sulcular brushing and c shaped flossing. Ruth explained to me how much she
hated flossing again but said she would try to floss more. I suggested using floss picks as they are
more convenient and can be carried in her purse.
Second Appointment, Wednesday May 6th:
Implementation & Evaluation:

Ruth took her premedication one hour prior to our appointment this morning, four 500mg
amoxicillin tabs. I evaluated the URQ that I had previously debrided. There was less inflammation
in this area then in the rest of the mouth with slight inflammation and plaque localized around the
crown on #2. No hard deposits remained in the URQ. Ruth stated that she had started flossing more
frequently.
I hand scaled her entire dentition, removing plaque that had accumulated in the URQ and began
scaling the rest of her mouth. There was slight spontaneous bleeding upon scaling. After scaling I
polished her entire dentition using coarse prophy paste. Then I applied fluoride varnish 5%. And
explained that the varnish helps protect the teeth and keep them strong. I taught Ruth how to use the
Perio-Aid to clean around her crowns because that is where most of her plaque accumulated. I
thought a 6 month recall appointment was appropriate.
Reflection: Because Ruth was previously a dental assistant dental health was very important to her.
For her age and with her arthritis, osteoporosis, and xerostomia I would say Im rather impressed
with her dental health and the fact that she has her own teeth still. She does have a lot of
restorations, but they are all over 15 years old. Even though she knew most of what I was telling her
already she was accepting of the information and will hopefully take a couple of tips from me. She
was a pleasant woman to deal with.

Journal Entry #2
Hayley, Age 18, High School Student
Initial Appointment 4/13/15
Assessment
Medical/Dental History: Has no infectious diseases, no systemic diseases, takes no medication, no
allergies, no existing conditions, no dental pain, last dental cleaning was in 2012, routine. Last
dental exam was in 2014 had selective PAs taken and discussed getting deciduous canines extracted
and braces put on. Her vitals were normal. Intra/extra oral exam showed palatal tori, has both
deciduous canines on the maxilla, #6 is in mouth malposed, #11 is impacted. #1 & #17 breaking
through gumline. Apthous Ulcer buccal to #28 5mm long by 2mm wide.
Dental: Has a couple amalgam restorations.
I took 4 BWX on her with indirect digital using the XCP. Interproximal caries on the mesial of #19
and the distal of #18 were visible on the films. Another area of decay was found during the clinical
exam on the occlusal of #31.
Assessment (Perio): Generalized slight marginal and papillary inflammation with localized
moderate inflamed tissue. The plaque was slight around the gumline and she had grainy
interproximal calculus. Deposit Evaluation: 1.5/1.5
Diagnosis:
DHD-Generalized Gingivitis; Perio Case type I. Hayley had no CAL or evidence of bone loss. All
of her probing depths were 2mm and 3mm. I taught her the importance of flossing using the c
shape and sulcular brushing 2X daily to help prevent any bone loss from occurring in the future and
to prevent more caries from occurring. I told her especially in the areas of her mouth that have
moderate inflammation that if the bacteria and debris isnt removed, the bacterial by-products will

eventually start breaking down her jaw bone which can lead to many things including tooth loss if
not treated.
Plan:
After explaining the details of her dental hygiene diagnosis and the dental exam, we planned our
treatment. I told Hayley that we would complete the scaling by arch starting with the maxillary
arch and then the mandibular arch. After scaling, we would polish using the prophy cup and apply
fluoride varnish.
OHI: Demonstrated sulcular brushing and c shaped flossing. I pushed the importance of brushing
2X daily, but if only once a day then should be before bed, because she stated she didnt always
follow a strict routine.
Implementation:
I hand scaled her entire dentition, there was slight spontaneous bleeding upon scaling. After scaling
I polished her entire dentition using coarse prophy paste. Then I applied fluoride varnish 5%. And
explained that the varnish helps protect the teeth and keep them strong. I thought a 6 month recall
appointment was appropriate.
Reflection: Hayley is pretty young so I expected her teeth and gums to be in pretty good condition.
Although she didnt have any periodontitis, she did have localized areas of moderate inflammation.
I taught her home care to reduce her inflammation and keep her bone healthy. Overall it was a pretty
routine cleaning and went very smoothly and relatively fast since I finished her in one appointment.
She was very receptive to everything that I went over with her and I hope she implements the
techniques I taught her.
Journal Entry #3
Lily, Age 7, Elementary School Student
Initial Appointment 4/14/15
Assessment
Medical/Dental History: No infectious diseases, no systemic diseases, takes fluoride supplements
for prevention of caries, no allergies, no existing conditions, no current dental problems. Vitals were
normal. ASA class I. IO/EO exam: multiple moles covering face, arms, and legs. Very large moles
with hair growing from them on legs. Reviewed by Dr. Kelley.
Dental: Came in with no restorations. Tammy Maahs, RDH, helped me take 2 size 1 indirect BWX
with bite tabs. I was trying to use the Kwik-Bite and Tammy told me with Pedos it is sometimes
best to have the least bulk in their mouth by using the tabs. Lily did not like the films in her mouth
and did not want to bite down for me, but Tammy got her to cooperate. We did have 1 retake
because Lily opened her mouth as soon as we left the room the first time. No caries or other
problems were found on the films. Dr. Kelley recommended sealants on tooth #3 and tooth #14.
Assessment (perio): Generalized slight inflamed papillary and marginal tissue. Lily was 27% plaque
free, which in my experience is quite good for a child. Most of the kids I have seen on our Pedo
days have been 12% or lower plaque free. Her deposit evaluation was .5/.5.
Diagnosis:
DHD-Generalized Gingivitis; Perio Case type I. Lily had no clinical markers or evidence of bone
loss. I taught her the importance of flossing using the c shape and sulcular brushing 2X daily to

