OHI Case Study

Presentation
ALEX DIMKE, DH2
Medical History Information:

 Age 70
 Female
 Type II Diabetic
 Controlled Hypertension
 Currently taking 8 medications on a daily basis
 ASA Classification: II
Dental Information:

 Last Dental appointment was a year ago

 Rated a 1.5/2
 Periodontal Case Type: Generalized Case Type II- Slight
Periodontitis, with Localized Case Type III- Moderate
periodontitis
 Generalized Moderate Inflammation
 Occlusion: Class III, with a cross bite on #7
 This patient was also my caries management patient
 Slight Xerostomia from medications
 First Appointment: 10-16-17

 Plaque Free Index Score: 46%

 Current Home Care: Brushes only once a day with an electric tooth
brush, which is generally at night. She also uses a G.U.M flosser if she
has food caught in between her teeth, this may occur once a week.
First Appointment: Cont.

 OHI Recommended: I first had the patient demonstrate to me how

she was brushing. She was going up and down from arch to arch
and she was making the movement with the toothbrush instead of
letting the electric toothbrush do the job for her.
 So I recommended that the patient first dry brush with a regular
tooth brush. Then go back with her electric tooth brush and hold it
for 3-5 seconds on each individual tooth, instead of going up and
down on each arch. Since she has a Oral B tooth brush, I also
recommended that she roll her toothbrush head into the
interproximal area when she is going from tooth to tooth.
 The next thing I recommended for the patient was to try to use her
flossers more regularly. A goal for her that I suggested was to try and
use them once a day while she’s relaxing in her chair watching TV.
 To help with the xerostomia I suggested that she try the biotene oral
rinse at night before going to bed. Then during the day to try the
xylitol gum or lozenges.
First Appointment Photos:
First Appointment Photos:
Second Appointment: 11-1-17

 Plaque Free Index Score: 76%

 Patient’s Response to New Home Care: The patient
seemed to be doing a lot better with her homecare.
She told me she would dry brush first and then focus
on holding her tooth brush on 1-2 teeth at a time for
about 3 seconds before moving to the next. She
said she tried the biotene at night but hasn’t
noticed a difference yet.
 She said that she try’s to use her flossers once a day
but it is probably more about 3-4 times a week that
she is using them
Second Appointment: Cont.

Home Care Modification:

 When I re-disclosed for this appointment my patient
seemed to still be having trouble with brushing her
maxillary and mandibular anterior teeth.
 I asked her to re-demonstrate to me on how she
was brushing. When I had her do this I noticed that
when she would switch from the right side to the left
side while brushing she would go right over her
anterior teeth.
 I explained this to her and suggested to really try
and focus on brushing her front teeth
Second Appointment Photos:
Second Appointment Photos:
 Conclusion:

 I believe that when my patient first came in she thought she was
doing just fine with her homecare. However, once I told her that she
was only 46% plaque free and our doctor told her that she had 3
cavities that needed filled, she then realized that she needed to
work on her homecare more. I think this was a great motivator for
her!
 With some modifications to her home care by the next appointment
she was 76% plaque free!
 I believe that she will continue with these slight modifications and
when she comes in for her next appointment she will even have a
higher plaque free score.