DEMOGRAPHICS
Patient is J.B. 23, medium/type II
ASSESSMENT
Patient has nothing significant in medical history to report. His vitals were within normal limits, his blood pressure was 117/75 and his pulse was 72.
Patient is a nonsmoker.
No premedication required.
No systemic condition.
No medicines are currently being taken.
ORAL PATHOLOGY (Extra and intra oral findings)
Patient had no significant EO findings. Intraorally patient had pigmentation on his soft palate, distinguished linea alba, and a mandibular torus on the right side. At the second visit patient presented with a 3mm white blisterform lesion on his labial mucosa, at his third visit the lesion had gone down to 1mm.
DENTITION
Patient is class 1 occlusion, has an overbite of 30% and a 3mm overjet.
Patient is missing teeth #1, #16, #17, and #32. Patient has a supernumerary tooth lingual between teeth #20-21
Patient has suspected caries on teeth #2, #6,#13-15, #19, #22, and #30.
PERIODONTAL
Patient had localized minimal inflammation as well as localized minimal bleeding upon probing. However where the patient exhibited no inflammation, stippling was present.
Patient had mostly 2-4 mm pockets, with some 5mm pockets in his molars and one tooth with 6mm.
Patient is classified as a type II.
Patient had recession on teeth #22 and #27.
ORAL HYGIENE
This patient was used for my prevention exam. His initial plaque score was 1.3. I used this patient for my prevention exam.
Patient had generalized supra and subgingival calculus.
In session one of the exam I showed him flossing because he had a lot of interproximal biofilm
In session two his plaque score had gone up from 1.3 to 1.8 and he did not remember the way I had taught him to floss so I taught him flossing again.
RADIOGRAPHS
Yes, the patient cannot remember how long it has been since he received dental x-rays but he says it was at least 8 years ago. I am scheduled to take FMS on this patient on May 1, 2015 if he does not cancel the appointment.
There were no radiographs available.
TREATMENT MANAGEMENT
At the initial visit I finished all assessments but did not get up to homecare or scaling.
At his second visit I took part 1 of my prevention exam, I taught him how to floss, at the time he seemed motivated to floss and was interested in learning about the efficacy of flossing, however when he came back for his next visit he informed me that he had not flossed since the previous visit and could not recall how to properly do it. During this same visit I hand scaled the upper right, lower right, and upper left quadrants.
At his third visit I reviewed all 3 previously scaled quadrants and then completed the second part of the prevention exam.
I believe my strength in the clinic is in probing depths, I am also good with time management.
I believe that a weakness of mine is in scaling hard to reach areas, I only used the Gracy’s at first which I realized by the third appointment was a mistake, when I used the universal curet it went much better.
There were no factors that impacted the treatment.
I mailed a referral to the patient to see a DDS for suspicion of caries.
Recall Time: 6 months.
EVALUATION
The patient was very interested in everything that I was doing and teaching him, he wanted to know everything that I was doing and what it meant. He remembered all of the terminology and reasons behind everything that I had been doing. However, the patient was very stuck in his ways as to his oral hygiene routine and had very little interest in learning anything new to do or change in his practices.
The patient’s gingiva had tightened over the teeth that had been scaled.
REFLECTION
In hindsight, I wish that I had spent more time explaining and expanding on the importance of oral hygiene and home care. The patient was very dismissive about learning new things and changing the way he was doing things, therefore while I accomplished everything mechanical for this patient I do not think that I sufficiently educated the patient.
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Journal Entry Guidelines (new or recall)
DEMOGRAPHICS
Y.S, 25 years old, Medium/Type I.
ASSESSMENT
Patient has nothing significant in medical history to report. Vital signs were within normal limits 120/81 RAS with a pulse of 79.
Patient is a nonsmoker.
No premedications needed.
No systemic conditions.
Patient does not take any OTC or prescribed medications.
ORAL PATHOLOGY (Extra and intra oral findings)
Patient had no extra oral or intra oral findings.
DENTITION
Patient is a class I occlusion, 4mm overjet and 20% overbite.
Teeth #17 and #32 were partially erupted.
PERIODONTAL
Patient had localized minimal inflammation in the molar area.
Patient had 4mm pockets in his third molars, with 2-3mm pockets in the rest of the dentition.
Patient is a Type I gingivitis with no bleeding upon probing.
ORAL HYGIENE
At the patient’s initial visit I did not get up to homecare, and therefore there is only one plaque score, which was 0.1.
