Alice Jones is 52-year-old female who has high blood pressure, which depicts hypertension. She is currently on medications and taking Vasotec (2.5 mg) to control her blood pressure. According to her dental history she has one missing tooth which is covered with bridge, have large embrasure spaces on some teeth, bleed on gums sometime when floss due to tight contact areas. She has minimal dental plaque biofilm on interproximal regions and also she use hard toothbrush with bass technique. Alice has good diet plan but she drinks juice, which is rich in carbohydrates and drink wine in a month.
As a dental assistant it is very important to identify and understand the risk factors for dental caries and periodontal disease. With the good knowledge about the stains, dental caries or periodontal disease a dental assistant can figure out the situation of the mouth. Dental assistant require discussing about the nutrition, habits, food selection as to prevent the tooth decay or serious disease, which can be prevented before it starts growing. Dental assistant can prepare a dental hygiene plan for the care of the dental caries control, periodontal disease, and management of risk factors. (Wilkins & Wyche & Boyd, 2017, p.408). It is very important for dental assistant to know form patients about the medications they are taking at the current time as it can affect their dental procedure if avoided. Patient need the education of the disease so its important that a dental assistant provides a knowledgeable education to the patient about the cause of their disease and also how they can use the oral hygiene techniques to keep themselves away from the diseases which can be preventable with their efforts. (Bird & Robinson, 2018, p. 934). With the clear understanding of the periodontal disease dental assistant can identify the disease. (Bird & Robinson, 2018, p.187&188). Identification of risk factors for the periodontal disease helps in discovering the awareness and care planning for an individual patient. (Wilkins & Wyche & Boyd, 2017, p.313). Also dental assistant has to prepare pre-operative set up which dentist has to use on patient. It is important that dental assistant go through all dental history, medical history and know the risk factors which can be told to the dentist who has to perform the procedure on the patient. Any wrong information or indication and procedure can lead to serious problem to the dentist or dental assistant as well as too the patient.
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Alice is a patient with high blood pressure, which means Hypertension. She is on a medication of Vasotec (2.5mg) to control her blood pressure and this medication usually makes her mouth, dry. So she has xerostomia. Although it states that she is on menopause, which can also be cause of a dry mouth. When a female is in menopause their estrogen level decrease, which can cause dryness on whole body and even mouth. A dry mouth is the cause of growing bacteria in the mouth, which cause tooth decay and make gums bleed. (Orenstein, 2017). By looking at Alice’s dental history, health history and diet plan it shows she use medium toothbrush and floss 2-3 times and on her mandibular anterior teeth she bleed due to tight contact areas which is the risk factor as interproximal regions have the minimal dental plaque biofilm, has large embrasure spaces (type 3), bridge on quadrant 4, localized bone loss, clenching or grinding of teeth, recession and abfraction, medium toothbrush and using non-fluoride toothpaste. Also she drinks apple or orange juice and a glass of wine once in month which is rich in sugar and the cause of dental caries. After eating or drinking which are acidic within 5 minutes the bacteria in the mouth start producing the acids and usually saliva helps in the repair of damage caused by the bacteria and neutralizing the acids. But as the patient has dry mouth it creates the risk factor of forming the dental caries in the mouth. (Bird & Robinson, 2018, p.170). Fluoride toothpaste helps in making tooth more resistant to decay but Alice used the non-fluoride toothpaste, which also causes the risk factor of cavities. Fluoride is known for strengthening the teeth. (Pratt, 2018). As floss cannot reach the contact areas of the lower anterior teeth the gums bleed occasionally which is cause periodontal disease as the dental biofilm plaque is deposited on the interproximal region. Gingival recession can also be due to improper tooth brushing, flossing and periodontal disease. Studies also show that using of hard toothbrush can cause recession too. (Pratt, 2018). Recession can lead to dental caries but it effect usually to the root so it causes root caries. Root carries develop on the root of the teeth, which have recession. It means root surfaces are exposing. (Bird and Robinson, 2018, p.). Abfraction leads to the loss of the tooth structure and it is not due to the dental caries but it is due to the pressure on the teeth, which usually happens during clenching or grinding the teeth. Alice eventually clench her teeth while she sleeps, which means she is putting pressure on the tissues of the teeth. Abrasion is another cause of Abfraction, which usually happens due to hardness of the tooth or improper brushing. (Pietrangelo, 2019). Bridging on the quadrant 4 replacing the tooth 4.5. Bridging is good if the mouth has missing teeth. Preparing a bridge cost some price as it need two healthy teeth in between them this bridge will be placed so removing the anchor teeth’s shape and structure is the disadvantage as it will affect the tooth tissue and it can weaken the tooth. Weakening the tooth means less the longevity of the teeth. (Westcoast international, n.d.) Embrasure space (stage III) means too much open space and interdental gingiva is missing. By reading case study it is concluded that the patient suffering from Aggressive periodontitis as it states that localized early bone loss. “The localized form is associated with less acute clinical signs of inflammation then would be expected on the basis of severity of destruction and it is associated with bone loss that is most often confined to permanent molars and/or incisors.” (Bird & Robinson, 2018, p.191)
Regular dental visit should be book to help in abfraction because abfraction is not treated at home with tooth brushing so it is situation where dental assistant has to explain patient that they need to book an appointment with dentist frequently. Abfraction is usually caused due to dry mouth, medications etc. and it can be treated by the fillings, mouth-guard and so on which can only be done or prescribed by the dentist. (Pietrangelo, 2019). Proper oral hygiene should be maintained as Alice is doing right by brushing her teeth twice and flossing 2-3 times but she should be using the fluoride toothpaste as fluoride helps in making tooth resistant to the tooth decay or acidic conditions. “Slowing demineralization and enhancing demineralization of tooth surfaces are now considered to be the most important ways that fluoride controls the caries process.” (Bird and Robinson, 2018, p.196). It is not always true that thinking of patient will be same as a dental assistant so being a dental assistant brings more responsibility of being patient and educating their patients. Proper instruction of removing dental plaque should be explained to the patient and try to educate them about the disclosing agent which can help the patient to see the dental plaque as dental plague is not visible. Disclosing agent helps in this and it comes in the form of tablet or liquid and explaining the patient straight may be not good method. Sometimes dental assistants have to modify or use different techniques to help the patient in knowing the procedures of taking care of oral hygiene. Motivation is always plays an important role and this can be done very easily through Education. For a dry mouth it is very important that saliva should be there in mouth so to increase salivary flow so it is optional if the patient can chew a sugar free gum to increase the flow of the mouth as it can help in neutralizing the acids. Also always choose the gums, which have Xylitol or baking soda. (Bird & Robinson, 2018, p.171). A nutrition plan should be given to the patient in which proper dietician plan and how to brush or floss is mentioned. If possible try to explain the patient by showing them in person so the patient can do in a right manner at home. A timely manner dental visit should be planned because sometimes floss doesn’t clean properly the food debris in the interproximal region and dental plaque remains there. A dentist can help in this by doing a proper cleaning of teeth. If patient has fixed bridge or open interdental spaces then dental assistant should recommend the interdental aids which includes the End-Tuft brushes, Bridge Threaders, Automatic flosses, and Perio-Aid. (Bird & Robinson, 2018, p. 207-208).
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