Specialized Patient Care Report

Lauren Holvey

DH 221B

2/12/2024

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 For this report I selected a patient of whom I first performed a new patient intake on. He

currently struggles with post-traumatic stress disorder (PTSD), depression, and anxiety. Going

into the cleaning appointment I was not sure what to expect as I did not know the full extent of

the patient’s condition at the new patient intake appointment. The patient’s current condition

seemed fair, and he only seemed to have certain triggers, specifically pain and needles. The

patient did state that he had spent seven years in therapy in the past, and it has helped him to find

ways to cope with these triggers.

Post-traumatic stress disorder is defined as a mental health condition that is triggered by a

terrifying event (Mayo Clinic, 2022). A symptom of this disorder is severe anxiety, which

seemed to be major factor for this patient. The Mayo Clinic also states that individuals with

PTSD experience traumatic events but “if symptoms [of the disorder] get worse, last for months

or even years, and interfere with your day-to-day function, you may have PTSD.” (Mayo Clinic,

2022). Having PTSD can also increase the risk for developing other mental health issues. The

Mayo Clinic states post-traumatic stress disorder can lead to further complications such as

depression and anxiety, issues with drugs or alcohol use, eating disorders and suicidal thoughts

and actions. This patient does suffer from depression and anxiety in addition to the PTSD, as

well as dealing with past alcohol and drug addiction.

Depression is an extremely common mental health disorder. The Depression and Bipolar

Support Alliance states “An estimated 21.0 million adults in the United States had at least one

major depressive episode. This number represented 8.3% of all U.S. adults.” (National Institute

of Mental Health, 2021). Depression is characterized by an unhappy mood or a loss of pleasure

in activities for an extended period of time. This depressed mindset can then affect the

individual’s relationships with family and/or friends, leading to problems at school or in the

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workplace. Depression is known for affecting physical health as well. The World Health

Organization goes on to state “Many factors that influence depression (such as physical inactivity

or harmful use of alcohol) are also known risk factors for diseases such as cardiovascular

disease, cancer, diabetes and respiratory diseases.” (World Health Organization, 2023). Typically,

treatment for moderate or severe depression is with antidepressant medications.

In addition to PTSD and depression, this patient is also dealing with diagnosed

generalized anxiety. John Hopkins Medicine describes generalized anxiety disorder as being “a

condition of excessive worry about everyday issues and situations.” (John Hopkins Medicine,

2024). The best treatment for generalized anxiety disorder is a combination of medicine and

cognitive behavioral therapy, which this patient has experienced in the past. This patient does

state that he has a special tactic (rubbing his fingers together) that works for him and helps him

to calm down when his anxiety has peaked, which does happen while in the dental chair.

The patient is taking numerous medications including apixaban (Eliquis), flecainide and

tamsulosin which he takes for the atrial fibrillation he was hospitalized for three months back. He

also takes numerous medications for hypertension including amLODPine and torsemide. He

currently takes atorvastatin to aid in the control of cholesterol levels. This patient is also a Type

II diabetic in which he takes glipiZIDE to keep his condition under control. He also takes

allopurinol and colchicine for treatment of gout. In addition to these medications, he also takes

ergocalciferol as a vitamin D dietary supplement, famotidine for acid reflux, gabapentin for

nerve damage and potassium chloride for hypokalemia.

When I first saw the patient for a new patient intake appointment, I was not anticipating

using him for as a special care patient, so I experienced the modifications to care rather than

preparing for them. One modification was he requested to schedule his treatment out at least a

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week to give him some time to prepare for the appointment, this is not of typical fashion as I try

my best to schedule my first available appointments. When I then saw this patient for assessment

procedures, I wanted to ensure I was utilizing stress reduction protocols such as gentle chairside

mannerisms by ensuring I had a calm and quiet voice, making sure I was explaining everything I

was doing and offering him some water before we began. Another modification to care I made

was to sit him up and allow him to use his calming tactic (rubbing his fingers together) multiple

times throughout the assessment procedures because he was feeling overwhelmed and anxious. It

was decided that nitrous oxide would probably be beneficial for this patient as well and I am

planning to use that at the next appointment. The patient was very appreciative of my flexibility,

working both with him and his schedule.

Overall, the modifications I have made to care so far, have benefitted the patient, and

helped him to remain more comfortable during treatment. These protocols will be implemented

at the next treatment appointment in addition to the use of nitrous oxide to ultimately achieve a

comfortable environment for the patient. A barrier to accessing dental treatment can often be fear

and this patient helped me to further realize the critical role the level of trust between the

provider and patient can play in a pursuit of dental healthcare treatment. It is important to adapt

and maintain a flexible attitude when working with patients that may be hesitant to dental

treatment. Patient comfort is so important to the dental hygiene process of care and can affect an

individual’s pursuit of treatment in the future.

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 References

Generalized anxiety disorder (GAD). Johns Hopkins Medicine. (2023, January 31).

https://www.hopkinsmedicine.org/health/conditions-and-diseases/generalized-anxiety-

disorder#:~:text=Key%20points%20about%20GAD%3F,muscle%20tension%2C%20and

%20trouble%20sleeping.

Mayo Foundation for Medical Education and Research. (2022, December 13). Post-traumatic

stress disorder (PTSD). Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-

causes/syc-20355967

U.S. Department of Health and Human Services. (n.d.). Major depression. National Institute of

Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression

World Health Organization. (n.d.). Depressive disorder (depression). World Health

Organization. https://www.who.int/news-room/fact-sheets/detail/depression