This case study was part of an assignment for my Introduction to Dental Hygiene Theory class. The patient in this slideshow is not a real person. I had a lot of fun with this assignment and learned so much from it. For example, I learned how to write a dental hygiene diagnosis and a treatment plan.

1. JOHNNIE JOHNSON
SPECIAL NEEDS PATIENT:
CASE K
Kalvin Smith
State Fair Community College
December 3, 2018

2. JOHNNIE’S SITUATION
oJohnnie is a DJ and frequent partier, who admits to heavy alcohol
consumption. His drinking appears to be affecting his physical
appearance.
oAt the time of his appointment, his hands have a slight tremor, and
he is speaking rapidly and nervously.
oWhile Johnnie doesn’t appear to be intoxicated at the moment, the
scent of alcohol is on his breath, hinting at recent alcohol
consumption.

3. JOHNNIE’S SITUATION CONT.
oAlthough the patient has arrived to his dental visit smelling of
alcohol, his speech is not slurred and his gait is steady. Due to this
observation, at this time, it is decided that we will continue with
today’s appointment.
oThe basis for this decision is that Johnnie still has decision-making
abilities, such as to give informed consent. If he was clearly
intoxicated in the clinic, the appointment would have been
postponed.

4. PATIENT HISTORY AND VITALS
oAge: 38 years-old
oSex: Male
oHeight: 5’10”
oWeight: 160 lbs.
oBlood Pressure: 118/76 mmHg
oPulse Rate: 90 bpm
oRespiration: 24 rpm
oSmokes/Uses Tobacco Products:
Yes

5. SOCIAL HISTORY
oJohnnie’s lifestyle involves sleeping for the majority of the day and
working in clubs and after-hour bars all night.
oHe does not have any long-term friendships and considers himself to
be a loner.
o“Johnnie” is a stage name that he uses for his job. He does prefer to
be called by this name.
oHe recently moved in with his girlfriend in her mobile home.

6. MEDICAL HISTORY AND CURRENT
MEDICATIONS
oMEDICAL HISTORY
oThe patient is not currently under the
care of a physician
oHas not had a medical examination in
several years
oCurrently experiencing stomach
problems but has chosen not to see a
physician
oAll medications taken by the patient
are self-prescribed
oMEDICATIONS
oMylanta®
o Gastrointestinal agent/antacid
o Effects on dental treatment: can cause
xerostomia
oMaalox®
o Gastrointestinal agent/antacid
o Effects on dental treatment: can cause
xerostomia
oPepcid®
o Histamine H2 antagonist
o Effects on dental treatment: N/A
oAdvil®
o Analgesic/nonsteroidal anti-inflammatory drug
o Effects on dental treatment: could inhibit
platelet aggregation and prolong bleeding time
in some patients

7. DENTAL HISTORY AND CHIEF
COMPLAINT
oDENTAL
oExtensive restorative treatment
throughout childhood and
adolescence.
oIn the last 10 years, Johnnie has only
received oral health treatment in
emergency situations
oOften schedules appointments that he
cancels or does not keep
oNo fluoridated water
oDoes not brush with toothpaste
because it triggers his gag reflex
oCHIEF COMPLAINT
oThe patient feels that the appearance
of his teeth is keeping him from
getting higher paying jobs.
oHe does not have a lot of money for
dental treatment

8. RADIOGRAPHIC FINDINGS:
FULL MOUTH SURVEY
o Restorations on
posterior teeth
o Proximal caries (will
discuss shortly)
o Periapical abscess
beneath #23

9. CURRENT ORAL HYGIENE STATUS
oModerate subgingival calculus in the posterior regions
oPlaque Index- 14%
oSlight papillary bleeding on probing
oBleeding Index- 2%, due to lack of blood flow caused by smoking
oPatient reports a burning sensation in his tongue with a loss of taste
oThis is most likely the result of a folic acid deficiency, which is associated with
alcoholism
oThe addition of folate supplements to his diet can address the patient’s deficiency
and help reverse the sensations in his tongue

10. ORAL EXAMINATION FINDINGS
oMissing teeth: #15 and #18
oProbing Depths Range: 1-6 mm
oVisible Carious Lesions:
oOcclusal: #4, #16, #17, #21, #32
oProximal: #7, #8, #9, #10, #12, #23
SUPPLEMENTAL FINDINGS (IO/EO)
oModerate xerostomia
oBilateral parotid gland enlargement

