Running head: CAPSTONE PRESENTATION 1

Capstone Presentation: Assessment, Nutritional Analysis, Dental Hygiene Diagnosis, Caries Risk

Assessment, Risk Assessment, Planning, Implementation, Evaluation, Reflective Conclusion,

and Documentation

by

Kari Burdick

Lake Washington Institute of Technology

In partial fulfillment of the requirements for

DHYG 341, 342, 412, 422, 432, 438 – Professional Practicum, Capstone, and Dental Hygiene

Theory and Practice series

Danette Lindeman RDH, BSDH, MEd

Spring 2019

May 8 , 2019
th
CAPSTONE PRESENTATION 2

Assessments

My patient is a 53-year-old woman, currently under the care of a Naturopath. Prior to

coming into the Lake Washington Institute of Technology Dental Clinic, the patient was a

patient of record at a private practice in Bothell, WA. Her last dental visit was about 12 months

prior to her initial assessment. The patient’s chief complaint was that she wanted to have her

teeth cleaned, as she felt like there were a few areas that “hitched” on build-up when she flossed.

The patient has a medical history significant for diabetes, and previous high blood pressure. Both

the high blood pressure and diabetes are well controlled with diet, but the previous uncontrolled

condition directly has impacted her oral and periodontal health. Diabetes is linked closely with

periodontal disease as they both involve enhanced inflammatory response. Chronic

hyperglycemia as seen with uncontrolled diabetes is one of the factors of systemic inflammatory

response, which includes the oral cavity (Southerland, Taylor, & Offenbacher, 2005). Not only

can the systemic disease predispose those with diabetes to periodontal disease, but the presence

of the oral infection can also contribute to the progression of the systemic disease.

The extra-oral exam was significant for generalized scattered macules, a larger 2x3 mm

macule at the angle of the chin on the right side, small 2x2 red erosion present near the left ear, a

3x3 purpura on the outer edge of the left ear, a small 2x2 bulla on the left side of the nose that

patient states bleeds if it is scratched, and a 2x2 mole on the left cheek near the upper lip. The

patient has not seen a dermatologist in the past, and we encouraged her to follow-up with a

dermatologist to have the findings followed regularly. A midsized submandibular lymph node

was palpated on the left, but patient has noticed this in the past and her medical doctor was not

concerned with it at the time. The intra-oral exam was significant for maxillary and mandibular

non-restrictive frenums, and slight leukoplakia on the buccal mucosa bilaterally opposite second
CAPSTONE PRESENTATION 3

molars. The hard palate was vaulted, and slightly erythematous anterior pillars were noted.

Scarring is present on retromolar pads and maxillary tuberosities from third molar extractions.

Small lingual tori present on the right, with a moderately coated tongue. All findings appear

within normal limits.

Although the patient has an established dental home, she states she dislikes the dentist

and is not generally regular in her recare appointments, going 12-18 months between recare

visits. The irregular periodontal therapy, in addition to the systemic conditions, have impacted

the oral health as seen in the radiographs and intra-oral photos with the gingival assessment. I

noted that the patient had generalized pink tissue with moderately erythematous band along the

buccal and lingual of #4-13, and generally slight erythema in the posterior of the maxilla and

throughout the mandible. The gingival margins were generally rolled with isolated moderate

rolling of the margin around #15, 18, and 19. The interdental papilla was generally bulbous with

isolated blunting present. The texture of the gingiva was stippled in the anterior and smooth in

the posterior with a generalized edematous consistency. Due to the patients clinically evident

recession, vertical bitewings were taken as part of the full mouth series of x-rays allowing

adequate evaluation of the alveolar bone height.

Tooth Chart

Patient presented with missing first premolars (numbers 5, 12, 21, and 28) extracted as a

teenager for orthodontic purposes. Third molars are also missing and patient reports having them

extracted about 9 years ago due to partial impaction and inaccessible decay on #2 that required

#1 to be extracted in order to restore. There are class I occlusal composite restorations on teeth

#’s 3, 15, 18, 19, 30, and 31. Tooth #2 is root canal treated and has a full porcelain crown with

the root canal access hole sealed with composite. There are class II composite restorations on
CAPSTONE PRESENTATION 4

#13-DO and #14-MO. Marginal ridge discrepancies are noted on the distal of #4 and the distal

of #19. There is significant crowding as well as Class II malocclusion with 9mm overjet and

normal overbite. Distal rotations are noted on teeth #’s 6, 11, 22, 23, and 25. Mesial rotations are

noted on teeth 8, and 26. Teeth 7, 24, and 27 are in linguoversion, and 8, 25, and 26 are in

buccoversion.