The patient localized subgingival calculus.
The patient had localized supragingival calculus on the lingual anteriors.
The patient had generalized staining that the patient complained had all come about in the previous month.
After discussing homecare with the patient we discovered that he had recently switched to Crest pro-health for toothpaste and rinse. Both of which have stannous fluoride, after explaining that this was most probably the reason for the staining on his teeth he said that he would switch his toothpaste back to colgate and his rinse back to listerine.
Most of the patient’s biofilm was located interproximally, so I instructed the patient how to properly floss.
RADIOGRAPHS
The patient had recently received radiographs and had no suspicious areas, therefore he did not require radiographs.
TREATMENT MANAGEMENT
There were no medical, social or psychological factors that impacted treatment.
At the initial visit I got up to calculus detection.
At the second visit I began with homecare, where I taught the patient how to properly floss. The patient was already flossing once a day but had been snapping over the contact, so I explained to him how he could be harming his gingiva and he seemed interested to learn how to do it correctly.
I hand scaled the lower right, upper right and lower left.
My weakness with this patient was definitely time management, however his initial visit was the first day of clinic this semester.
I think my strength with this patient was in identifying the cause of staining that had accumulated between his first and second visit.
The patient did not need a referral for any reason.
EVALUATION
The patient seemed interested to learn how he should be properly flossing, but his real enthusiasm came when we identified the cause of the staining and told him that it was removable. This patient takes very good care of his teeth and was very upset when he started noticing the stains. At the end of his visit he was very excited about the look of his mouth (while I have not yet completed him, the staining was on his mandibular teeth, so it has all been removed).
REFLECTION
I do not think that there would be much that I would change with this patient other than time management, and I believe that I naturally improved on this as the semester went on.
I have not yet accomplished everything as there is still one quadrant left for me to scale.
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Journal Entry Guidelines (new or recall)
DEMOGRAPHICS
E.E., 52 years old, Medium/Type II.
ASSESSMENT
Patient has nothing significant in medical history to report. Her vital signs were within normal limits 115/77 RAS with a pulse of 76.
Patient is a nonsmoker.
No premedication required.
No systemic conditions.
Patient takes 10 mg of OTC claritin a day for seasonal allergies, and is prescribed 5 mg of prozac for anxiety.
ORAL PATHOLOGY
Patient has a high hard palate, ankyloglossia, and large circumvallate papillae.
DENTITION
Patient is class I occlusion, with a 3 mm overjet and 10% overbite.
Teeth #1 and #16 were not clinically present.
Patient had a very complicated dentition with only 2 teeth completely clean of any restorations, she had a fixed bridge, 9 PFM crowns, 5 porcelain laminate veneers and numerous amalgams.
Patient had no area of suspicious decay.
PERIODONTAL
Patient had generalized moderate inflammation.
Patient is a Type II periodontitis. Patient had localized 5 and 6mm pockets in the lingual of the molar area. Around the rest of her dentition the patient had 3-4mm pockets. With localized minimal bleeding upon probing.
ORAL HYGIENE
Patient’s initial plaque score was 0.66 with most of the biofilm near the gingival margin, when the patient demonstrated how she brushes her teeth, it seemed that she was mostly brushing the incisal edge and the occlusal surfaces, therefore I taught the patient how to brush properly according to the Modified Bass Method.
Patient’s revisit plaque score, which was only taken two days later, had improved to 0.5, she demonstrated proficiency in toothbrushing so I taught her how to properly floss her teeth, including how to use superfloss under her pontic. The patient admitted to rarely flossing in recent years. However she had recently gone to the dentist and they informed her that she had bone loss, and she was therefore motivated to take up flossing again.
Patient had generalized subgingival calculus and localized supragingival calculus mostly on the lingual anterior teeth.
RADIOGRAPHS
The patient had been to the dentist earlier in the week and had a full mouth series and therefore did not require radiographs.
TREATMENT MANAGEMENT
There were no medical, social or psychological factors which impacted the treatment.
In the first visit I completed assessments and hand scaled the upper left quadrant.
In the second visit I reevaluated the upper left quadrant and hand scaled the lower left, lower right, and upper right quadrants.
As previously stated, the patient had recently gone to the dentist and was told that she had alveolar bone loss and this was the reason for her visit. She was afraid of experiencing more bone loss and was motivated to increase her homecare. The patient was already using super floss under her pontic but was enthusiastic about learning how to properly brush her teeth and floss the rest of her mouth.
