IMPLEMENTATION

Number of Appointments
■ A total of seven appointments used from the initial appointment to the tissue
re-evaluation appointment.
– 3 appointments for Assessment, Diagnosis, Planning.
Ø EO/IO/GD, radiographies
Ø PC/DHDX, intra-oral photos
Ø Risk assessment: dental caries and periodontal disease, oral health education, first plaque
index, oral hygiene instructions, and DDS exam.
– 3 appointments for Implementation.
Ø Lower right quadrant
Ø Sextant 1, second plaque index
Ø Sextant 2
– 1 appointment for Evaluation.
Ø Third Plaque index, tissue re-evaluation, gross debridement, air polishing, oral hygiene
instructions, and 5% NaF varnish application
Number of Appointments
■ Reflection: it took a total of seven appointments to complete the entire dental hygiene
treatment. It was a big commitment from the patient. Even thought it was a slow process, the
patient was happy about the result.
• Patient received comprehensive dental exam, including
Ø Full month X-ray series and Panoramic x-ray
Ø Full dental assessment and periodontal assessment
Ø Caries risk assessment and periodontal disease risk assessment
Ø 3 plaque indices at different appointment
Ø Diagnostic cast
• Patient received dental hygiene services, including
Ø Nutritional counseling
Ø Tobacco cessation counseling
• Patient received appropriate pain control throughout the treatment, including
Ø Nitrous oxide, 20% topical benzocaine gel, 2% Lidocaine for local anesthesia.
• Patient received appropriate dental education and home care education, including
Ø Etiology of periodontal disease, dental caries, parafunctional habits, extrinsic staining, and halitosis.
Ø Modified Bass brushing technique, Tepe® interdental brush technique, tongue cleaner, and mouth rinse.
DENTAL HYGIENE NOTES
DENTAL HYGIENE NOTES
Instrumentation
■ Strategy to address patient’s needs and chief concern.
– Thorough communication with the patient regarding LA, SRP prior to treatment.
– LA used to manage pain.
– Small breaks were given to the patient throughout the procedures.
– Kept communicating with the patient to ensure the safety and comfort of the treatment.
– Post-op instruction was provided to the patient.
■ Specific instrument selection and rationale for choices
– Periodontal files were used to break up large and tenacious calculus deposits in deep pockets
on molars (Darby & Walsh, 2019).
– Universals 4R/4L, H5/6 were used to remove moderate calculus (Darby & Walsh, 2019).
– Graceys 11/12, 13/14, 15/16, 17/18 were used in conjunction with Universals.
– Nevi Sickle scaler was used on the anterior teeth to remove supra calculus and plaque (Darby &
Walsh, 2019).
Instrumentation
■ Calculus removal instrumentation assessment
– Cavitron blue tip was used before hand scaling for gross debridement. Tapping motion was
used to break up large and tenacious calculus. I was able to remove a large amount of
calculus. I was able to see the calculus coming out. The calculus varied in color, including
brown, green and yellow, which may indicate various years of accumulation and different
bacterial complexes.
– Hand scaling involved with a combination of instruments followed Cavitron. Periodontal
files were used first on the molars under the supervision of the RDH. I was able to loosen
large and tenacious calculus. I was able to secure the files on the calculus surface with
minimal tissue stretch. A systematic use of universals followed the files. I started with the
most posterior tooth distal surface and worked toward the anterior direction. After
universals, I used graceys for more precise root planing. Nevi scaler was used on the
anterior teeth to remove supra-calculus and plaque. I was able to stay only on the supra
surfaces. Firm pressure was applied from the cervical third all the way to the incisal third
of the crown. Interproximal surfaces were scaled with controlled pressure and firm fulcrum
in the upward direction
– Cavitron purple tip was used in the end to provide refinement of root planing and irrigation
of the pockets. Light and gentle pressure was used.
Instrumentation
■ Calculus removal instrumentation assessment
• Challenges
Ø Indirect vision on sextant 2 and 5 lingual surfaces.
Ø Differentiating roughness and individual root anatomy
Ø Maintaining firm fulcrum

• Strategies used to overcome challenges

Ø Asked instructor for demonstration and feedback
Ø Asked patient for feedback

Ø Consciously reminded myself to avoid finger pulling and to maintain stable

fulcrum.
 Dental Hygiene Service(s)
This Photo by Unknown Author is licensed under CC BY-SA-NC

■ Tobacco cessation: 5 “A” strategy (Darby & Walsh, 2019).

– ASK: I had a smoking cessation conversation with the patient on 1/2/2020. Pt has been smoking
cigarette for over 30 years, approximately half pack per day.
– ADVISE: Informed the patient that cigarette contains carcinogenic agents and the heat generated from
smoking can irritate oral tissues. It is a risk factor for many systemic diseases (hypertension) and
localized oral diseases (Oral pathologies).
– ASSESS: Patient had a long history of smoking cigarette. He wanted to try to quit smoking and
understood quitting could be challenging
– ASSISST: Patient wanted to try nicotine gum 4mg 5 time a day for 2 weeks to aid the smoking cessation
process. Also, advised patient to try the skinnier type of cigarettes, which contains less carcinogenic
chemicals and less heat generate while still giving him the experience of smoking cigarette.
– ARANGE: followed up patient on 1/20/2020. Pt felt very challenging to quit smoking and did not want to
continue the quitting process. Nicotine gum did not help much, because patient is not only addicted to
nicotine but also the gesture when smoking. Pt liked the idea of the skinnier cigarette. He will continue
to smoke the skinnier cigarettes and try to cut down to less than 8 cigarettes a day.
Patient Participation
■ Patient tolerant LA and SRP well. He was able to metabolize LA within a reasonable
time period. Patient only experienced post-operative sensitivity on the day of
procedure. He was able to eat and drink as normal the day after SRP procedure.
■ Patient noticed cleaner teeth and cleaner breath after the first SRP procedure.
■ Patient noticed reduced bleeding and swelling after the completion of full mouth SRP.
■ Patient was surprised that there was no bleeding at all upon brushing and using
interdental brushes.
■ Patient was very happy to see the result of air polishing.
■ Patient’s compliance with OHI improved. He used interdental brushes every other day.
■ Patient’s 3 plaque indices showed slight improvement. Patient said he would need
some time to adjust to new home care routine. I will follow up him after 2-3 months.
Daily Biofilm Control
■ Home care compliance
– Patient had improving plaque index.
Ø 82% on 7/20/2019
Ø 78% on 1/22/2020
Ø 66% on 2/26/2020
■ Oral hygiene aids and adjuncts.
– Patient has class II embrasure space. Patient tried different types of interdental
brushes. He liked Tepe® brushes.
– Patient used Peridex after SRP for only 3 days. He did not like the flavor of it.
– Patient did not have any post-operative sensitivity and recovered fast; no other
adjuncts were indicated.
 References
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