Clinician Capstone Project

By Nancy Sarahi Serna Cabrera

In partial completion of the requirements for
DHYG Senior Capstone & Portfolio
September 25, 2019.
Food Intake
Record
9/23/19
Food Intake
Record
9/24/19
Food Intake
Record
9/25/19
Food Intake
Record
9/26/19
Sugar intake
Pre-treatment
Intraoral
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Pre-treatment
Intraoral
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Pre-treatment
Intraoral
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Pre-treatment
Intraoral
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Pre-treatment
Intraoral
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DIAGNOSIS
Copy of
Dental
Hygiene
Diagnosis
Copy of
Dental
Hygiene
Diagnosis
Dental
Hygiene
Diagnosis
  The dental hygiene diagnosis and care plan for this patient consist of
health history, dental history, extraoral and intraoral examinations,
gingival description, oral hygiene, hard tissues, and periodontal. Patient
presents with palmoplantar hyperhidrosis and its taking glycopyrrolate.
Sweating palms and sole feet is the etiology of palmoplantar
hyperhidrosis. My goals for this is to keep monitoring the patient to
make sure he is taking his medication. The patient’s last dental visit was
Dental February 2017, this is related to busy school and work schedule. My goal
is to get patient back in a constant dental schedule. Upon extraoral and
Hygiene intraoral examination a scar that measures 12x5mm was found on the
middle of the forehead. This scar is related to a fall during childhood.
Diagnosis Scattered macules were found on the patients left cheek. This is related
to genetics. My goal is to monitor both of this findings for any changes.
For gingival description is was found that gingiva was generalized slight
erythematous, slight edematous, with rolled margins, and smooth
texture. There was some severe erythematous and edematous on the
facials of #22-27. The condition of the gingiva is related to not having a
cleaning in the last two and half years. My goal is to review importance of
cleaning and put the patient in an appropriate continuing care schedule.
  Patients present routine is toothbrushing twice a day and flossing
sometimes once per week. The present plaque is light and calculus
is moderate. The reason for the plaque and calculus is because the
patient has been busy and hasn’t had time to get a cleaning done.
My goal for oral hygiene is to demonstrate flossing and motivate
patient to floss twice a week. Also I would like to demonstrate the
Dental modified bass toothbrushing technique. There is moderate
attrition on teeth #6-11 and #22-27. The reason for this is
Hygiene grinding. My goal is to educate patient on the complications of
Diagnosis grinding. Patient does wear a nightguard to sleep. Patient has
existing amalgam and composite fillings. The periodontal exam
shows generalized 2-3mm pockets with localized 4-5mm pockets,
recession class I and II, bleeding on probing is generalized
moderate. This is related to not cleaning interproximal regularly.
My goal is to educate the patient on the meaning of the pocket
depths.
 Based on his infrequent dental history, the intervention goal was to
educate the patient on the importance and reasons of regular dental
check ups, x-rays, and dental cleanings. The CDA recommends to get a
thorough professional cleaning as needed for the patient’s periodontal
Methods Used health (Featherstone, Domenjean-Orliaguet, Jenson, Wolff, & Young,
to Achieve 2007).Intraorally his moderate coated tongue, showed that the
patient’s tongue was being left out from his home oral hygiene. My
Goals and plan is to introduce him to a tongue cleaner and demonstrate how to
Outcomes properly use it. His slight erythematous, slight edematous, and
localized severe erythematous, edematous, rolled margins, and glossy
texture on teeth #21-27, was because of inadequate biofilm removal
and the amount of time since his last dental cleaning. It has been
demonstrated that the prevention of plaque formation or repetitive
removal prevents gingivitis (Contreras, 2017). Crowding from #22- 25
also contributed to severe erythematous gingiva. My intervention plan
was to demonstrate the modified bass toothbrushing technique and c-
shape flossing technique. Patient was instructed to spend two minutes
 Patient admitted to me that he does not like flossing, because
it irritates his gums and brushing is easier. The patient
reported that he brushes once a day, sometimes two. He
Patient usually brushes in the morning after waking up. The reason
for this is because sometimes he’s too tired to brush his teeth
Compliance at night and falls asleep. He uses a soft manual toothbrush
and Colgate toothpaste. Sometimes he uses mouthwash once
a week. Rarely flosses his teeth.
  Patient was motivated to change his oral hygiene habits after I
showed him the disclosing agent on his teeth and the plaque
present. He was very attentive and asked questions while I was
demonstrating the modified bass toothbrushing technique. He
Patient was also willing to try to start flossing at least twice a week,
because he saw the dark purple interproximal areas from the
Motivation disclosing solution indicating that’s where most plaque was
present. After showing him the plaque on his tongue, he
understood that a tongue cleaner will be helpful for him. After all,
he was very thankful for me taking the time to properly show him
how to improve his oral health.