help prevent any bone loss from occurring in the future and to prevent any caries or sugar bug
holes as I called them, from occurring.
Plan:
After explaining the details of her dental hygiene diagnosis and the dental exam, we planned our
treatment. I told Lily that we would complete the scaling by arch starting with the maxillary arch
and then the mandibular arch. After scaling, we would polish using the prophy cup. Then we would
do sealants on teeth #3&14 and then apply fluoride varnish.
OHI: Demonstrated sulcular brushing and c shaped flossing. She stated that she had an electric
toothbrush at home and I told her that was very good and had her show me with the regular
toothbrush we had at the clinic how she brushed her teeth. She brushed straight across the facial
surfaces of her teeth but missed the cervical third of her teeth, so I stressed holding her toothbrush
so that the bristles were pointing up under her gums.
Implementation:
I hand scaled her entire dentition, there was generalized slight spontaneous bleeding upon scaling.
After scaling I polished her entire dentition using coarse prophy paste. Then Cheryl assisted me in
applying sealants to teeth #3&14. Lily did not like that we had more things to do, as she had been
wanting to leave and eat lunch since she got there, but Cheryl and I worked quickly and got the
sealants done. Then I applied fluoride varnish 5%. And explained that the varnish helps protect the
teeth and keep them strong. She did not like the way that the varnish tasted or felt, I explained to her
that by bedtime she could brush it all away and that this would help keep those sugar bugs we
talked about away. She seemed to accept that answer.
Reflection: Lily was a very talkative and busy little girl. She did not like sitting still and had
questions about everything. I tried to answer her questions very simply and with short answers and
had to ask her to stay still and lay back down quite frequently. I told her the more she stayed still
and cooperated, the faster she could leave and go to lunch. Her plaque and calculus levels were
relatively low so luckily it was a pretty simple and routine cleaning so I finished her relatively
quickly. Pedos are definitely trying sometimes and she was wearing my patience thin, but I kept my
calm and did what I had to do as quickly as possible.
Journal Entry #4
Caleb, Age 7, Elementary School Student
Initial Appointment 5/19/15
Assessment
Medical/Dental History: No infectious diseases, no systemic diseases, no medications, no allergies,
no existing conditions, no current dental problems. Vitals were normal. ASA class I. IO/EO exam:
WNL. Reviewed by Dr. Kelley.
Dental: Had permanent first molars and permanent centrals on both the maxilla and mandible, the
rest of the teeth were deciduous. Had a couple stainless steel crowns and a couple composite
restorations, all restorations were on deciduous teeth.
I took 2 BWX with indirect digital, no retakes. No caries or other dental problems were found on
the radiographs or clinically. Dr. Dunham recommended sealants on teeth #3,14, 19, & 30.
Assessment (perio): Generalized moderate inflamed papillary and marginal tissue. Caleb was 8%
plaque free. His deposit evaluation was 1/1.