Periodontal Chart

The periodontal chart was completed on 11/13/2018. Patient had generalized 2-4 mm

pocket depths with isolated 5 mm pocket depths on the interproximal surfaces between #30 and

31 lingual. Generalized recession of 1-2 mm found in the posterior and lingual of the lower
CAPSTONE PRESENTATION 5

anterior. Isolated class I furcation is noted on the buccal of #18, 19, and 30. The width of

attached gingiva is less than 2 mm on the buccal of #18-20 and #29. Localized bleeding upon

probing throughout the maxilla and mandible, with more concentrated bleeding in the lower left

posterior. No mobility is noted.

Radiographs

At the patient’s initial appointment on 7/16/2018 she stated she had a full mouth series of

x-rays at the previous dental office. At that time, it was decided to take a conservative approach

and take a periodontal series consisting of 4 vertical bitewings and 3 anterior bitewings. After

this appointment the previous office was contacted and informed me that she did not have any

current radiographs on file with them. At the patients next appointment on 11/13/2018 a full

mouth series was completed utilizing the vertical bitewings taken on 7/16/2018.
CAPSTONE PRESENTATION 6

Dental Examination

The comprehensive dental examination with Dr. Lowell found no new concerns or watches. All

existing restorations are functional with good margins.

Intra-oral Photos taken 11/21/2018:

CAPSTONE PRESENTATION 7
 CAPSTONE PRESENTATION 8

Bulbous papilla Generalized

clinically evident slightly rolled
margins

Recession
clinically evident

Nutritional Analysis

My patient was asked to complete a 7-day nutritional log enabling me to analyze and

assess her dietary risk factors for caries and other vitamin or mineral deficiencies (see Appendix

A for full food diary). The patient is very dedicated to logging her food as she utilizes dietary
CAPSTONE PRESENTATION 9

control for management of diabetes and considers herself a “nutrient seeker.” She additionally

only logged food on 4 days of 7 requested. After questioning what she consumed on the other 3

days she explained that the other days were fasting days as she also follows an intermittent

fasting protocol.

ChooseMyPlate.gov, a resource through the United States Department of Agriculture

recommends dietary guidelines based on age and gender. The MyPlate recommendations for this

patient consist of about 1,600 calories per day, made up by 10-35% protein, 45-65%

carbohydrates with about 22.4 grams of dietary fibers, and about 20-35% fat (health.gov).

However, due to the patient’s history of diabetes, we also consulted the American Diabetes

Association. According to the ADA dietary recommendations, a plate of food should consist of

25% protein, 25% grains and starchy foods, and 50% non-starchy vegetables (diabetes.org).

Based off this she is severely deficient in her consumption of carbohydrates, and consuming

excessive amounts of fats. However, there is evidence that the benefits of low-carbohydrate diets

are more beneficial for management of diabetes than consuming the recommended carbohydrate

amounts and using medications to reduce the blood glucose levels. There is also research that

suggests that there is no meaningful correlation between dietary fat intake and cardiovascular

disease (Feinman et al., 2014).

In regard to micronutrients, the patient was deficient in all categories of vitamins and

minerals on 4 of the 7 days. I counseled the patient to focusing on a more consistent, nutrient

dense diet that will provide her will the minimum micronutrients each day as opposed to

consuming excessive amounts half of the time and being severely deficient the rest of the time.

The patient seemed receptive to this. Although she still plans to continue with intermittent
CAPSTONE PRESENTATION 10

fasting, she will try to schedule the fasts between early evening and the morning to allow for

more opportunities to get a better micronutrient ratio.