Caries
  Based on the American Dental Association’s Caries Risk
Assessment Form, the patient has a high risk for caries
(American Dental Association, 2009). This is based on
Gerardo’s lack of an established dental home and not
receiving regular dental care. One of the contributing factors
is that he drinks juice primarily at mealtimes. Under general
health conditions, he takes medication that reduces his saliva
flow. Under clinical conditions he had one carious restoration
Caries in the last 36 months, has visible plaque, has exposed root
surfaces from recession, and has severe dry mouth. Overall,
the patient is at a high dental caries risk. Studies have shown
that patients are at higher risks of developing caries because
of salivary malfunctions. Exposure to fluoride can successfully
treat and prevent decay. 0.05 NaF rinses, high prescription
dentifrices, and in-office fluoride are some options for
patients with xerostomia ( Fontana & Zero, 2006)
 The patient lives in an area where tap water is floriated. He
usually drinks bottle water. He uses Colgate toothpaste with
sodium fluoride once to twice a day. My goal for this patient
is to brush his teeth twice a day with Colgate toothpaste
containing sodium fluoride. Also I have asked the patient to
Fluoride drink tap water instead of bottled water, to get the benefits of
Sources the fluoride. Black tea and shrimp are foods high in fluoride
too, patient was advised to have more of these. The CDC
studies show the decline in the seriousness of dental caries in
the United States due to fluoride. There are many effective
ways to obtain fluoride, both in private and public health
settings. Dentifrices, mouth rinses, dietary supplements and
professionally applied products are available to US residents
(Horowitz, 2003).
 According to the study from the article “A comparative study of
electric toothbrushes for the effectiveness of plaque removal in
relation to toothbrushing duration” the efficiency in removing
plaque interproximally and cervically on buccal and lingual surfaces
of teeth was greater using a electronic tooth brush compared to a
Methods of manual conventional toothbrush. Six surfaces of each tooth was
evaluated before and after brushing without toothpaste. The
Evaluating results showed an increase in the effectiveness of plaque removal 
going from 7.5 seconds to 90 seconds per quadrant. The study also
Success showed that spending more time brushing will more successfully
remove interproximal plaque. In conclusion, the amount of time
spend brushing is essential to plaque removal. Also the type of
toothbrush will affect the efficiency of plaque removal (Weijden,
Timmerman, Nijboer, Lie, & Velden, 1993)
PLANNING
 After non-surgical periodontal therapy it is expected to
reduce the depth of periodontal pockets, reduce
bleeding areas, and gain clinical attachment loss. The
goal is to also reduce inflammation, rolled margins,
bulbous severe erythematous, edematous, and glossy
Goals and texture on teeth #21-27, especially.
Expected The biggest goal I have for the patient is to start flossing
Outcomes once a week at night before bed. I have also
recommended a tongue cleaner to reduce the amount of
plaque and avoid halitosis. As well as to brush at night
instead of brushing in the morning.
 My initial goal for the patient was for him to establish a dental home
and get him back to a consistent dental schedule. I advised him to
start flossing at least once a week at night preferability, since he was
flossing irregularly.
A tongue cleaner was recommended as an oral aid to help with the
reduction of bacteria on the tongue and prevent halitosis. The
Patient patient’s motivation increased after showing him the plaque on his
teeth after disclosing him. This helped him understand why flossing is
Education important and needs to be integrated into his oral hygiene at home.
I believe the patient is motivated enough to decrease plaque levels
and indices. The demonstration on modified bass tooth brushing
technique and c-shaped flossing technique will help him accomplish
this. As well as the education I provided him on periodontal disease
and gingivitis.
 Patient is classified as an AAP II/2/D2 full mouth. A
hygiene treatment plan of four quadrants of scaling and
Dental root planning code D4341 were proposed and signed by
the patient. My plan is to complete the patient’s cleaning
Hygiene in two appointments: Upper and lower right and then
Treatment lower and upper left. Patient informed of possible local
anesthetic or Oraqix needed at each appointment to
Plan ensure his comfort during the procedure.
and Informed A 4-6 week tissue re-evaluation and fluoride varnish was
Consent also treatment planned and to be scheduled after scaling
and root planning is completed.
 At each appointment I plan to follow up on the patients
oral hygiene at home. I would have the patient
Dental demonstrate the bass modified tooth brushing
technique that we went over together on previous
Hygiene appointments and make any modifications to ensure the
Treatment appropriate technique. I will also reinforce the
importance of flossing and motivate the patient to try to
Plan make this a habit. I would demonstrate c-shaped flossing
and Informed technique again, and have him show me flossing. I also
plan to keep educating the patient on his oral health
Consent status.