Treatment Planning Assignment 3

Emily Petersen

I. Assessment

 Patient Interview: The patient states a chief complaint of having a broken tooth

and xerostomia.

 Medical/Dental History: Patient has type 2 diabetes (last HbA1c value was 7.5%),

hypertension, early dementia and Parkinson’s disease. Patient reports tremors in

his hands, stiffness in his joints and impaired balance. Patient reports and

exhibits mild signs of dementia but is still independently functional. Patient

reports he has been told he breathes primarily through his mouth. Patient

reports an allergy to penicillin. Patient is currently taking (Lisinopril) Prinivil. This

medication is an ACE inhibitor that is used for treating high blood pressure. This

medication can cause xerostomia, dizziness, nausea and lightheadedness. There

is no contraindication for use with local anesthetics. Patient is currently taking

(Glipizide) Glucotrol. This medication is a sulfonylureas drug that is used to lower

blood sugar in people with type II diabetes. Possible side effects associated with

this medication include nausea, vomiting, upset stomach and headache. There is

no contraindication for use of local anesthetic with this medication. Patient is

currently taking (Carbidopa/Levodopa) Sinemet. This medication is used to treat

symptoms of Parkinson’s disease. Side effects of this drug include dry mouth,

dyskinesia, nausea, dizziness, insomnia, orthostatic hypotension and anxiety.

There is no contraindication for use of local anesthetic with this medication.

 Patient is currently taking (Escitalopram) Lexapro. Lexapro is an SSRI that is used

to treat depression and anxiety. Potential side effects of this medication include

nausea, xerostomia, difficulty sleeping, and drowsiness. There is a potential of

prolonged QT interval and bradycardia therefore caution should be taken when

using local anesthetics and consultation with medical provider should be taken

prior to local anesthetic use (Wynn et al.).

Patient reports his last dental visit was over 10 years ago. Patient reports using a

hard-bristled toothbrush once daily and does not floss. Patient is unsure of

fluoride use/brand of toothpaste and states he rinses with hydrogen peroxide or

salt water, occasionally.

 Social History: Patient is a 67 year old Caucasian male. Patient reports being

forced to retire from his factory job early (5 years ago), due to his symptoms

associated with Parkinson’s disease. Patient reports having lost his wife “several

years ago” to cancer and has an adult son that live 1,000 miles away. Patient

reports having several veteran friends that he regularly interacts with and states

these friends “look out for him”.

 Vital Signs: Blood Pressure 135/88; Heart Rate 100 bpm; Respiration: 18

breaths/minute.

No additional vital signs available

 Intra-Oral/Extra-Oral Examination: Tenderness reported in the maxillary left

quadrant. Redness and inflammatory infiltrate present in the region of tooth

#12. Attached gingiva in maxillary anterior region appears pink and stippled,
 marginal gingiva exhibits generalized redness and swelling. Extra oral findings-

WNL.

 Periodontal Examination: 0-7mm probing depths, 0-2mm recession, suppuration

noted on DF of #3 and DL #32, Class II mobility noted on #3, #10, #11, and #15,

Class I mobility noted on #32. Bleeding index 65%, Plaque index 35%. No

furcation involvement noted.

 Radiographic Evaluation: One panoramic film made and interpreted. Maxillary

and mandibular arch digital photos made, bilateral maxillary digital photos

made.

II. DH Diagnosis

 Level of Health: Poor oral health

 Diagnosis: Patient has localized advanced chronic periodontitis on maxillary

molars, generalized moderate chronic periodontitis, stage IV, grade C.

III. Plan

 Consultations Necessary: An evaluation from a general dentist and an oral

surgeon is recommended to address patient’s need for any restorative work and

to address patient’s mobile teeth. An evaluation from a prosthodontist is

recommended to discuss replacement of missing teeth and to restore

mastication function. Nutrition/dietary and oral hygiene counselling are

recommended to help the patient better understand why he has periodontal

disease and how to prevent the disease from progressing/maintain his oral

health at home.
  Treatment Goals: Reduce gingival inflammation, probing depths, bleeding and

pain. Remove biofilm/plaque, sub and supra calculus. Improve clinical

attachment levels. Educate patient on how his systemic health is related to his

periodontal health and how to maintain his oral health at home. Overall

stabilizing periodontal health, preventing further bone loss and tooth loss.

 Phases of Treatment:

o Summarize all information from the initial assessment and help establish

goals with the patient.

o Evaluation by general dentist and oral surgeon to address

restorative/extraction needs.

o Debridement, scaling and root planing, fluoride treatment, nutritional and

oral hygiene counselling.

o Evaluation of outcome: periodontal response to treatments.

o Maintenance appointments for continued care and re-evaluating periodontal

health, refining biofilm control techniques and revisiting home care routines.

IV. Implementation

 Consultations: Oral surgeon to address #10, #11, and #12, possibly #3 and #15

due to mobility. Prosthodontist to discuss replacement of missing teeth, restore

esthetics and mastication.

 Instruments used: Hand scaling instruments will be used for all for quadrants.

Ultrasonic will be used, if needed.

  Methods: Full mouth debridement and hand scaling will be done in one

appointment. Use of anesthetic will be on a need be basis. Patient will have 3-4

month recare visits to ensure his home care is sufficient and to prevent further

progression of periodontal disease.

 Homecare Aids: Soft bristled tooth brush is recommended with a toothbrush

sleeve to help with dexterity. Hand held flossers would be beneficial due to

patient’s dexterity issues. I would also recommend incorporating a calendar

system to help remind patient of when to brush and floss.

 Anesthetic: If needed, anesthetic can be administered to help alleviate

discomfort during scaling and root planing. This patient would be a good

candidate for Oraquix, if discomfort presents.

V. Evaluation

 Care evaluation was done by reviewing patient’s health history, chief complains

and diagnosis at each appointment.

 Follow up charting will be done at each visit to monitor patient’s oral health. This

will help determine if periodontal disease has stabilized or is progressing. This

will also help to determine any areas that may need refinement of home care.

 A complete mouth series of remaining periapical radiographs is recommended

initially. Then vertical bite wing x-rays and anterior periapical x-rays are

recommended yearly to monitor to progression in periodontal disease.

 At each visit, patient will be informed of any areas that are needing

improvement at home. Demonstration of proper brushing and flossing

 techniques will be given at each visit, followed with a request for patient

demonstration. Revaluation of recommended homecare aids will be done at

each visit. All questions patient may have will be addressed and answered.

References:

Boyd, L. D., Mallonee, L. F., Wyche, C. J. (Eds.). (2021). Wilkins’ clinical practice of the dental
hygienist (13th ed., Sect. V, pp. 383-402). Jones & Bartlett Learning.

Wynn, R. L., & Meiller, T. F., & Crossley, H. L. (2021). Drug information handbook for
dentistry: 27th edition. Lexicomp.