Diploma in Dental Hygiene and Therapy<\/p>\n
November 2013<\/p>\n
Adult Therapy Presentation Case ReportCandidate Number:68<\/p>\n
Diagnosis:dental caries <\/p>\n
Date Treatment Commenced:21st May 2013<\/p>\n
Date Treatment Completed:18th September 2013<\/p>\n
Patient\u2019s details <\/p>\n
Gender:female<\/p>\n
Age:40yrs<\/p>\n
Occupation: <\/p>\n
Referred by:Professor P Preshaw<\/p>\n
Background history<\/p>\n
This patient was referred by his general dental practitioner to professor Preshaw\u2019s consultant clinic at the Newcastle dental hospital regarding her periodontal condition. GDP tried routine scaling and OHI, yet there has been no change<\/p>\n
The patient was examined on professor Preshaw\u2019s clinic and patient was then referred to myself for treatment of dental caries and generalised mild chronic periodontitis.<\/p>\n
Restorative history<\/p>\n
She is a regular attender to GDP every 6-12 months. She has been attending scale appointments for 30minutes, without LA; 31 is root filled with composite.<\/p>\n
Presenting complaint<\/p>\n
Patient noticed bleeding upon brushing, but other than that she did not have any concerns.<\/p>\n
Medical history<\/p>\n
Patient is fit and well<\/p>\n
Social history<\/p>\n
None smoker and drinks about 3 units per week<\/p>\n
Oral hygiene habits<\/p>\n
Patient brushes twice a day with an electric tooth brush and also reports using bottle brushes once per day<\/p>\n
Basic Periodontal Examination<\/p>\n
3 1 4<\/p>\n
2 2 3<\/p>\n
Examination<\/p>\n
Minimal soft deposits present, generalised extensive hard deposits present, caries present on 16, 26, 27, 28, 46<\/p>\n
Treatment plan<\/p>\n
caries management 16, 26, 27, 28, 46<\/p>\n
plaque score<\/p>\n
full periodontal indices<\/p>\n
course of RSI on pockets of 4mm+ with LA<\/p>\n
OHI basis technique and interdental cleaning<\/p>\n
Bitewings to confirm caries 46<\/p>\n
Radiographic report: (DPT\/OPG and bitewings)<\/p>\n
View: DPT\/OPG<\/p>\n
Quality: Grade 1<\/p>\n
18 17 16 \u00a0 14 13 12 11 21 22 23 24 \u00a0 26 27 \u00a028<\/p>\n
47 46 \u00a0 44 43 42 41 31 32 33 34 \u00a0 36 37 38<\/p>\n
Teeth present: <\/p>\n
Unerupted: 48 horizontal impacted <\/p>\n
Restorations: 36m, 31 lingual <\/p>\n
Root filled: 31<\/p>\n
Horizontal bone loss: 20-30%<\/p>\n
Calculus present: 18d, 17dm, 16m, 26dm, 28d, 44d, 46m, 36m, 37dm<\/p>\n
Radiographic report: (bitewing)<\/p>\n
View: bitewing<\/p>\n
Quality: grade 1 and 2<\/p>\n
18 17 16 \u00a0 14 13 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 24 \u00a0 26 27 \u00a0<\/p>\n
47 46 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 34 \u00a0 36 37 38<\/p>\n
Teeth present on radiograph: <\/p>\n
Restorations: 36m<\/p>\n
Crestal bone loss: 10-15%<\/p>\n
Overerrupted: 17<\/p>\n
Caries into dentine: 16, 26, 27, 28, 46o<\/p>\n
Treatment visits: (verbal consent was gained from patient and medical history was checked, with no changes throughout) <\/p>\n
Visit 1: 21\/05\/13<\/p>\n
Explained to patient that the treatment was to be carried out over several visits. Verbal Consent gained from patient for photographs and the use of the treatment carried out as my case study.<\/p>\n
intra oral exam was undertaken<\/p>\n
PPD\u2019s under taken<\/p>\n
recession and mobility completed<\/p>\n
Plaque score completed 39%<\/p>\n
OHI given, electric tooth brushing instructions given and introduced bottle brushes green, purple and red<\/p>\n
Visit 2: 11\/06\/13<\/p>\n
Pre-treatment photos taken with patient\u2019s consent<\/p>\n
bitewings taken<\/p>\n
plaque score 29%<\/p>\n
re-enforced OHI<\/p>\n
Visit 3: 09\/07\/13<\/p>\n
Buccal infiltration administered to 26, 27, 28 with epinephrine 1:80, 000 2,2ml <\/p>\n
Access gained with high speed and round heard diamond bur<\/p>\n
Caries removed on 26, 27, 28<\/p>\n
26 and 27 filled with composite a1 shade and occlusion checked<\/p>\n
28 filled with amalgam and calcium hydroxide placed before the restoration as filling was deep<\/p>\n
Post ope given and patient warned about 28 being deep and might be sensitive to hot and cold<\/p>\n
Visit 4 :10\/09\/13<\/p>\n
46 and 16 caries removed without LA as patient requested to try without LA first and if needed she would let me know and it was not required at this time<\/p>\n
46 setting calcium hydroxide placed before amalgam<\/p>\n
16 was filled with composite a1 shade<\/p>\n
occlusion checked for both dentations<\/p>\n
gross scale lower arch<\/p>\n
introduced single tufted brush and re-enforced OHI<\/p>\n
diet sheet given <\/p>\n
Visit 5: 18\/09\/13<\/p>\n
plaque score 17%<\/p>\n
vitality test done on the 28 and it gave positive response<\/p>\n
localised RSI completed on pockets greater than 4mm without LA as patient declined LA<\/p>\n
Full mouth fine scale<\/p>\n
reviewed bottle brushes<\/p>\n
re- enforced OHI<\/p>\n
diet analysis carried out and diet advice given<\/p>\n
Maintenance phase patient to be reviewed every 3months, for 6months on her periodontal condition<\/p>\n
Reflection<\/p>\n
One of my concerns, while treating this patient, was the fact that the patient did not seem to have any concerns about her teeth and she also didn\u2019t seem to understand why she had been referred to professor Preshaw\u2019s clinic by her GDP as she said her teeth didn\u2019t bother her that much other than a little bit of bleeding upon brushing occasionally. Going by this, it made me assume that patient might not be ready to make any changes. <\/p>\n
Yet, this turned out to be a mistake, because patient seemed very open to change. So even though, as a health care professional I am to understand that not everybody is ready for a change and I have to respect patient\u2019s wishes, it would be wrong to rash to conclusions based on other observations than the one done by myself.<\/p>\n
When I met the patient, she was very interested in what I was advising her and she was open to making changes. This taught me that I should not just read the letters and the notes and assume that patient might not be ready for a change. This also made me think about the methods of identifying patients that are ready for change and the ones that are not. Never take patients at face value, but always observe them and communicate with them in order to find out their inner concerns.<\/p>\n
Another thing that I realised while treating this patient, was that sometimes when you are looking at the carious teeth on the radiograph, you cannot predict how deep the lesions are, before carrying out treatment; I always told myself that the lesions are not that deep, only to find them deeper than what I actually anticipated.<\/p>\n
Overall I am quite pleased with the outcome of the treatment and patient was happy with the results.<\/p>\n","protected":false},"excerpt":{"rendered":"
Diploma in Dental Hygiene and Therapy November 2013 Adult Therapy Presentation Case ReportCandidate Number:68 Diagnosis:dental caries Date Treatment Commenced:21st May<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-53458","post","type-post","status-publish","format-standard","hentry"],"yoast_head":"\n