need for scaling residual calculus and reinstrumenting regions of unchanged pocket depths;
perform periodontal debridement; refer to periodontist
Deficit identified in biologically sound and functional dentition Due to: potential for tooth loss
Evidenced by: tooth mobility
Goals: ______________________________________________________________ Dental hygiene actions/interventions: ____________________________________
Deficit identified in conceptualization and problem solving Due to: misconceptions associated with oral health care Evidenced by: lack of replacement of missing teeth
Goals: ______________________________________________________________ Dental hygiene actions/interventions: ____________________________________ Deficit identified in responsibility for oral health
Due to: lack of regular oral care; neglecting the signs and symptoms of periodontal
disease
Evidenced by: periodontal disease and caries; lack of awareness of the patient’s role
in his own oral health
Goals: ______________________________________________________________ Dental hygiene actions/interventions: ____________________________________
ASSESSING RISK
What is this patient’s risk for:
● Caries
● Periodontal disease
● Oral cancer
Use the appropriate form (see appendices) to determine the patient’s level of risk and to plan strategies for reducing this risk.
APPLYING EVIDENCE-BASED PRACTICE
Using a database or search engine (consult your campus library), find and evaluate articles on a product or treatment that you will recommend for this patient. Use the PICO process (see Chapter 1) to determine your recommendation. Provide the list of references used to support your decision. Here is one example of a possible recommendation for this patient. Repeat this process for additional recommendations.
PICO question
P = Problem/Patient I = Intervention C = Comparison O = Outcomes For this patient (P), will a nicotine lozenge (such as Nicorette Lozenge) (I) as compared with a nicotine nasal spray (such as Nicorette Nasal Spray GSL 10ML) (C) increase success of smoking cessation (O)?
Chapter 7 Case E 93
MAKING ETHICAL DECISIONS
After the initial treatment, the patient calls the office to complain that you made his oral condition worse. He states that several more teeth have become mobile and that all of his teeth are now very sensitive to cold. He says he will make an appointment to see the dentist, but he does not want you to treat him again.
● What ethical issue(s) do you face?
● Is there a law, regulation, or standard of care objective that can assist you with resolving the issue(s)?
● What choices of action do you have?
● What are the worst- and best-case scenarios of your choices of action?
● Determine and defend your choices of action.
LEARNING ACTIVITIES
1. Investigate tips and techniques to alleviate nicotine withdrawal symptoms that can be shared with this patient.
2. Role-play a script between the dental hygienist and a patient who (1) is not inter- ested in quitting smoking; (2) thinks that switching from smoking cigarettes to using spit tobacco is a safe alternative; and (3) is interested in quitting, but does not know how to begin.
3. Initiate a smoking cessation program (such as the National Cancer Institute and the Agency for Healthcare Research and Quality strategy the Five A’s approach—ask, advise, assess, assist, and arrange to smoking cessation ) with one of your patients who uses tobacco.
BIBLIOGRAPHY
Agboola S, McNeill A, Coleman T, Leonardi Bee J: A systematic review of the effectiveness of smoking relapse prevention inter- ventions for abstinent smokers. Addiction,105(8), 1362–1380, 2010.
Darby ML, Walsh MM: Dental Hygiene Theory and Practice, 3rd ed. St. Louis: Saunders (Elsevier), 2010, pp. 38–55, 219–222, 467–474.
Freudenthal JJ: How to encourage change. Dimensions of Dental Hygiene, 8(9), 60–65, 2010.
Glickman I: Clinical Periodontology. Philadelphia: Saunders, 1953. Guntsch A, Erier M, Preshaw PM, Sigusch BW, Klinger G, Glockman
E: Effect of smoking on crevicular polymorphonuclear neutrophil function in periodontally healthy subjects. Journal of Periodontal Research, 41, 184–188, 2006.
Kaplowitz G: Essential elements of oral care. RDH, 26(9), 2006. Lupus Foundation of America. http://www.lupus.org/webmodules/
webarticlesnet/templates/new_aboutaffects.aspx?articleid= 1456&zoneid=17. Accessed August 12, 2011.
Mecklenburg RE, Christen AG, Gerbert B, Gift HC, Glynn TJ, Jones RB, Lindsay E, Manley MW, Severson H: How to Help Your Patients Stop Using Tobacco. A National Cancer Institute Manual for the Oral Health Team. U.S. Department of Health and Human Services, Public Health Service, National Insti- tutes of Health, American Cancer Society, NIH Publication No. 98–3191, 1998.
Nield-Gehrig JS: Fundamentals of Periodontal Instrumentation, 6th ed. Baltimore: Lippincott Williams & Wilkins, 2009, pp. 275–283, 333–360, 455–460, 481–493.
Perry DA, Beemsterboer P, Taggart EJ: Periodontology for the Dental Hygienist, 3rd ed. St. Louis: Saunders (Elsevier), 2007, pp. 151–152, 175–177, 269–270.
Serio FG, Hawley CE: Manual of Clinical Periodontics. Hudson, OH: Lexi-Comp, 2002, pp. 32–34.
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Weinberg MA, Westphal C, Froum SJ, Palat M, Schoor R: Com- prehensive Periodontics for the Dental Hygienist, 3rd ed. Upper Saddle River, NJ: Pearson, 2011, pp. 26, 56–58, 157–158, 253, 255–256, 383–389, 424, 441, 428–431, 553–556.
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Wilkins EM: Clinical Practice of the Dental Hygienist, 10th ed. Phil- adelphia: Lippincott Williams & Wilkins, 2009, pp. 238–248, 501–517, 608–616, 677–678.
Wolf HF, Hassell TM: Color Atlas of Dental Hygiene. Periodontol- ogy. New York: Thieme, 2006, pp. 54, 165, 222, 303.
Wright R: Tough Questions, Great Answers. Responding to Patient Concerns about Today’s Dentistry. Chicago: Quintessence, 1997, pp. 79–108
Wynn RL, Meiller TF, Crossley HL (eds.): Drug Information Hand- book for Dentistry: Including Oral Medicine for Medically- Compromised Patients & Specific Oral Conditions, 16th ed. Hudson, OH: Lexi-Comp, 2010, pp. 261–265, 1220–1223.
PEARSON
Use this address to access the Companion Website cre- ated for this textbook. Simply select “Dental Hygiene” from the choice of disciplines. Find this book and
click the Enter button to access interactive assessment, sample forms, and much more.
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