This patient had a lot of restorations, some of which I had never seen clinically before and I had trouble identifying which teeth had porcelain laminates, and identifying the difference between a PFM crown with the metal showing through due to attrition and a metal amalgam. Because of my confusion I incorrectly charted a lot and had to redo her Dental chart. I think this was an incredible learning experience as up until then most of my patients didn’t have many restorations, and this was a way for me to really see the difference between a lot of things. While technically this was a weakness on my part I found it to be a very positive experience.
The patient did not need a referral.
EVALUATION
The patient had once been an avid flosser and did not need a lot of instruction on how to do it, she was enthusiastic about upping her homecare and getting her oral health back to what it once was, or as close to it as possible.
The patient started out very enthusiastic and therefore was not more interested as the treatment progressed.
The gingival tissue noticeably tightened around the area that I had scaled and there was no bleeding upon probing in an area that previously had.
This patient mentioned that she hated using Listerine due to the burn and would only used Scope, I explained the health benefits in using a rinse such as Listerine or Colgate as opposed to Scope and recommended that she try Listerine Zero. At her second visit she reported that she had tried it and was going to use it from now on.
REFLECTION
In hindsight I probably should have taught her how to floss at the initial visit due to the fact that she was already brushing her teeth twice a day but was not brushing.
I did accomplish everything that I had planned and truly enjoyed working with such an enthusiastic patient.
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Demographics
Patient is Z.H age 21, heavy/ type III.
Assessment:
Patient has mild asthma for which he takes Advair when he is having an attack and Albuterol twice daily. His vital signs were within normal limits 103/83 RAS and pulse was 94.
Patient is a nonsmoker.
No premedications required.
No systemic conditions.
Oral Pathology:
- Patient has bilateral crepitations and has experienced mild pain.
- Patient has bilateral mandibular tori.
Dentition:
Patient is class I occlusion with an overjet of 3mm and an overbite of 10%
Patient had generalized attrition and localized erosion.
Patient has suspected caries on all molars.
Periodontal:
Patient had generalized minimal bleeding upon probing and moderate generalized inflammation. Stippling was not present.
Patient is classified as a type III
Patient had 1-6 mm pockets.
Patient had no recession.
Oral Hygiene
Patient’s initial plaque score was 2.1. At his first revisit his plaque score improved to 1.3, and at his second revisit his plaque score improved further to 0.8.
Patient had generalized subgingival calculus and supragingival calculus on his mandibular anterior teeth.
At the patient’s first visit I taught him how to properly floss because he did not floss regularly.
At the patient’s second visit after he showed success flossing and after seeing that his plaque score had improved, I taught him how to properly brush his teeth using the Modified Bass Method.
I shared this patient with another student, therefor I did not see him at his third visit to the clinic.
Radiographs:
Yes, the patient had not had radiographs since 2013 and he had many areas of suspected caries, therefore I took bitewing radiographs at his second visit, however due to placement errors these radiographs were not usable.
Treatment Management:
In the first visit I finished all assessments and hand scaled teeth #2,3,4. At his second visit I took horizontal bitewings and finished scaling his upper right quadrant and scaled his lower right quadrant.
I did not see patient at his third visit to the clinic.
There were not factors that impacted treatment.
I taught the patient how to floss correctly, which he demonstrated at his second visit. I also taught this patient the modified bass method of toothbrushing however, as I did not see him at his third visit I do not know if he demonstrated it properly.
I felt that my strenght this session was dealing with a slightly difficult patient. The patient kept falling asleep and did not seem to want to be in the clinic, however I managed to get everything done in what I think was a timely manner.
My clinical weakness is still scaling. Twice I thought I had completed scaling but the professor found calculus.
I gave this patient a referral for suspected caries.
EVALUATION
The patient did not see very interested in flossing when I originally taught it to him, however at his second visit he stated that he had begun flossing, his plaque score had improved and he demonstrated near perfect technique.
He seemed a lot more interested in learning how to brush his teeth properly and seemed excited and encouraged by the positive feedback from the plaque score improvement.
The gingiva had tightened over the previously scaled teeth at his second visit, however I was not there to evaluate his gingiva at his third visit.
REFLECTION
In hindsight I would have spent more time perfecting the PID placement and angle when I took the horizontal bitewings.
I did accomplish everything I had planned.
