how to perform a self-examination of the oral cavity for the effects of smoking (stains, peri-
odontal disease) and excessive alcohol use (swollen parotid glands, condition of the tongue,
dry mouth conditions); teach the patient how to perform a self-screening for oral cancer;
communicate that resources are available should he decide to moderate unhealthy behav-
ior; provide resources as requested; encourage the patient to make and keep appointments
for dental treatment and regular dental hygiene care
Deficit identified in wholesome facial image
Due to: self-consciousness of appearance; dissatisfaction with smile
Evidenced by: severe rampant caries of anterior teeth; lack of regular dental care Goals: ______________________________________________________________ Dental hygiene actions/interventions: ____________________________________ Deficit identified in skin and mucous membrane integrity of the head and neck Due to: xerostomia
Goals: ______________________________________________________________ Dental hygiene actions/interventions: ____________________________________ Deficit identified in biologically sound and functional dentition
Due to: lack of professional oral care
Evidenced by: multiple dental caries and defective restorations
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.
PICO question
P = Problem/Patient I = Intervention C = Comparison O = Outcomes In addition to physician recommended supplements, for this patient (P), will daily consumption of a breakfast cereal fortified with folic acid (such as Total® Whole Grain) (I) as compared with a nutrition shake fortified with folate (such as Ensure® Nutrition Shake) (C) better assist with eliminating his burning tongue sensation (O)?
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.
Chapter 13 Case K 165
MAKING ETHICAL DECISIONS
This patient is satisfied with the appearance of, and the cost for, his restored maxillary anterior teeth. He expresses to you that he is upset that the dentist he sought a consultation with at another practice recommended full crowns and did not give him this option for composite restorations.
● 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. Individuals who smoke and use excessive amounts of alcohol have a significantly increased risk of oral cancer. Determine how you would approach this patient regarding moderation of alcohol use and smoking cessation. Explain how counsel- ing can contribute to his knowledge, attitudes, and practices regarding his unhealthy behavior.
2. Alcohol abuse and alcoholism often result in poor nutrition. Write a detailed treat- ment plan to assess this patient’s diet and provide nutritional counseling. Include a description of the tools you will use to help provide an accurate survey of his eating habits.
3. In a small-group activity, brainstorm several possible reasons why this patient has difficulty making and keeping dental and dental hygiene appointments. Use this list as a basis for role-playing how the dental hygienist might address each of the reasons.
BIBLIOGRAPHY
Alvarez K: Dental Hygiene Handbook. Baltimore: Lippincott Wil- liams & Wilkins, 1998, pp. 419–421.
Darby ML: Mosby’s Comprehensive Review of Dental Hygiene, 7th ed. St. Louis: Mosby (Elsevier), 2012, pp. 537–540, 746. DeLong L, Burkhart NW: General and Oral Pathology for the Den-
tal Hygienist. Baltimore: Lippincott Williams & Wilkins, 2008, pp. 321–360.
Ibsen OAC, Phelan J: Oral Pathology for the Dental Hygienist, 5th ed. St. Louis: Saunders (Elsevier), 2009, pp. 124, 241–244.
Langlais RP, Miller CS, Nield-Gehrig JS: Color Atlas of Common Oral Disease, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2010, pp. 48–51, 72–73, 76, 86–87, 164.
Medical Economics: PDR for Nonprescription Drugs, Dietary Sup- plements, and Herbs. Montvale, NJ: Thomson Healthcare, 2008, pp. 685–706.
Kimbrough-Walls VJ, Lautar CJ: Ethics, Jurisprudence, & Practice Management in Dental Hygiene, 3rd ed. Upper Saddle River, NJ: Pearson, 2012, pp. 30–41.
Weinstein B: Dental Ethics. Philadelphia: Lea & Febiger, 1993, p. 69.
Wilkins E: Clinical Practice of the Dental Hygienist, 10th ed. Phila- delphia: Lippincott Williams & Wilkins, 2009, pp. 996–1015. Wynn RL, Meiller TF, Crossley HL (eds.): Drug Information Handbook
for Dentistry: Including Oral Medicine for Medically-Compromised Patients & Specific Oral Conditions, 16th ed. Hudson, OH: Lexi- Comp, 2010, pp. 90–91, 703–705, 885–890, 1886–1887. Rule JT, Veatch RM: Ethical Questions in Dentistry, 2nd ed. Chi-
cago: Quintessence, 2004, pp. 85–102.
Stegeman CA, Davis JR: The Dental Hygienist’s Guide to Nutri- tional Care, 3rd ed. St. Louis: Saunders (Elsevier), 2010, pp. 34–48, 104–144, 175–197, 372–390.
Weinberg MA, Westphal C, Froum SJ, Palat M, Schoor R: Com- prehensive Periodontics for the Dental Hygienist, 3rd ed. Upper Saddle River, NJ: Pearson, 2010, pp. 310–325.
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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