I.

Assessment

A. Patient Interview
1. Patient does not have any current dental concerns or discomfort
2. Feels like he has some areas where food gets caught
3. Has fluoride in water and uses a fluoride toothpaste
4. Snacks occasionally, usually candy, trail mix, popcorn, fruit, chips
5. Brushing is sometimes uncomfortable due to arthritis
6. Trouble with getting exercise due to arthritis of the hips
7. Regularly consumes alcohol

B. Medical/Dental History
1. Seen regularly by a dentist-every 6 months
2. Mostly brushes twice a day with an electric toothbrush
3. Flosses once a day
4. On several medications and supplements including: Cialis, Alprazolam,
Glucosamine, Fish Oil, and a Multivitamin
1. Patient takes Cialis for erectile dysfunction
1. No dental concerns
2. Patient rarely takes but is prescribed Alprazolam for occasional
anxiety
1. Patient knows to avoid alcohol with this medication
2. Medication can cause dry mouth but patient does not feel
he has this
5. Osteoarthritis of the joints, mostly hips and hands
1. Glucosamine
1. Joint supplement for arthritis
2. No dental concerns
2. Fish Oil
1. Supplement for arthritis
2. May cause an increase risk of bleeding or bad breath
3. Multivitamin
1. Supplement for arthritis
2. No dental concerns if taken as directed by physician
6. Hearing and vision impairments
1. The patient has difficulty hearing, applied to the military for
hearing aids

C. Implications to Treatment of Special Needs Patient

Osteoarthritis of the hands and hips –
1. Arthritis of the hands causes difficulty of oral home care – need to discuss
brushing and flossing aids that may be helpful to patient
2. Arthritis of the hips causes difficulty for dental treatment due to patient comfort
while in the chair – make adjustments as needed for comfort

D. Social History
Age: 56
Height: 5 foot 11 inches
Weight: 215
Caucasian
Male
Patient tries to eat healthy
Does not smoke
Consumes roughly 10 alcoholic beverages per week
Does not exercise much

E. Vital Signs
BP: 124/80
Pulse: 74

F. Intra-oral/Extra-oral Examination
TMJ click on the right side, does not bother him
Scar tissue from extractions
Tongue slightly coated
Very slight bilateral mandibular tori
Fissuring on the cheeks
Cheek bite on the right side by tooth #2
Amalgam tattoo between #3 and 4 lingual
Generalized attrition
Occlusion class II on the right and class I on the left
4mm overjet
Gingiva Description: generalized marginal redness, flat tissue where teeth have been extracted,
slightly bulbous tissue in the left posterior lingual molar region, generalized recession,
generalized firm, texture non-stippled and slightly inflamed, generalized bleeding when probing
Plaque Score: 38%
Periodontal Examination: generalized 3 and 4mm depths, localized 6mm depths interproximal of
#5 and 6 facial, 5mm on the mesial facial of #17 and the distal lingual of #14, generalized
recession
Probing depths increased 1-2mm in the posteriors from last full periodontal charting in February
of 2015
Bridge on maxillary #6-8
Patient is missing teeth #5, 7, 16, 18, 30, 31
Crowns on #3, 9, 10, 19, and 29
Amalgam or composite restorations on #1, 2, 3, 4, 12, 13, 14, 15, 17, 20, 21, 22, and 23
#4, 17, and 32 are all shifted mesially
Calc class: B

G. Oral Changes Based on Special Needs Patient

1. Oral health can be negativity effected if the patient is unable to do an adequate job with home
care due to the arthritis in the patients hands
2. This is visible in the increase in probing depths since patient’s last visit – pt also stated that his
arthritis has gotten more uncomfortable since 2015
H. Radiographs
Available from two years ago, 4 bitewings taken at this visit, generalized moderate alveolar bone
loss visible

II. DH Diagnosis

A. Level of Health-fair
1. Trouble areas that need to be addressed for oral health to improve
2. Osteoarthritis of the hips makes dental treatment somewhat difficult-
patient would often have to adjust during treatment to be comfortable
3. Arthritis of the hands makes brushing and flossing uncomfortable
4. Exercise is difficult due to osteoarthritis of the hips
5. Patient consumption of alcohol
6. Overall appearance of healthy, BP was good
B. Diagnosis
1. Periodontal disease
Periodontal case type: generalized moderate
2. Special needs in relation to diagnosis
Due to difficulty with home care, the patient is not able to properly take care of his oral
health. This is likely a link between the progression of this patient’s periodontal disease since his
last visit.