DIETARY ASSESSMENT LOG

Day Adequate
Food Groups 1 2 3 4 5 6 7 Daily Avg Yes No
Fruits 0 0 0 0 0 0 0 0 X
Vegetables (also, beans 0 3 0 15 0 16 14 6.85 X
and peas)
Grains 0 0 0 0 0 0 0 0 X
Dairy (milk, yogurt, cheese, 0 0 0 0 0 0 0 0 X
calcium fortified soy milk)
Protein (meat, poultry, fish; 0 8 0 6 0 6 6 3.7 X
eggs, nuts, seeds, dry
beans, peas, processed soy
– tofu)
Fats & sweets 0 4 0 4 0 5 4 2.4 Eat Less Sparingly
Water 120 oz 85 oz 120 oz 70 oz 120 oz 75 oz 80 oz 95.7 X
DAILY ACID EXPOSURE TOTALS OF ACID EXPOSURE
Fermentable Day 1 2 3 4 5 6 7 Total Total all fermentable liquid exposures; multiply by 20
Liquids w/a meal 1 1 1 1 1 1 1 7 minutes; divide by total number of days to determine daily
(juices, soda, End of 0 0 0 0 0 0 0 0 acid attack from sweet liquids.
energy drinks, meal
milk etc.) b/w meals 2 2 2 2 2 2 2 14 Total liquid minutes ___60______________
Soft/Solids w/a meal 0 0 0 0 0 0 0 0 Total all soft & hard fermentable exposures; multiply by 40
(sticky/retentive End of 0 0 0 0 0 0 0 0 minutes; divide by total number of days to determine daily
foods: cookie, meal acid attack from sweet solids.
ice-crm,raisins, b/w meals 0 0 0 0 0 0 0 0
etc.) Total solid minutes _____0____________
Hard/Solids w/a meal 0 0 0 0 0 0 0 0 Total all liquid and solid exposure totals together to
(slow dis- End of 0 0 0 0 0 0 0 0 determine number of minutes per day teeth are under acid
solving food: meal attack.
Altoids, cough b/w meals 0 0 0 0 0 0 0 0
drops, etc) Total daily minutes of acid attack __60_______________
Plaque Index Score: 36 % Caries Risk Assessment: Low Moderate High

Evaluator Name Kari Burdick DHS Patient’s Name Karen B

Dental Hygiene Diagnosis

Through the dental hygiene diagnosis, it was determined that the largest contributing

factor to the patient’s periodontal disease is her history of type II diabetes mellitus. The patient

has been irregular with dental care throughout her life because she does not like going. She

stated she had a bad experience as an adolescent with extractions being done without anesthetic.

The patient seemed reluctant to come in for multiple appointments as she does not like dental

treatment but is committed to the process and is excited to be part of the capstone project.
CAPSTONE PRESENTATION 11

The patient was increasingly motivated to improve oral health as the correlation between

systemic inflammation and oral inflammation was explained to the patient. During the initial

discussion the patient stated that she did not have periodontal disease, but as soon as she

understood the inflammatory factors involved with periodontal disease, she said “well then of

course I have it! Diabetes and inflammation go hand in hand.” Although this is a simplification

of the correlation, “elevated levels of the inflammatory marker high-sensitivity C-reactive

protein (hs-CRP) are associated with increased risk for CVD and diabetes mellitus” (Haffner,

2006, p. 3A)

She mentioned that her previous office has presented the possibility of doing isolated scaling and

root planing in some areas that were not improving. She declined at the time, not fully

understanding the need. With assistance of the radiographs and periodontal charting we were

able to show the patient the levels of horizontal bone loss accompanied with the areas of 4-5 mm

pocket depths and bleeding with probing. This helped explain the status of the patient’s

periodontal disease. The patient stated that she does not use fluoride products but does use a

natural toothpaste containing xylitol. She does drink tap water that is fluoridated. As the patient

has no current restorative needs and she consumes adequate amounts of fluoridated tap water, I

had no recommendations at this time aside from considering a fluoridated toothpaste when she is

done with the current tube she is using. My primary goal in treating this patient was to not only

remove the calculus acting as a nidus for harmful bacteria, but also to help the patient value her

homecare routine in managing her oral health and reducing her levels of inflammation. The first

step in addressing these goals is to complete full mouth scaling and root planing. Accompanied

with oral hygiene demonstrations and instructions on brushing and flossing techniques. At the

time of the tissue re-evaluation I will assess to see if any further aid can be added to her
CAPSTONE PRESENTATION 12

homecare routine and ensure there is no residual calculus possibly causing gingival irritation. I

will use an updated periodontal chart and gingival description to evaluate pocket depths and

bleeding upon probing.

