Sclerosis Case Study Essay

The original dental hygiene diagnosis for patient number 12931 was a P4. A full mouth supplemented with bitewings were exposed to monitor and examine the extent of periodontal disease. This patient as you would expect is at a high risk for periodontal disease. While the patient’s caries risk is only considered to be moderate. Biofilm plaque score was low, but the patient could increase their flossing frequency as she admitted to rarely making the commitment. However, the patient did mention she had vision impairment, in which could add an extra obstacle to homecare.
At the previous appointment, the patient received education in regards to flossing more frequently and brushing more efficiently. Probing was completed to measure bone health,

as well as to document her BOP index. Recession was documented on tooth numbers twenty-one to twenty-eight. This brought to my attention that perhaps we need to educate the patient about how hard she is brushing and perhaps her brushing technique. I would recommend the modified Stillmans method, which is often indicated for areas with progressive gingival recession. The hygienist did not use the ultra-sonic, due to the patient’s inability to adapt to the constant flow of water. Therefore, hand scaling was used throughout all four quadrants.
This patient had a three-month recall, in which she did adhere too.

The patient had no changes to her health history and is overall healthy despite vision impairment. After reviewing her probe depths in comparison to her last appointment, it was apparent there was no longer bleeding upon probing in the first quadrant. Her probe depths had also gone down generally by one mm in both quads one and two. The treatment therapies that were performed for this patient at recall included using the ultrasonic throughout all four quads. This patient did not handle the ultra-sonic well, so we took many breaks and touched up with hand scaling. The patient had multiple open contacts, so during patient education I showed her the proxy brush and how to adapt it within the embrasures. I emphasized the importance of flossing and using the proxy brush in regard to decrease the amount of plaque between her teeth and hindering her risk for continued bone loss and interproximal caries. I placed most of this education under the urgency that we would like to maintain the teeth and their surrounding bone structure. The plaque score was still low. I also explained to her the importance of brushing without added pressure and demonstrated the modified Stillmans method to prevent future gingival recession on the lower anteriors. Although the patient hadn’t showed much improvement in regards to homecare, I believe that sometimes hearing it over and over can help advance them up on the learning

ladder.
The treatment modalities introduced was the brief debridement of the ultrasonic and the education on the use of a proxybrush.” The Proxabrush® was more effective than the rubber cone stimulator in its ability to remove proximal plaque … “ ( Nayak,Ramnath) this aid is used to reach interproximally and aid in plaque removal. According to the Journal of Clinical Periodontology it is the most preferred interproximal aid when compared to the rubber cone stimulator. However, neither achieved complete removal.
The ultrasonic was another modality used in treatment. Reducing the bacterial load within the sulcus, is beneficial to the patient in both short term and long-term aspects. “Ultrasonic scalers were found to be more efficient than hand scalers.” (Jacob George) The success of a prophylaxis depends on the efficacy of the instruments used and the clinician’s skill. Although I also used hand scalers the ultrasonic is a Magnetostrictive scaler that “ showed the lowest mean scores for the roughness/loss of tooth substance index, indicating less removal of cementum and fewer marks of instrumentation on the dentin surface.” (Rishna,Ranijtha K)
Overall, data suggest the oral health of her periodontium is showing slight improvement in regards to maintenance. However, the patient is still in need of motivation and continued education, therefore I believe the appropriate recall appointment should remain at three months. Personally, this patient has brought to me the understanding that learning isn’t necessarily a linear process. Each patient learns at a different rate, with different levels of understanding. However, the fact that she is faithful to her maintenance appointments displays that she is committed to improving her oral health.
As a student hygienist I remain hopeful that slowly she will improve her oral health, through my help and the help of other students on continued patient education. With each patient I see, I am better able to communicate the effects and causes of periodontal disease on their level of understanding. I’m yet still interested in the application of Arestin in relation to periodontal disease and re-evaluation, in the future I hope to have more experience with its application. Although I will not see this patient upon her next maintenance appointment, I have faith that I made a difference in her oral health.