OHI CASE STUDY

By: Melody
Ferzacca

BEFORE I BEGIN
My OHI patient was also my caries remineralization patient,
therefore:
His plaque index was assessed a total of four times
I have included three (from the 1 st , 2 nd , and 4 th caries appointments)

Some of the home care instructions and modifications utilized came

from the caries management protocol
Patient states that he is currently using an Oral -B Professional Series
toothbrush at home for 2 minutes, twice each day
He also has a Sonicare at home, and that he alternates toothbrushes
every few months or so

APPOINTMENT #1
Initial plaque index: 18% plaque free

APPT. #1 CONTD.
Maxillary images

APPT. #1 CONTD.
Mandibular images

APPT. #1 CONTD.
OHI
Showed patient how to perform and utilize c -shaped flossing
When brushing, angle toothbrush at 45-degree angle to aid in plaque
removal along the gingival margin, as well as to remove debris that
may have made its way into the sulcus. Also, be sure to brush
interproximal areas well
Rubber gum stimulator to also facilitate debris removal along
gingival margin and prevent plaque and calculus build up
Tuft ended brush to dry brush molars, especially distal surfaces of 2 nd
molars, as well as the lingual surfaces of the mandibular anteriors,
as they tend to acquire heavier calculus build up
Gave patient xylitol toothpaste and prescribed CHX to help decrease
plaque formation and adherence, help decrease bacterial levels, and
promote remineralization

CHART NOTE FROM APPT. #1

PATIENT MOTIVATION
Patient claims that about one month after he gets his teeth
cleaned, calculus begins to build up, resulting in heavy
supragingival calculus
Heavy build up causes the patient to be self conscious
The patients goal is to formulate a solution to at least slow
down the process of rapid calculus formation
Tissues tend to bleed when brushing, but no pain
Patient does not experience any sensitivity or pain during
scaling

APPOINTMENT #2
Patient claims that he has been using sulcular brushing twice
a day since his last visit using the xylitol toothpaste. He has
used the gum stimulator a few times, but since no scaling was
done at his last appointment, he has not seen much
improvement. He has flossed a few times since his last visit
as well, but not every day. He has been using the tuft ended
brush to dry brush each night before his routine bedtime
brushing. He has only been using the CHX rinse once a day in
the afternoon or evening when he returns home from work.
Patient stated that he has seen improvement with his
brushing technique and has also experienced less bleeding
when brushing.
The patient was informed of his CRT results as well
S. Mutans equal to 10^5 and Lactobacillus >10^5

APPT. #2 CONTD.
Prior to disclosing, and after discussing home care since his
last visit, modifications to home care that were made were to
take a manual toothbrush to work so he can brush his teeth
after lunch, and ensure that brushing is done for at least 2
minutes. Less time may result in inadequate plaque removal. I
also gave the patient a pedo-timer to use so he can be sure to
brush for two minutes, especially at work with a manual
toothbrush.
Patient goals have not changed and continue to remain the
same: to form a solution to prevent recurrent heavy calculus
formation.

APPT. #2 CONTD.
After discussing home care compliance and modifications, the
patient was instructed to brush his teeth for two minutes,
prior to disclosing for the plaque index. This was the result.

APPT. #2 CONTD.
Maxillary Images

APPT. #2 CONTD.
Mandibular Images

APPT. #2 CONTD.
After disclosing and attaining the patients plaque index, I
gave him a mirror, so he could again see the amount of
stained plaque, especially after having just brushed his teeth.
I, again, stressed the importance of adequate plaque removal.
I asked if anything hindered him from brushing his teeth, such
as comfort, taste, etc. He said there was not. I informed him
that it would be very beneficial for him to brush after every
meal, and/or even dry brush while driving too and from work,
or while running errands. I told him that the amount of plaque
forming and not being removed is greatly contributing to his
calculus formation and that this issue must first be addressed
before we can jump ahead to the next step. I reminded him
that cleanings from the dentists of fice do not remove plaque
for 6 months, and that the patient is overall responsible for
their oral health

CHART NOTE FROM APPT. #2

NOTES FROM THE 3 RD CARIES

APPOINTMENT
At the third caries remineralization appointment, the patient
claimed to be doing all of the proper home care techniques
we had discussed, with the exception of brushing his teeth at
work. He did state that he had been dry brushing between
meals and while on the go.
The patients plaque index was 17.5% plaque free at this
appointment.
The patient was informed that his plaque index had actually
decreased in the number of plaque free areas. He was given
disclosing tablets to use at home after his own routine
brushing twice a day. He was instructed to reevaluate these
areas to see what he missed, and what he needed to work on.
He was also prescribed Prevident 5000 Plus to replace xylitol
toothpaste

APPOINTMENT #3
At this appointment, the patient stated he had been using the
disclosing tablets most days, and that he believed there had
been improvement in his home care. He also stated at this
appointment that he liked the Prevident toothpaste. I told him
if he would continue to use them, I would give him some more
disclosing tablets to use at home to continue to improve. He
assured me he would.
After brushing his teeth, as instructed, with regular
toothpaste, prior to disclosing, the patient finally gave me
insight to his poor home care. He stated that one of the
reasons he liked the Prevident is because it does not foam us
as much. He said most other toothpastes cause him to gag
and sometimes even vomit, which is probably the reason for
his poor home care.

APPT. #3 CONTD.
I told him that I am happy he is finally informing me of this,
but had he told me this earlier, we could have been
formulating solutions to address that issues which has a great
deal to do with the issue we are currently trying to address.
I told him to continue with the Prevident he is currently using,
along with the refill he has. Once these are both gone, and he
purchases his next toothpaste, to avoid anything that has
sodium lauryl sulfate in it. I informed him that this is a soap
and is what causes the foaming of toothpaste. I suggested
that he try Toms of Maine, or another natural toothpaste, to
see how he feels about it and see if his gagging and vomiting
is decreased.

APPT. #3 CONTD.
Some improvement!

APPT. #3 CONTD.
Maxillary Images

APPT. #3 CONTD.
Mandibular Images

APPT. #3 CONTD.
I informed the patient that there was slight improvement and
that had he informed me of his issue with most tootpastes, I
would have asked him to bring the Prevident to his
appointment with him to brush with that to make it less
uncomfortable for him. I did tell him that for future
appointments I would like him to bring whichever toothpaste
is working for him at his recall appointment so we can do
another plaque index to gauge improvement with disclosing
tablets and with a toothpaste that is more comfortable for
him to use daily.

CHART ENTRY FROM APPT. #3

CHANGES IN MOTIVATION
The patients motivation never truly changed between
subsequent appointments. I believe that he truly wants to
improve home care so as not to gain calculus build up so fast.
I also think that admitting that he cannot tolerate the same
dentifrices that most other people can might have been
embarrassing to him.

MY REFLECTION
Although I asked the patient if there were any issues or
anything that hindered adequate home care, he said that he
had nothing like that. When he finally revealed the true
reason he had poor home care, I was surprised that he had
not said something before. Now that I know that this could
potentially be a contributing factor of another persons poor
home care, I have specific questions I can ask. Patients are
more likely to answer specific questions, rather than broad
range questions.
I will be bringing this patient back again as a recall patient,
as well as to do a restoration. Im crossing my fingers that
since we have a plan for true improvement, that it shows at
his next appointment.

REFLECTION CONTD.
I believe that recommendations may have been utilized, but
not to the full extent that the patient stated they were. Had
any of the recommendations been used, there would have
been a noticeable dif ference in his tissues, as well as the
amount and extent of plaque formation. Im interested to see
his calculus level when he returns.