CAPSTONE PRESENTATION 13

Caries Risk Assessment

The patient has a low cariogenic intake in her diet, as she follows a ketogenic lifestyle to manage

her diabetes and high blood pressure. Other than coffee, the patient only consumes water or

occasional electrolyte drinks sweetened with stevia. The patient has low caries risk due to the

lack of fermentable carbohydrates or sweets in the diet and lack of acidic drink intake. The

patient does occasionally consume carbonated water- either Perrier or La Croix, which has a

lower pH of about 5.25 as opposed to still water that has a pH ranging from 6.0-7.0 (Reddy,

Norris, & Momeni et al. 2016). Beverages with a pH of 4.0 or higher are considered to be

minimally erosive. The patient states that she is opposed to fluoride, but she does drink

fluoridated tap water, uses toothpastes with xylitol and chews Spry gum, which also contains

xylitol.
CAPSTONE PRESENTATION 14

Risk Assessment

The risk assessment summarizes the status of the patient’s oral health as well as the hard

tissue and soft tissue risk factors. The only significant health history finding was a history of

endocrine dysfunction as evident by her diabetes mellitus. Clinically evident in the hard tissues

was attrition, and misaligned teeth. Based on her habits, she is at an increased risk for caries due

to her infrequent flossing and lack of belief in fluoride. Clinically evident in the soft tissues is

gingival recession and periodontal disease; which is unsurprising due to the direct relationship

between periodontitis and type II diabetes mellitus. Chronic hyperglycemia is associated with

increased severity of periodontal disease (Sanz, & Ceriello et al. 2018). She is not a risk for other

soft tissue concerns. She has a history of anxiety and fear of dental treatment, although she feels

it is low in regard to cleanings. When she was younger, she had extraction of her first premolars

to alleviate crowding and it was done without any anesthesia. This has left her with a low level

of anxiety associated with all dentists. The patient stated that she does notice bad breath

occasionally. She stated she drinks bottled electrolyte water, filtered water, along with tap water
CAPSTONE PRESENTATION 15

that is fluoridated, but she is opposed to additional fluoride supplementation. The patient did not

have a specific explanation for her opposition to fluoride besides she didn’t feel she needed it.

She feels like she has medium levels of stress load with low levels of exercise. She did smoke

when in college but that was over 33 years ago. She follows a ketogenic/low carbohydrate diet.

However, on occasion she consumes carbs in the form of sweet potatoes or gluten-free bread.

The patient’s intra-oral and extra-oral exams were within normal limits. She has no

unrestored or active caries but does have a history of composite restorations and crowns. The

periodontium was significant for low-moderate levels of plaque, calculus, bleeding upon

probing, clinical attachment loss, and isolated furcation involvement. The patient currently uses a

soft manual tooth brush 1-2 time a day and flosses 2-3 time per week. She thinks her toothpaste

is a natural fluoride-free formulation by Tom’s of Maine and does not use any mouth rinses. The

plaque index showed a score of 36%, primarily in the anterior around the cervical margin and

around the crowding of the lower anterior, along with interproximal line angles in the posterior.
CAPSTONE PRESENTATION 16

Planning

The plan for treatment included 4 quadrants of isolated scaling and root planing, D4342

(1-3 teeth per quadrant) as the patient has some radiographic horizontal boneless, class I

furcation involvement, and isolated recession that designates the patient as an AAP III. Although

she is an AAP III, she does not have more than 3 teeth per quadrant that are showing signs of

chronic, active infection as seen with deeper pocket depths or heavy bleeding. This treatment

was scheduled to be completed in 2 appointments, as the patient had heavier calculus on the

mandible and would benefit from local anesthetic on the mandibular quadrants. The goal is to

reduce the inflammation and erythema of the gingiva. I would like to see a reduction in gingival

bleeding as it is one of the most prevalent indicators of periodontal disease (Petersen & Ogawa,

2012). Each appointment will include subgingival chlorohexidine irrigation, and homecare

technique review with education on the importance of flossing. I will also continue to educate

her on the increased risk factors for oral inflammation due to her diabetes. The patient currently

uses floss picks when she does floss. We will review flossing with traditional waxed floss using

the “C” shape technique to encourage more effective and frequent use of floss at home. At the

time of the tissue re-evaluation I will assess the need for additional therapeutic interventions such

as Arestin.
CAPSTONE PRESENTATION 17

Implementation

In the implementation phase the patient was seen a total of 3 times. The sequence of

appointments was as follows: lower right quadrant scaling and root planing, upper right and left

scaling and root planing, and finally lower left scaling and root planing. The patient was initially

scheduled for a tissue re-evaluation at 4 weeks post scaling for half of the mouth, however due to

inclement weather conditions closing the clinic, she was not seen until about 7 weeks post

scaling of the upper and lower right quadrants. My proposed treatment plan included scaling

with local anesthetic, but the patient refused any form of anesthetic.