12. CAMBRA
o Caries Risk Level: HIGH
o Disease Indicators Marked: carious
lesions, interproximal demineralization,
new restorations
o Risk Factors Marked: consumption of
sugared beverages/snacks, iatrogenic
restorations, medications causing
xerostomia, and recreational drug use
o Periodontal Disease Risk Level:
HIGH
o Disease Indicators Marked: LOA >4mm
o Risk Factors Marked: current use of
tobacco
o Oral Cancer Risk Level: HIGH
o Prior Cancer or Pre-Cancer: history of
other cancer/family history of cancer
(lung cancer)
o Exposures to Carcinogens: smoking
tobacco, alcohol use (>2 drinks/day)
o Nutrition Risk Level: HIGH
o Intra-oral Nutrition Risk Factors:

13. DENTAL HYGIENE DIAGNOSIS
oLocalized, moderate periodontitis associated with
dental restorations and a periodontal abscess on tooth
#23.
oThe patient is an ASA class III

14. PROGNOSIS & DENTAL HYGIENE
GOALS
oPrognosis: Poor- patient often fails to maintain dental appointments
and has high risks on CAMBRA
oIf the patient shows true commitment to the treatment plan and attends his NSPT
appointments, the prognosis can be changed to fair.
oShort Term Goals: Lower BI and PI by half, cut back on cariogenic
beverages/snacks, increase water intake, and begin smoking
cessation
oBI down to 1%
oPI down to 7%
oLong Term Goals: Reduce BI and PI to zero, quit smoking, and
continue scheduled dental visits

15. APPOINTMENT PLAN/SCHEDULE
oThe patient needs to be seen every 3 months due to high caries risk
and periodontitis
oAppointment #1: Assessment, FMX, oral health instruction,
nutritional counseling, treatment plan presented
oAppointment #2: Assessment, NSPT on max. and mand. right
quadrants (1&4), OHI, nutritional counseling, fluoride varnish
application
oAppointment #3: Assessment, NSPT on max. and mand. left
quadrants (2&3), OHI, nutritional counseling
oAppointment #4: Reevaluation of NSPT and homecare, polishing,
fluoride varnish application, review short term and long term goals

16. THE TREATMENT
PLAN
oDuring patient education, the
treatment plan will be presented to
Johnnie, along with the following…
oA referral to a physician for alcohol
withdrawal
oThis referral is the first that should
be given to Johnnie.
oHe should also be referred to an
alcoholism recovery group, smoking
cessation classes, and to a dietician
for his cariogenic diet.
oProduct recommendations
oHomecare instructions
oCosts of treatment and therapeutic
services

17. THE PROCEDURE
oAn alcohol-free preprocedural rinse is indicated because of the
patient’s alcohol use pattern and xerostomia.
oFollowing the preliminary phase of the periodontal procedure where
periapical emergencies are treated, Johnnie will enter Phase I
Nonsurgical Initial Therapy.
oNSPT to remove subgingival calculus found during clinical
examination
oIf stain is present, a rubber cup and fine polishing paste is
recommended for use, especially on the patient’s restorations.
oThe stain most likely to occur is brown stain because the patient is a smoker.
oA fluoride varnish is indicated for use at the end of the appointment.

18. PRODUCT RECOMMENDATIONS
Toothbrush
oDue to Johnnie’s financial situation, I
would recommend a soft bristled
manual toothbrush.
oThe toothbrush head should have a
multilevel brush trim profile in order
to brush hard-to-reach areas and
increase Johnnie’s cleaning
performance.
oEx: Oral-B® Pro-Expert Antibacterial Manual
Toothbrush; includes a tongue scrubber.
Toothpaste and
Rinse
oDue to Johnnie’s caries and lack of fluoridated
water, I would recommend he begin using a
toothpaste containing fluoride, such as Crest®
Cavity Protection
oAs stated previously, Johnnie will require an
alcohol-free mouth rinse. A good
recommendation would be Listerine® Total
Care Zero Anticavity Mouthwash because it
contains sodium fluoride.

19. TOOTHBRUSHING METHOD AND
INTERDENTAL AIDS
oI would recommend Johnnie begin brushing with the Charter’s
method twice a day.
oMany of Johnnie’s caries appear on the proximal surfaces of his
teeth. This method was created specifically for cleaning interproximal
surfaces. With the addition of fluoridated toothpaste and Johnnie’s
commitment to homecare, this brushing method can help prevent
future caries.
oJohnnie should floss at least once a day, though I would advise him
to floss before he brushes his teeth, morning and night.
oI would discuss the benefits of a waterpik for his interdental needs,
but I would not push Johnnie on this subject, as it may be out of his

20. REFERENCE
S
Thomson, E. M.
(2013). Case aa studies
in dental hygiene.
aaBoston: Pearson.
Wilkins, E. M., Wyche, C. J.,
& aaBoyd, L. D.
(2017). Clinical aaPractice
of the Dental aaHygienist.
Philadelphia: aaWolters
Kluwer.