Jane Doe's Case Study
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School
University of the People *
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Course
106
Subject
Medicine
Date
Dec 6, 2023
Type
Pages
4
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Case Study – Jane Doe
Jane Doe, a 28-year-old female, presents for prophylaxis. Her last dental visit was at Open Door Health
Center in Mankato about 10 years ago. She has noticed some bleeding lately when she’s brushing. She
has also noticed a “pimple” in the LR molar area. She notices a dull ache there from time to time. In
general, she has some sweet sensitivity. She’s been using a sensitive toothpaste for the last 6 months but
it hasn’t been helping. She said she brushes maybe 1 time per day and sometimes uses the flossers.
Jane lives outside of Mankato with her unemployed mother and her unemployed boyfriend. She also has
two younger brothers she helps care for. She stated that home life is a bit stressful at times but is thankful
for her family.
Jane works the night shift at a nearby gas station. She stated she came to MSU to get her
teeth cleaned as it was hard to find a dentist who takes her insurance, which is Medical Assistance.
Jane’s main concern is the ache that she’s been experiencing lately. She stated that both her parents lost
their teeth before they were 30 years old and feels that because of this, she will also lose her teeth at an
early age. They lost them because of abscessed teeth due to large cavities. She would really like to keep
her teeth and also asked about how to care for her baby’s teeth.
She is under the care of a physician, Dr. Peterson, for her pregnancy. She is 5 months pregnant with her
first child. She also stated that recently, she took a gestational diabetes test and didn’t pass it, so she is
now taking daily insulin injections. She is also taking her daily prenatal vitamins. She’s aware she
should quit smoking but has cut back to 1-3 cigarettes per day since she found out she was pregnant.
Because of her work schedule and helping her family, she tends to grab fast food most days and drinks a
lot of soft drinks during the day, especially during her night shift at the gas station, to keep her awake.
She mentioned that her employer lets her fill her cup for free while she’s on duty.
During the assessment, you find that patient d has a draining fistula in the area of #30, along with a visible
advanced carious lesion. You also notice several other areas of moderate to advanced caries. She has
mod-heavy plaque throughout (DI-S score of 2.3) and is a DHI 2 for calculus. She has generalized
3-4mm pockets with localized 5mm lingual of #30 and #31. She has 1-2 mm of recession in the
premolar/canine area. Her radiographs exhibit localized mild bone loss around the molars. Her gums
were very sensitive when probing.
Complete the ADA Caries Risk Assessment
●
Identify how many risk factors you marked in each category
Category
Risk Factors
Low
-Sugary Foods or Drinks: Primarily at
mealtimes
-Special Health Care Needs
-Chemo/Radiation Therapy
-Eating Disorders
-Medications that Reduce Salivary Flow
-Drug/Alcohol Abuse
-Sugary Foods or Drinks
-Teeth Missing Due to Caries in the past
36 months
-Unusual Tooth Morphology that
compromises oral hygiene
-Exposed Root Surfaces Present
-Restorations with Overhangs and/or
Open Margins; Open Contacts with
Food Impaction
-Dental/Orthodontic Appliances (fixed
or removable)
-Severe Dry Mouth (Xerostomia)
Moderate
-Fluoride Exposure
-Dental Home
-Cavitated or Non-Cavitated Carious
Lesions or Restorations
-Visible Plaque
-Interproximal Restorations - 1 or more
High
None
Identify 2 dental hygiene interventions for both the caries risk level and Perio risk level.
Caries Interventions
●
Fluoride Treatment:
Given the patient's caries risk level and the presence of 1 or 2 new carious
lesions or restorations in the last 36 months, we may administer topical fluoride treatments. These
treatments strengthen tooth enamel, enhancing resistance to acid attacks and reducing the risk of
additional cavities.
●
Oral Hygiene Education:
provide comprehensive oral hygiene education, emphasizing
proper brushing, flossing techniques, and the use of fluoride toothpaste. This education helps the patient
to maintain better oral health and prevent further cavities.
Perio Interventions:
●
Scaling and Root Planing (SRP):
Advised for gum pockets measuring 3-4mm and localized
5mm, SRP involves a deep cleaning to remove plaque and calculus below the gum line, effectively
managing and preventing periodontal disease progression.
●
Periodontal Maintenance:
Regular maintenance appointments are crucial to monitor gum
health, provide thorough cleanings, and guide the patient on effective oral hygiene practices for ongoing
periodontal health.
Fill out the patient notes identifying the OHI Options and Instructions that would best suit the
patient.
Caries Risk Assessment:
Factors: Presence of 1 or 2 new carious lesions or restorations in the last 36 months, frequent
consumption of sugary and acidic foods and drinks, infrequent brushing, and the use of sensitive
toothpaste without improvement.
Perio Risk Assessment:
Factors: Generalized 3-4mm pockets and localized 5mm pockets, moderate-heavy plaque accumulation
(DI-S score of 2.3), and visible plaque with sensitivity during probing.
OHI Options:
Caries Risk:
●
Fluoride Treatments:
Suggest regular fluoride treatments to strengthen enamel and reduce caries
risk.
●
Oral Hygiene Education:
Provide comprehensive education on effective brushing, flossing, and
dietary choices to prevent cavities.
Perio Risk:
●
Scaling and Root Planing (SRP):
Recommend SRP to address periodontal concerns and manage
gum disease.
●
Periodontal Maintenance:
Schedule regular periodontal maintenance appointments to monitor
and control gum health.
Note:
Addressing Jane Doe's immediate concern, which is her caries risk and the discomfort associated
with the "pimple" in her lower right molar area, is a priority. It is advisable first to manage the caries risk
to provide her with relief and prevent further dental issues. However, it's crucial to acknowledge the
presence of periodontal risk factors. Once her caries risk is under control and she adopts improved oral
hygiene practices, the focus can shift to addressing the periodontal risk through treatments such as scaling
root planing and periodontal maintenance. A comprehensive, phased approach is necessary to ensure her
overall oral health is well-maintained.
P: Education:
Current OHI habits: Jane currently brushes once a day, uses sensitive toothpaste, and occasionally uses
flossers. She has frequent consumption of sugary and acidic foods and drinks, especially between meals
and during her night shift.
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OHI Options: A power toothbrush is recommended. Brushing at least twice daily with fluoride toothpaste,
soft-bristle toothbrush, daily flossing, interdental brushes, or water flossers as alternatives for interdental
cleaning. As well as fluoride treatments.
OHI Instructions: Start brushing at least twice daily with fluoride toothpaste for two minutes per session
and daily flossing to remove plaque from between teeth. Additionally, reduce intake of sugary and acidic
foods/drinks, particularly between meals. Start fluoride treatments at each dental visit to bolster protection
against cavities.