Each appointment consisted of scaling with the use of a Cavitron and Piezo ultrasonic

scalers to debride the quadrants. Following ultrasonic instrumentation each quadrant was hand

scaled with both universal and Gracey curettes, this is an important aspect of the treatment as
CAPSTONE PRESENTATION 18

research has found that “Ultrasonic instruments are simple to use, but it is often difficult to

achieve smooth and calculus-free root surface,” (Dahiya, Kamal, Gupta, & Pandit, 2011, pg 1).

The hand instrumentation allowed me to properly adapt to the root concavities and areas with

bone loss. The patient tolerated the treatment well. However, I was initially a little tentative with

scaling as the subgingival calculus was quite deep. Which lead me to worry about causing pain

to the patient due to the refusal of anesthetic. I recommended she follow each scaling

appointment with warm salt water rinses to help soothe any tissue discomfort post scaling.

Evaluation

The tissue re-evaluation involved the upper right and lower right quadrants. I assessed for

changes to the tissue as evident in the gingival description and updated periodontal charting to

assess for improved areas or unresponsive areas post-nonsurgical periodontal therapy. My

gingival description findings revealed decreased marginal erythema and edema. The periodontal

charting showed multiple areas of reduced pocket depth, with all previous 5 mm depths reducing

by 1-2 mm. Multiple 4 mm pockets remained in the posterior of both quadrants. So, I stressed the

need for regular flossing to help further reduce the depth of these pockets. A decrease in the

sites of bleeding upon probing was noted as well. As there were no periodontal pockets of 5 mm

or deeper, further interventions such as Arestin were not indicated. An updated plaque index was

done on the right side to see if there were improvements on her homecare and plaque control.

The plaque index score was 20.3% (see image below), showing improved brushing around the

gingival margins and line angles of the posterior teeth. The areas still needing improvement of

plaque control were mainly in the anterior, on the mandible where there is crowding and

rotations of the teeth, making it a little more difficult to access with a toothbrush. Also, the

lingual of the maxillary incisors have deep fossae causing more plaque retention. We reviewed
CAPSTONE PRESENTATION 19

where to rotate the brush head at different angles allowing access to the areas being missed.

Then, I had the patient demonstrate to me with use of a handheld mirror until all of the visible

plaque was removed. In addition to these assessments, I explored the areas thoroughly for

calculus that may have built-up since the initial therapy was completed. I used the Piezo

ultrasonic scaler to aid in the removal of residual deposits as well as disrupt unattached

subgingival plaque and biofilm. I explained the benefits of this to the patient as research has

shown that “removal of subgingival microbial biofilms is essential for controlling inflammatory

periodontal disease” (Arabaci, Çiçek, & Çanakçi, 2007). Following this I fine scaled with

universal curettes and sickle scalers. The appointment was concluded with polishing and flossing

the two quadrants. I commended the patient for the improvements noted at the re-evaluation

appointment and recommended she be kept on a three-month continuing care frequency, in

efforts to prevent any further destruction of the periodontium due to inflammation or bacteria.

The patient was in agreement and is scheduled to return in May 2019.

Reflective Conclusion

Combined theory acquired from the health science classes in addition to dental hygiene

classes enabled me to provide comprehensive treatment for this patient. The knowledge of

metabolic diseases like diabetes and inflammation from pre-requisites allowed for me to really

hone in on the oral implications for my patient. We also gained value of the purpose for

periodontal therapies through our dental hygiene theory and periodontology classes. In addition,
CAPSTONE PRESENTATION 20

I was able to see a growth in my instrumentation skills from the first scaling appointment to the

last scaling appointment due to advanced instrumentation skill labs and constructive feedback

from instructors received at each appointment. The capstone project was a great way to ensure

we are incorporating easily overlooked aspects of patient care. I have felt more comfortable

discussing nutritional counseling with patients as a result of this project, as well as delving

deeper into caries risk assessments for patients with a significant history of decay. I felt I was

very successful in showing the value of the treatment provided to my patient, as she was initially

hesitant, or skeptical of the necessity of non-surgical periodontal therapy. However, once she

understood the role that inflammation played in periodontal disease, she was very eager to

proceed with treatment. I have also noted areas that I need to improve, primarily in

instrumentation around the distal of all canines, as I noted rough areas were left here. I also could

improve on my time management as I generally left “extra” procedures like impressions and

photos for the end of the appointments and as a result frequently ran out of time for these.