Diagnosis:
DHD-Generalized Gingivitis; Perio Case type I. Caleb had no clinical markers or evidence of bone
loss.
Plan:
After explaining the details of his dental hygiene diagnosis and the dental exam, we planned our
treatment. I told Caleb that I would pre-polish his teeth to get rid of the plaque or sugar bugs as I
described them to him, then I would complete scaling by arch starting with the maxillary arch and
then the mandibular arch. After scaling I would do sealants on teeth #3,14, 19, & 30 and then apply
fluoride varnish.
OHI: I taught him the importance of flossing using the c shape and demonstrated sulcular
brushing, explaining he should brush 2X daily to prevent any more cavities like hes has in the past
from occurring.
Implementation:
I pre-polished his entire dentition using coarse prophy polish and the rubber cup. I then hand scaled
his entire dentition, there was generalized slight spontaneous bleeding upon scaling. Caleb did not
like the suction to be in his mouth so after I polished and while I was scaling if he needed to rinse or
spit he would ask to spit in a cup instead of the suction, I let him because he started crying when I
went to put the suction in his mouth and it wasnt a big inconvenience or anything to our treatment.
After polishing and scaling however, it was sealant time, and I explained to him that we had to use
the suction now just for these four sealants because we had to keep his mouth dry for the sealants to
stay in. I earned his trust by letting him hold the suction and turn it on and off and play with it a bit
just to see that it wasnt scary. He then let me put the suction in his mouth a couple of times so that
he could get used to the noise it made and how it felt in his mouth. I assured him Cheryl (who was
assisting me with sealants) would be holding onto it the entire time and that it wasnt going to hurt
him in any way. Then Cheryl assisted me as I applied all four sealants. His tongue was very curious
and wiggly so one of the sealants fell out when he wetted the tooth with his tongue, but he was very
cooperative with us and allowed me to redo it, I just made sure to let him know I would be holding
his tongue out of the way with my fingers this time and to breathe through his nose because he was
uncomfortable with everything we had in his mouth. Then I applied fluoride varnish 5%. And
explained that the varnish helps protect the teeth and keep them strong. He didnt like the taste at all
but he bore through it with me.
Reflection: Caleb was a very sweet boy and he stole my heart the second he walked through the
door. He was scared of the suction at first but I gained his trust throughout the appointment by
explaining everything in easy to understand terms and keeping him informed step-by-step of what I
would be doing. He eventually let me do everything that I needed to do and didnt seem scared
anymore. Im glad I get to be a part of helping children learn about dental health, early care is very
important to lifelong dental health. It is days like this that I feel extremely rewarded by my future
career choice.
Journal Entry #5
Jorge, Age 25, Warehouse Operator at Oregon Freeze Dry
Initial Appointment 6/03/15

Assessment
Medical/Dental History: Has no infectious diseases, no systemic diseases, takes no medication, no
allergies, no existing conditions, no dental pain, last dental cleaning and exam were in June 2014,
routine. Had 4 BWX taken. Patient had all four wisdom teeth extracted, no complications. Has
never had a cavity and has had routine dental care every 6 months since he has had dental insurance
with his job at Oregon Freeze Dry for the past 3 years (he waited to get his teeth cleaned for a year
so that I could clean them). Because of this and because he is still pretty young and at low risk for
caries and periodontal disease, I only took 4 BWX on him instead of a FMX. He was unsure if or
when he had ever had an FMX. I used direct digital and had one retake. Direct digital images never
turn out the way I would like them to and I always end up having retakes, I need to use direct digital
more so that I get more practice and get better at it. There were no caries or other dental problems
shown on the films. His vitals were normal. Intra/extra oral exam: moderate attrition due to grinding
at night. Patient wears night guard that was custom made for him at his regular dental office.
Reviewed by: Dr. Macready. Dr. Macready said to put a watch on the interproximal surfaces of both
the 1st and 2nd premolars on the left and right side of the maxilla, as they are starting to demineralize,
they have a more white appearance than the rest of the teeth.
Assessment (Perio): Generalized moderate marginal and papillary inflammation. Patient has
generalized slight fibrotic tissue, he stated he has never smoked or chewed. The plaque was slight
and sticky around the gumline and he had grainy interproximal calculus. Deposit Evaluation:
1.5/1.5
Diagnosis:
DHD- Generalized Slight Periodontitis; Perio Case type II. He has IAG on the facial of #21,22,27
&28. He has 1-2 mm CAL due to generalized slight recession and some localized probing depths of
4mm and one 5mm pocket on the molars of both the maxilla and mandible. I taught him about
periodontitis and told him he needs to have diligent home care and keep seeking regular dental care
to stop his periodontitis from progressing.
Plan:
After explaining the details of his dental hygiene diagnosis and the dental exam, we planned our
treatment. I told Jorge that we would complete the scaling by arch starting with the mandibular arch
and then the maxillary arch. After scaling, we would polish using the prophy cup and apply fluoride
varnish.
OHI: Demonstrated sulcular brushing and c shaped flossing. I stressed the importance of flossing
daily and brushing 2X daily.
Implementation:
I hand scaled his entire dentition, there was moderate spontaneous bleeding upon scaling. His gums
were pretty sore after I was done scaling. After scaling I polished his entire dentition using coarse
prophy paste and the rubber cup. Then I applied fluoride varnish 5% and explained that the varnish
helps protect the teeth and keep them strong. I thought a 6 month recall appointment was
appropriate.
Reflection: Jorge was very receptive of everything that I taught him and didnt want his
periodontitis to advance so I feel like he will implement the instructions that I taught him. I didnt
eval Jorge because he is pretty young and told me that he had pretty routine care for the past couple
years. I was kind of surprised that he wasnt a 1/1. He was only a 1.5/1.5, but his sub deposit was

pretty tenacious and he had moderate inflammation and moderate bleeding upon scaling. I am glad
that I got everything done in one appointment.