III. Plan

A. Consultations Necessary
1. OHI
1. Demonstrate proper brushing technique, encourage patient to use
his electric tooth brush to add some agitation to plaque, also has a
larger grip to help with arthritis
2. Provide patient with floss instruction and aids
3. Encourage brushing and flossing routinely (also brushing tongue)
4. Encourage patient to drink water after meals
2. Diet
1. Discuss healthy snack/meal options i.e. water, fruits, vegetables,
nuts
2. Discuss the effects of alcohol on the oral cavity and systemically
3. Lifestyle/systemic health
1. Encourage patient to stay active
Specialty referrals
1. Oral Surgery- May need #15, 17, and 32 extracted at some point due
to the angle of these teeth they are causing a lot of food trapping and areas
of potential decay
2. Periodontics- may need periodontic evaluation with the increase in
bone loss and probing depths
3. Operative- May need #15, 17, and 32 restored if incipient caries
progress, extraction with oral surgery if non-restorable
B. Treatment Goals
 Increase gingival health
 Improve oral hygiene, improve plaque score
 Find aids and techniques that help patient improve homecare
 Keep remaining teeth
 Improve probing depths
 Place patient on regular dental recall

C. Addressing Phases of Treatment

 Preliminary phase- assess and collect data
 Phase I therapy- control biofilm, additional preventative measures, calculus
removal, correction of biofilm traps
 Evaluation of phase I- probing depths, inflammation, biofilm control, patient’s
participation
 Phase II surgical- periodontal needs
 Phase III restorative- fixed/removable prostheses, any final restorations
 Evaluation of overall outcomes- response to restorations and plaque control
 Phase IV maintenance- appointments for continuing care, refining techniques

IV. Implementation

Due to this patient’s osteoarthritis in his hands, he has difficulty with home care. This

requires modifications such as floss aids and recommending an electric toothbrush. As for the

hips, it is important to make sure the patient is comfortable in the chair. This may require a

pillow under a hip or time to adjust as needed in the chair. Remove excess plaque with a

toothbrush. Use an ultrasonic to remove large calculus. Hand-scale all four quadrants with

Gracey curettes and a sickle. If patient is uncomfortable, anesthesia may also be helpful for

areas with deeper probing depths. Monitor patient for discomfort due to osteoarthritis of his

hips. Polish (toothpaste on restorations, fine paste elsewhere) and floss full-mouth. Remove

debris under patient’s bridge with superfloss. Application of neutral fluoride trays is

recommended. Send patient home with floss holder, gum stimulator, superfloss, and a soft

manual toothbrush. Consultations necessary may include: periodontic department, operative

department, and oral surgery department. Patient may benefit from prescription fluoride

toothpaste. Recall patient in six months, if probing depths do not improve recall in four
 months. The prognosis for this patient is fair, he has greater than 50% attachment loss, and

tipped teeth that are difficult for self-care. However, the overall prognosis is dependant on

the patient’s compliance and willingness to make adjustments to his current oral care.

V. Evaluation

A. How Care is Evaluated

1. Follow up charting
1. Probing depths
2. Bleeding
3. Intra-oral images (before and after)
2. Radiographs
1. Evaluate need for vertical BWs in one year to evaluate calculus
and bone level
3. Patient OH behavioral changes
1. Plaque score
2. Gingival health/condition
3. Questionnaire: eating habits, oral hygiene routine, alcohol
consumption
 References

Curran, A. E., Myers S. L. (2015). General and oral pathology. Philadelphia, PA: F. A. Davis

Company.

Wilkins, E. M. (2013). Clinical practice of the dental hygienist. Philadelphia, PA: Lippincott

Williams & Wilkins.

Wynn, R. L., Meiller, T. F., & Crossley H. L. (2016). Drug information handbook for dentistry

22nd edition. Hudson, Ohio: Lexicomp, Inc.

Treatment Plan Assignment #3

Special Needs Patient

Dental Hygiene III

Amanda Schultz (Reau)

July 25, 2017