Documentation

Thorough chart notes were kept throughout the care of this patient. I made a point of

always reviewing the chart notes from previous visits prior to seating the patient, which allowed

for me to be familiar with the previous concerns and discussions, but also assess accurately for

any changes in the gingival condition at each appointment. Reviewing previous notes also

enabled me to ensure that the planned services were in line with the treatment plan. The areas of

documentation that were not done as thoroughly, were the post-op photos and impressions. I

believe using before/after photos are a great motivational factor for patients and would have

liked to have been able to show the patient the improvement in inflammation and erythema. The

post-op impressions would have also helped demonstrate the improvements of the contour of the
CAPSTONE PRESENTATION 21

gingival margins and papilla to the patient. Despite these areas that I could have improved on, I

believe by use of a paper chart audit throughout the course of treatment I was able to maintain

accurate records for my patient.

CAPSTONE PRESENTATION 22

REFERENCES:

Arabaci, T., Çiçek, Y., Canakci, C.F. (2007). Sonic and ultrasonic scalers in periodontal

treatment: a review. International Journal of Dental Hygiene vol. 5, issue 1, pages 2-12.

Retrieved from https://doi.org/10.1111/j.1601-5037.2007.00217.x

Create Your Plate (n.d.) Retrieved from http://www.diabetes.org/food-and-fitness/food/planning-

meals/create-your-plate/?loc=ff-slabnav

Dahiya, P., Kamal, R., Gupta, R., & Pandit, N. (2011). Comparative evaluation of hand and

power-driven instruments on root surface characteristics: A scanning electron microscopy

study. Contemporary Clinical Dentistry, 2(2), 79-83. doi: 2091/10.4103/0976-

237X.83065

Dietary guidelines for Americans 2015-2020 (2015) Retrieved from

https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

Feinman, R., Pogozelski, W., Astrup, A., Bernstein R., Fine, E.,

Westman E., … Worm, N. (2015) Dietary carbohydrate restriction as the first approach in

diabetes management: Critical review and evidence base Nutrition vol. 32, issue 1, pages

153-154. Retrieved from https://ac.els-cdn.com/S0899900714003323/1-s2.0-

S0899900714003323-main.pdf?_tid=603d8412-8f2a-4e12-ad5e-

e6eb308722af&acdnat=1550545448_c0910d034061661a43c7673c2f9a7ad0

Haffner, S.M. (2006) The metabolic syndrome: Inflammation, diabetes mellitus, and

cardiovascular disease. The American Journal of Cardiology, V.97, Issue 2, pages 3-11.

Retrieved from https://doi.org/10.1016/j.amjcard.2005.11.010

CAPSTONE PRESENTATION 23

Moment, S., Norris, D., Reddy, A., Ruby, J., Waldo, B. (2016) The pH of beverages in the

United States. JADA, pages 1-9. Retrieved from

https://www.ada.org/en/~/media/ADA/Public%20Programs/Files/JADA_The%20pH%20

of%20beverages%20in%20the%20United%20States

Offenbacher, S., Southerland, J.H., Taylor, G. (2005) Diabetes and periodontal infection: Making

the connection. Clinical Diabetes (4), pages 171-178. Retrieved from

https://doi.org/10.2337/diaclin.23.4.171

Peterson, P., Ogawa, H. (2012) The global burden of periodontal disease: towards integration

with chronic disease prevention and control. Periodontology 2000 vol 60, issue 1, pages

15-39 Retrieved from https://doi.org/10.1111/j.1600-0757.2011.00425.x

Sanz, M., Ceriello, A., Buysschaert, M., Chapple, I., Demmer, R., Graziani, F., … Vegh, D.

(2018) Scientific evidence on the links between periodontal diseases and diabetes:

Consensus report and guidelines of the joint workshop on periodontal diseases and

diabetes by the International diabetes Federation and the European Federation of

Periodontology. Diabetes Research and Clinical Practice vol. 137, pages 231-241.

