Dental Case Study - Ms patient

Best Whitening Toothpaste Stains - Dental Case Study - Ms patient

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49 year old married female with many sclerosis. She is very open to discuss her disease and the impact it has on her life. She practises yoga and relaxation therapy. A friend of hers mentioned that Ms was caused by mercury toxicity from dental amalgam fillings. Her chief complaints were sensitivity to hot, cold in her upper left lower right quadrant, bleeding gums, possible amalgam extraction and dry mouth. Client used to see her dentist commonly for dental check ups but stopped all of a sudden. Her last dental visit was at a Dental Hygiene College 3 years ago. In 1976 She reported to have trigeminal neuralgia that lasted about 2 months, and old use of cigarettes and marijuana from (1974 to 1988). She also reported to have problems with urine leakage. She sees her doctor and neurologist bi-annually. Her vital signs were within general limits, she was hospitalized two times due to acute Ms episodes one in 1978 and the other in 1992. She reported taking medication to preclude the progression of Ms, and gets injected every other day with Betaseron 5mg and Copaxone 20mg; diazepam 1mg twice daily; ibuprofen 800mg three times a day and baclofen 10 mg four times a day. Dry mouth is a frequent side consequent of these medications. Client is disabled she must use a walker to walk. Fatigue has affected her oral hygiene before bedtime so she often brushes only in the morning. This client lacks manual dexterity and coordination due to the paralysis and pain in her hands. Her diets consist of fried foods and lots of soda.

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Clinical estimate Data

On the first appointment the following things were completed. Extra and intraoral, periodontal hard tissue examination, a full mouth serious, intraoral photographs were taken and homecare practices were observed and discussed. Necessary findings included the following.

Extraoral: Unilateral swelling on the right side of the face; bilateral firm masseter muscles; Tmj crepitation; occasional pain upon chance mouth in the morning and nocturnal bruxing.

Intraoral: Linea Alba bilateral 6mm on both sides; small tori on the palate and decreased salivary flow. Moderate subgingival calculus with grayish extrinsic stains.

Periodontal: Generalized 2-6 mm probing depth and localized 5mm readings on the posterior interproximal areas; furcations placed on 16,14,47,46. Bleeding upon probing on all posterior teeth.

Hard Tissue: Generalized minuscule attrition. Multi surface restorations on most posterior teeth.

Plaque control Record: Plaque-free score 75%; Radiographs: Generalized bone loss 10 to 30% horizontal bone loss; localized minuscule vertical bone loss in posterior; illustrated calculus spicules; suspected caries on #15 under restoration.

Nutrition: Meal pattern consist of breakfast, snack, lunch, snack, dinner, snack. Calorie intake is inadequate. Food Groups consumed daily are in general Meat and alternatives. Fat intake high. Body weight above healthy. Action level low.

Social: Regardless of having Ms client feels her overall condition is good. The client has no insurance, so that's why she has been avoiding dental care but she is ready to make a lifestyle change. She has a retain law to aid her with transportation

Dental hygiene treatment care plan

1. Take vital signs at each appointment to ensure that V/S are Wnl

2. Modernize curative history for any possible contraindication to treatment.

3. Relate her medication intake to resolve any side consequent that might compromise the treatment.

4. Book the outpatient at morning appointments since morning appointments tempt to be less stressful to patients with neurological problems.

5. Ensure a quite and relaxant environment for the outpatient while the appointment.

6. Allow many brakes while the appointment to help relaxing her facial muscles and allow Necessary frequent urination.

7. Minimize fatigue by complying with the outpatient daily regime and ease while treatment (positioning the chair in the most comfortable position for the patient).

8. Monitor oral conditions that are related with client at every appointment and make referral if necessary, (to resolve any intra extra oral changes that might compromise treatment or outpatient health).

9. Use clorhexidine prior to treatment to sacrifice bacterial flora within the oral cavity.

10. Debridement of calculus and plaque by ultrasonic (One quadrant at the time) to sacrifice the scaling time. 1-2 appointments.

11. Debridement by hand scaling ( one quadrant at the time) to make sure that all the calculus and dental plaque left after using ultrasonic is removed. 1-2 appointments

12. Selective polishing to selectively take off intristic stain. (Whiter teeth are related with attractiveness and a healthier lifestyle)

13. Use fluoride rinse Neutral sodium 2% to help re mineralize clients teeth.

14. Take an impression on lower anteriors to create a mouthguard that will preclude additional attrition on the lower anteriors due to buxism.

15. Referral to Dds for resumption due to clients ask to replace old amalgam fillings with white resumption material

16. Diet counseling to increase salivary flow. ( while intra oral exam xerostomia was clear perhaps from medication side effects)

17. Think Local anesthetic ( Lidocaine 2% in case Topical anesthetic 2% is not enough in development client comfortable while the appointment.

Osc planning

1. Prescribe antisensitivity toothpaste to eliminate sensitivity to hot and cold.

2. Propose addition of H2o consumption to increase salivary flow in the oral cavity.

3. Client will be educated in the relationship that Ms has on her oral cavity to increase her cognitive knowledge towards Osc (for example bruxism, subluxation, crepitation, xerostomia).

4. Discuss the relation in the middle of Ms patients and the high risk of caries activity.

5. Demonstrate floss and brushing aids to the client. ( proxy brush, floss aid, modified brush handles.) to heighten patients Osc skills.

6. Use disclosing agent to show to the client the problematic areas that are missed while at home oral self care. This will increase the awareness of the client to the present oral situation.

7. Propose powered toothbrush to increase the brushing time due to clients compromised plaque extraction skills.

8. Propose separate modifications to the Osc aids that client will feel comfortable with, to increase ease in grasping oral aid handles

9. Propose water pick to allow a certain degree of independence in cleaning interproximal areas from plaque.

10. Propose separate corporeal activities ( like yoga) to heighten the dexterity that will help client with self oral care.

Multiple Sclerosis and Dental Hygienist

Treating patients with Ms provides dental hygienists with many opportunities to learn. The many links in the middle of oral conditions and Ms symptoms enable dental hygienists to fulfill their roles as original holistic condition care providers. Ms is the most prevalent demyelinating disease of the Cns, and the third prominent cause of neurological disability in the United States. For patients presenting with Ms, the dental hygienist can lead by promoting both corporeal and oral comfort. Appointments that adapt special corporeal needs and treatment plans that offer meaningful condition promotion and disease arresting plans are ways to look after Ms outpatient compliance. Current knowledge about Ms symptoms, etiology, corporeal limitations, treatments, and Cam will aid the dental hygienist in providing optimal care.

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