Dental Hygiene Treatment Plan
Client name: __Chart #: ______
Student name: ___Priscilla Kaljanac___Date: ______
Appointment 1
- Review and update health history, and consider any changes that may require or have contraindications on treatment. (3min)
- Instructor tissue check (2min)
- Update intra/extra oral status as needed, and consider any changes that may require or have contraindications on treatment. (5min)
- Discuss diagnosis and treatment plan with client and acquire informed consent. (10min)
Debridement:
- Prepare and administer lidocane with epinephrine (Inferior alveolar, Buccal injection) if needed, due to possible sensitivity and discomfort during debridement of inflamed gingival in sextant 4.
Lidocane with epinephrine is chosen to prolong effect of anaesthetic, and provide adequate time to debride deep pockets. (10min)
- calculate maximum dose of lidocane according to total body weight. Max dose of vasoconstrictor epinephrine = 0.2mg/appt for healthy client.
- Debride Sextant 3 and 4 with a combination of cavitron and hand instrument: teeth with 5mm pockets in sextant 3 and 4, furcation involvement and moderate to heavy calculus. (1h)
- Instructor tissue/debridement check (5min)
- Further debridement as needed following instructor check. (15min)
Oral self care Instruction:
- Quick review on gingivitis, periodontitis, and the importance of effective daily tooth brushing, due to client’s lack of technique and to instil the link of oral health to overall health . (5min)
- OSC in Bass method. Originally taught stillmans due to client’s gingival recession, but client proved to have difficulty with this method. Emphasis on technique and duration of brushing to improve on client’s 21% plaque effectiveness. (5min)
- Review spool method flossing technique and its importance to maintain oral health due to clients omission of interdental care. Client prefers floss to other interdental aides.(5min)
-Spool method is chosen due to client’s preference and previous success in mastering the technique.
- Discuss importance of using night guard. (5min)
Post op instruction :
- LA Post Op: LA with epinephrine causes vasoconstriction which prolongs effect of anaesthetic.
- Inform client that he should avoid eating on the affected side of the mouth until the effects of the LA (numbness) is gone, to avoid unintended trauma to tissues from mastication.
- Inform client that when the effects of epinephrine wears off, the blood vessels will dilate, and not to worry if there is some bleeding. (2min)
- Debride Post Op:
-Inform client that subgingival debridement may cause slight inflammation and soreness in the surrounding tissues for a short time after treatment, therefore it is very important keep clean with gentle daily brushing and flossing. Also that teeth may be temporarily sensitive to temperature changes and may need to temporarily alter diet. (2min)
Documentation and Approval:
- Document treatment in the EOHR
- Acquire instructor signature
Appointment 2
- Review and update health history, and consider any changes that may require or have contraindications on treatment. (3min)
- Instructor tissue check(2min)
- Update intra/extra oral status as needed, and consider any changes that may require or have contraindications on treatment. (5min)
Debridement:
- Prepare and administer lidocane with epinephrine (Supraperiosteal, inferior alveolar and Buccal injection) if needed due to possible sensitivity and discomfort during debridement of 5mm pocket in sextant 1 and inflamed gingiva in sextant 6. (10min)
- calculate maximum dose of lidocane according to total body weight. Max dose of vasoconstrictor epinephrine = 0.2mg/appt for healthy client.
- Debride Sextant 1 and 6 with a combination of cavitron hand instrument: sextant 1 with deep pocket and furcation involvment. (1.5h)
- Instructor tissue/debridement check) (5min)
- Further debridement as needed following instructor check (15min)
- Instructor recheck (5min)
Oral self care
- Feedback and review of Bass and spool method. Modify technique if needed to encourage and increase frequency of brushing and flossing, and improve plaque effectiveness. (5min)
Post op instruction :
- LA Post Op: LA with epinephrine causes vasoconstriction which prolongs the effect of anaesthetic.
- Inform client that he should avoid eating on the affected side of the mouth until the effects of the LA (numbness) is gone, to avoid unintended trauma to tissues from mastication.
- Inform client that when the effects of epinephrine wears off, the blood vessels will dilate, and not to worry if there is some bleeding. (2min)
- Debride Post Op:
- Inform client that subgingival debridement may cause slight trauma to the surrounding tissues, therefore it is very important keep clean with gentle daily brushing and flossing. Also that teeth may be temporarily sensitive to temperature changes and sweets, and may need to temporarily alter diet.(2min)
Documentation and Approval:
- Document treatment in the EOHR
- Acquire instructor signature
Appointment 3
- Review and update health history, and consider any changes that may require or have contraindications on treatment. (3min)
- Instructor tissue check(2min)
- Update intra/extra oral status as needed, and consider any changes that may require or have contraindications on treatment. (5min)
Debridement:
- Debride Sextant 2 and 5- No deep pockets (1h)
- Detection before instructor check. (5min)
- Instructor tissue/ debridement) check (5min)
- Further debridement as needed following instructor check(15min)
- Instructor recheck (5min)
Fluoride:
-Applyduraflor, due to exposed roots from generalised recession. (5min)
Post Op instruction:
- Fluoride post op: Duraflor needs to remain on teeth for 4-6 hrs for maximum effect. Client may eat soft foods or drink immediately after, but must refrain from hot liquids. Fluoride may be removed by brushing after 4-6 hrs.(2min)
Recare:
- Make appointment for 6 week reassessment.
- Discuss and agree with client on appropriate recare interval: Suggest 4 month interval to address periodontal pockets. (5min)
Documentation and Approval:
- Document treatment in the EOHR
- Acquire instructor signature
Appointment 4 – (6 week reassessment)
- Review and update health history. (5min)
- Instructor tissue check(2min)
- Update intra/extra oral status as needed, and consider any changes that may require or have contraindications ontreatments. (5min)
Oral Exam
- Conduct Dental exam and update status. (5min)
- Conduct periodontal assessment and compare against last update. (30min)
- Asses plaque effectiveness to compare against earlier assessment. (10min)
- Debridement of newly formed calculus.(30min)
- tissue check and débridement check. (10min)
Oral Hygiene Instruction
- Feedback and review of Bass and flossing method. Modify technique if needed to encourage and increase frequency of brushing flossing and improve plaque effectiveness. (5min)
- Refer to appropriate oral care specialist as necessary.
Documentation and Approval:
- Document treatment in the EOHR
- Acquire instructor signature
Signatures
Client: ______Date: ______
Faculty: ______Date: ______
Student: ______Date: ______