Retrieved from https://doi.org/10.1016/j.diabres.2017.12.001

CAPSTONE PRESENTATION 24

APPENDIX A
LAKE WASHINGTON INSTITUTE OF TECHNOLOGY
Health Sciences Division
DHYG 342 – Dental Hygiene Practice IV

Student Name Kari Burdick Patient’s Name Karen B

Daily Food Diary

Day of the week: Saturday Date 1/12/2019
QUANTITY EATEN
FOOD/BEVERAGE PREPARATION (fried, grilled, steamed,
(in cups, oz., tsp, tbs,
TYPE etc)/SERVINGS
etc.)
Food
Breakfast Preparation Servings
Group
None- fasting day

Snack

Lunch

Snack

Dinner
CAPSTONE PRESENTATION 25

Snack

Daily Food Diary

Day of the week: Sunday Date 1/13/2019
QUANTITY EATEN
FOOD/BEVERAGE PREPARATION (fried, grilled, steamed,
(in cups, oz., tsp, tbs,
TYPE etc)/SERVINGS
etc.)
Food
Breakfast Preparation Servings
Group
Rib eye steak 152 grams grilled Protein/m
eat
Chicken thigh 128 grams broiled
Avocado 3 oz raw

Snack

Lunch
Rib eye 125 grams grilled
Chicken thigh 175 grams broiled

Snack

Dinner

Snack
CAPSTONE PRESENTATION 26

Daily Food Diary

Day of the week: Monday Date 1/14/2019
QUANTITY EATEN
FOOD/BEVERAGE PREPARATION (fried, grilled, steamed,
(in cups, oz., tsp, tbs,
TYPE etc)/SERVINGS
etc.)
Food
Breakfast Preparation Servings
Group
None- fasting day

Snack

Lunch

Snack

Dinner

Snack
CAPSTONE PRESENTATION 27

Daily Food Diary

Day of the week: Tuesday Date 1/15/2019
QUANTITY EATEN
FOOD/BEVERAGE PREPARATION (fried, grilled, steamed,
(in cups, oz., tsp, tbs,
TYPE etc)/SERVINGS
etc.)
Food
Breakfast Preparation Servings
Group
Broccoli 459 grams Steamed Veg
Zucchini 284 grams steamed Veg
Avocado 45 grams raw Veg
Cabbage 333 grams sauteed Veg
MCT oil 1 teaspoon Fat
Chipotle lime mayo 14 grams Fat
Almonds 20 grams raw
Snack
Cashews 20 grams raw
Avocado oil 5 grams raw fat

Lunch

Snack

Dinner

Snack

Food was prepped in AM and eaten at each meal

CAPSTONE PRESENTATION 28

Daily Food Diary

Day of the week: Wednesday Date 1/16/2019
QUANTITY EATEN
FOOD/BEVERAGE PREPARATION (fried, grilled, steamed,
(in cups, oz., tsp, tbs,
TYPE etc)/SERVINGS
etc.)
Food
Breakfast Preparation Servings
Group
None- fasting day

Snack

Lunch

Snack

Dinner

Snack
CAPSTONE PRESENTATION 29

Daily Food Diary

Day of the week: Thursday Date 1/17/2019
QUANTITY EATEN
FOOD/BEVERAGE PREPARATION (fried, grilled, steamed,
(in cups, oz., tsp, tbs,
TYPE etc)/SERVINGS
etc.)
Food
Breakfast Preparation Servings
Group
Zucchini 253 grams Steamed
Cauliflower 288 grams Steamed
Onion 114 grams Sautéed
Cabbage 211 grams Sautéed
Celery 95 grams Sautéed
Avocado 3 oz Raw
Olive oil 4 grams Raw
Snack
Almonds 23 grams Raw
Cashews 23 grams Raw
MCT oil 1 teaspoon raw
Lunch
Sir kensington’s mayo 2 teaspoon
Collard greens 77 grams sauteed

Snack

Dinner

Snack

All food was prepped in the morning and eaten at each meal.
CAPSTONE PRESENTATION 30

Daily Food Diary

Day of the week: Friday Date 1/18/2019
QUANTITY EATEN
FOOD/BEVERAGE PREPARATION (fried, grilled, steamed,
(in cups, oz., tsp, tbs,
TYPE etc)/SERVINGS
etc.)
Food
Breakfast Preparation Servings
Group
Cauliflower 331 grams
Zucchini 345 grams
Celery 110 grams
Summer squash 238 grams
Collard greens 89 grams
Onion 119 grams
Kale chips 20 grams
Snack
Cashews 25 grams
Almonds 23 grams
avocado 2 oz
Lunch
Olive oil 4 grams
Coconut oil 4 grams

Snack

Dinner

Snack

All food was prepped in AM and eaten at each meal.