OHI Case Study

(DH - 220A)
Presented By:
Savanna Beddoes DH2

Initial Appointment
o Lots

Patient was 1% plaque

free at initial appointment

of staining
moderate hard
deposits
o Generalized moderate soft
deposits on all surfaces of
dentition except for one!
o Localized

Photos from
Patients First
Appointment After
Disclosing
The extent of plaque was evident
on virtually every surface of
every tooth. The patient claimed
to have brushed just prior to
coming to the appointment, but
admits that she is a heavy
smoker. The following collection
of slides help to establish the
need for OHI intervention.

Mandibular Lingual View

Mesial, Distal, Buccal and

Incisal Surfaces

Posterior Teeth ( Molars)

OHI Instructions
O Brush twice a day with a

product that includes fluoride

O Brush for a full two minutes
each time
O Focus on each part of dentition
equally
O Look in mirror while brushing
O Angle brush to clean lingual
surfaces of anterior teeth (both
maxillary and mandibular)
O Demonstrated bass method of
brushing to patient
O Demonstrated c-shaped
flossing method

O Floss once daily.

O Use interproximal brush to

O
O
O
O
O

efficiently clean in between

teeth.
Rinse with an antibacterial
mouthwash
Eat a balanced diet
Limit the number of
between-meal snacks
Avoid sugary foods and
foods high in carbohydrates.
Try eating crunchy foods
such as popcorn, carrots
and cucumbers.

OHI Instruction Cont.

O Discussed process of

decay
O Discussed risk factors,
including tobacco use
O Patient also agreed to
purchase a xylitol
product (such as
mints/gum) and use it 35 times a day.

Photos From
Patients Second
Visit After
Disclosing
Some progress was made,
and the plaque free
surfaces increased from 1%
to 23%.

Maxillary Incisors

Posterior Teeth

Premolars / Molars Lingual &

Occlusal Views

Profile View of Left Maxillary and Mandibular Linguals

O Much

improvement
from the previous
week.
O Patient scored
26% plaque free

O Still room for

improvement

Review of OHI
O At initial appointment patient agreed to

stated OHI instructions and expressed her

desire to take better care of her teeth.
O At follow up appointment patient was not as
complient.
O Reviewed OHI with patient and was
disappointed to hear that she was not
making an effort to follow the agreed upon
instructions.

Review of OHI
O Patient refused to brush for two minutes

even once daily as she did not like the feel

of toothpaste in her mouth.
O Patient refused to floss.
O Patient refused to use antimicrobial
mouthrinse.
O She was still not looking in the mirror while
brushing and still not focusing on removing
plaque from tooth surfaces.

Review of OHI
O Patient reverted back to her own way of

O
O
O
O

brushing, disregarding the bass method

taught at previous appointment.
Patient continued to drink soda and foods
high in sugar and carbohydrates.
Patient did by xylitol product and was using
at least twice daily.
Patient does not wish to cut back on or quit
smoking.
She was impressed with the results of her
cleaning but not willing to work on improved
home habits.

Reflections &
Modifications
O It was both frustrating and discouraging to have the patient

disregard all OHI instructions within a weeks time. I felt

like she was really not interested in making any changes,
even though she originally expressed her desire to take
better care of her teeth. I attempted to motivate her by
encouraging her on her xylitol purchase and again
discussing the risk factors involved with plaque build up. I
asked her if she thought she could maybe pick one or two
of the instructions I had given her and start by working on
just those. She agreed but still refused to try different,
more effective brushing methods. We finally agreed that
she would purchase a bottle of fluoride mouthwash within
the next week and start using it twice a day. We also
agreed that she would purchase a bag of floss picks and
use them at least 3-4 times a week.

Reflections & Modifications

O The end result was somewhat anticlimactic

and I had really hoped for better compliance

and enthusiasm from the patient.
O I was glad that we were able to modify her
OHI instructions to something she felt was
more manageable and realistic to her
lifestyle.
O I hope in the future we are able to
implement more healthy practices and
techniques into her daily routine