Kaley OBrien DH2 First Visit Patients gingival condition Generalized moderate papillary and marginal hyperemia Generalized severe papillary and marginal enlargement with generalized moderate bulbous ID: 576157
Download Presentation The PPT/PDF document "OHI Case Study" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
OHI Case Study
Kaley O’Brien DH2Slide2
First Visit
Patient’s gingival condition:
-Generalized moderate papillary and marginal hyperemia
-Generalized severe papillary and marginal enlargement with generalized moderate bulbous
-Generalized spontaneous bleeding
-Generalized severe papillary and marginal inflammation
-Rating 2.5/3
Microscope sample:
- very motile and active. Spirochetes, spinning and gliding rods, and WBC were all present and TNC
Probing depths:
-Generalized 4-6mm pockets
-deeper in posterior lingual teeth and the facial of the anterior maxillary teeth. Slide3
First Visit (cont.)
Plaque index:
-28 teeth present
- 140 surfaces possible
-98 surfaces containing plaque
- 42 surfaces plaque free
-30% plaque free
(28teeth x 5possible surfaces=140 Total surfaces
140total surfaces-98 covered surfaces= 42 plaque free surfaces
42/140= 30% plaque free)
High Plaque Areas:
- Plaque was interproximal between most teeth, the gingival margin of all teeth. Slide4
First Visit (cont.)
OHI Strategies:
-Patient is brushing once per day with a manual toothbrush, usually just in the morning. Patient demonstrates a circular motion with toothbrush and very rapid movements. Little attention to the occlusal surfaces, lingual surfaces, or gingival margin. Patient isn’t sure how long they spend brushing.
- Patient flosses when she remembers, or when she has something stuck in-between her teeth.
- Bleeding occurs during brushing and flossing. Patient doesn’t like to brush gums because they are tender and bleed.Slide5
First Visit (cont.)
OHI Instruction:
- Demonstrated the Bass Method of brushing to the patient. Explained the importance of getting the bristles under the gums.
- Brushing the buccal, lingual, and occlusal surfaces.
- Using visual aid I demonstrated how the floss needs to be in a complete “c” shape around the tooth, and how the floss can reach even farther under the gums.
-Talked to patient that the reason the gums are inflamed and bleeding is because of the calculus that is underneath them. Told the patient that it is like having a sliver under your skin and how the skin gets red and inflamed, and hurts to touch. The bristles of the toothbrush help sweep the plaque out so the saliva doesn’t mineralize the plaque.
- Disrupting the biofilm the goal, and the contact time of brushing should be 2 minutes.
- After I demonstrated I had the patient show me how they were going to do it in a hand mirror. Slide6
Maxillary Buccal View
Mandiular
Lingual ViewSlide7
Maxillary Facial View
Mandibular Lingual of
AnteriorsSlide8
Second Visit
Patient’s gingival condition:
-Generalized slight papillary and marginal hyperemia
-Maxillary generalized moderate papillary and marginal enlargement Mandibular generalized slight papillary and marginal enlargement.
(this difference due to mandibular arch being fully debrided earlier)
-Generalized spontaneous bleeding
-Generalized severe papillary and marginal inflammation
Probing depths:
-Generalized 4-6mm pockets
-deeper in posterior lingual teeth and the facial of the anterior maxillary teeth. Mandibular pockets slight decrease in pocket depthsSlide9
Second Visit (cont.)
Plaque index:
-28 teeth present
- 140 surfaces possible
-48 surfaces containing plaque
- 92 surfaces plaque free
-66% plaque free
(28teeth x 5possible surfaces=140 Total surfaces
140total surfaces-48 covered surfaces= 92 plaque free surfaces
92/140= 66% plaque free)
High Plaque Areas:
- Plaque was localized to the lingual gingival margin of most teeth. Slide10
Second Visit (cont.)
OHI Strategies:
- Patient now brushing with an electric toothbrush for at least two minutes, morning and night.
- Brushing the gum line and has noticed that the bleeding has diminished.
- Flossing multiple times throughout the week, and at least once per day. Makes sure that floss is all the way around the tooth. Slide11
Second Visit (cont.)
OHI Compliance/Modifications:
- OHI compliance is great! Patient is applying all of the things that we talked about.
- Patient even invested in an electric toothbrush with 2 minute timer.
- The lingual surface is still being missed at the gum line, after looking that the mandibular occlusal plane, I believe due to the anterior plane being higher than the posterior the patient needs to get even more of an angle with the toothbrush to make sure they are getting all the way to the
gumline
.
- Encouraged the patient to keep up the great work!Slide12
Mandibular Buccal View
Mandibular Buccal ViewSlide13
Lingual Mandibular View
Mandibular Lingual ViewSlide14
Anterior Lingual View
Facial View
Facial ViewSlide15
Comparison
Before ^
After>
Before ^
< AfterSlide16
Observations and Reflections:
This was the first patient of this level of difficulty that I have seen. The amount of inflammation and spontaneous bleeding was profound. I would hardly touch the gums and they would bleed; this made it hard to get accurate probe readings. The patient had a lot of discomfort for probing and exploring, but I was able to anesthetize the patient during the debridement. I also found that due to the vast amount of inflammation the anesthetic quickly wore off, and usually by the time I got from posterior to midline the midline was already un-anesthetized. As the cleaning process went along I kept reinforcing the importance of good oral hygiene. I believe that the microscope sample helped push the patient to have good compliance, and after she saw a decrease in bleeding the patient had a lot more faith in the things I was saying. This was a great experience for me!Slide17