COVER
PREFACE
1 Patient Examination
1. Case 1: Examination and Documentation
  1. Medical History
  2. Dental History
  3. Social History
  4. Review of Systems (Physical Examination)
  5. Head and Neck Examination
  6. Radiographic Examination
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Progress Notes
  10. Discussion: Examination and Documentation in Patient Assessment
  11. Take‐Home Hints
  12. References
2. Case 2: Head and Neck Examination
  1. Medical History
  2. Dental History
  3. Social History
  4. Head and Neck Examination
  5. Radiographic Examination
  6. Dental Hygiene Diagnosis
  7. Planned Interventions
  8. Progress Notes
  9. Discussion: The Head and Neck Examination
  10. Take‐Home Hints
  11. References
  12. Additional Resources
3. Case 3: Radiographic Exam
  1. Introduction
  2. Medical History
  3. Medications
  4. Review of Systems
  5. Social History
  6. Dental History
  7. Head and Neck Exam
  8. Radiographic Examination
  9. Differential Diagnosis
  10. Clinical Management
  11. Treatment Plan
  12. Discussion
  13. Take‐Home Hints
  14. References
4. Case 4: Occlusal Examination
  1. Medical History
  2. Review of Systems
  3. Social History
  4. Dental History
  5. Head and Neck Examination
  6. Radiographic Examination
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Progress Notes
  10. Discussion
  11. Take‐Home Hints
  12. References
  13. Additional Resources
5. Case 5: Gingival Examination
  1. Introduction
  2. Medical History
  3. Medications
  4. Review of Systems
  5. Social History
  6. Dental History
  7. Regional Head and Neck Exam
  8. Examination Findings and Problem List
  9. Differential Diagnosis
  10. Treatment
  11. Histopathological Description
  12. Definitive Diagnosis
  13. Clinical Management
  14. Discussion
  15. Take‐Home Hints
  16. References
6. Case 6: Periodontal Exam
  1. Introduction
  2. Medical History
  3. Medications
  4. Review of Systems
  5. Social History
  6. Dental History
  7. Head and Neck Examination
  8. Radiographic Findings and Problem List
  9. Clinical Impressions
  10. Treatment Plan
  11. Discussion
  12. Take‐Home Hints
  13. References
2 Dental Hygiene Diagnosis
1. Case 1: Plaque‐Induced Gingivitis
  1. Medical History
  2. Dental History
  3. Social History
  4. Head and Neck Examination
  5. Risk Assessments
  6. Problem List
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Appointment Schedule
  10. Discussion
  11. Take‐Home Hints
  12. References
2. Case 2: Non‐Plaque‐Induced Gingivitis
  1. Medical History
  2. Dental History
  3. Social History
  4. Assessments
  5. Risk Assessments
  6. Problem List
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Appointment Schedule
  10. Discussion
  11. Take‐Home Hints
  12. References
3. Case 3: Drug‐Induced Gingivitis
  1. Medical History
  2. Dental History
  3. Assessments
  4. Risk Assessments
  5. Problem List
  6. Dental Hygiene Diagnosis
  7. Planned Interventions
  8. Discussion
  9. Take‐Home Hints
  10. References
4. Case 4: Chronic Periodontitis
  1. Medical History
  2. Dental History
  3. Social History
  4. Assessments
  5. Risk Assessments
  6. Problem List
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Appointment Schedule
  10. Discussion
  11. Take‐Home Hints
  12. References
5. Case 5: Aggressive Periodontics
  1. Medical History
  2. Dental History
  3. Social History
  4. Assessments
  5. Risk Assessments
  6. Problem List
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Appointment Schedule
  10. Discussion
  11. Take‐Home Hints
  12. References
6. Case 6: Local Contributing Factors
  1. Medical History
  2. Dental History
  3. Social History
  4. Assessments
  5. Risk Assessments
  6. Problem List
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Discussion
  10. Take‐Home Hints
  11. References
3 Planning and Managing Dental Hygiene Care
1. Case 1: Infection Control
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Examination
  5. Dental Hygiene Diagnosis
  6. Planned Interventions
  7. Progress Notes
  8. History and Clinical Pathophysiology
  9. Take‐Home Hints
  10. References
2. Case 2: Emergency Situations and Provision of Appropriate Care
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Examination
  5. Dental Hygiene Diagnosis
  6. Planned Interventions
  7. Progress Notes
  8. Discussion
  9. Take‐Home Hints
  10. References
3. Case 3: Individualized Patient Care
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Examination
  5. Dental Hygiene Diagnosis
  6. Planned Interventions
  7. Progress Notes
  8. Discussion
  9. Take‐Home Hints
  10. References
4. Case 4: Nutritional Counseling
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Examination
  5. Dental Hygiene Diagnosis
  6. Planned Interventions
  7. Progress Notes
  8. Discussion
  9. Dietary Deficiency
  10. Food‐Cobalamin Malabsorption
  11. Lack of Intrinsic Factor
  12. Take‐Home Hints
  13. References
5. Case 5: Dental Hygiene Treatment Strategies
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Examination
  5. Dental Hygiene Diagnosis
  6. Planned Interventions
  7. Progress Notes
  8. Discussion
  9. Take‐Home Hints
  10. References
4 Nonsurgical Periodontal Procedures
1. Case 1: Periodontal Debridement (Hand, Ultrasonic, Sonic Instrumentation)
  1. Dental History
  2. Medical History
  3. Social History
  4. Dental Examination
  5. Radiographic Examination
  6. Dental Hygiene Diagnosis
  7. Planned Dental Hygiene Interventions
  8. Progress Notes
  9. Discussion
  10. Take‐Home Hints
  11. References
2. Case 2: Reassessment and Maintenance
  1. Dental History
  2. Medical History
  3. Social History
  4. Dental Examination
  5. Radiographic Examination
  6. Dental Hygiene Diagnosis
  7. Planned Dental Hygiene Interventions:
  8. Progress Notes
  9. Discussion
  10. Take‐Home Hints
  11. References
3. Case 3: Oral Hygiene Instruction with Limited Dexterity
  1. Dental History
  2. Medical History
  3. Social History
  4. Dental Examination
  5. Radiographic Examination
  6. Dental Hygiene Diagnosis
  7. Planned Interventions
  8. Progress Notes
  9. Discussion
  10. Take‐Home Hints
  11. References
5 Pharmacology
1. Case 1: Pain and Anxiety Control: Analgesics
  1. Medical History
  2. Review of Systems
  3. Dental History
  4. Social History
  5. Extraoral and Intraoral Examination
  6. Diagnosis
  7. Treatment Plan
  8. Discussion
  9. Take‐Home Hints
  10. References
  11. Additional Resources
2. Case 2: Pain and Anxiety Control: Topical and Local Anesthetics
  1. Medical History
  2. Review of Systems
  3. Dental History
  4. Social History
  5. Extraoral and Intraoral Examination
  6. Clinical Diagnosis
  7. Treatment Plan
  8. Discussion
  9. Take‐Home Hints
  10. References
  11. Additional Resources
3. Case 3: Pain and Anxiety Control: Nitrous Oxide
  1. Medical History
  2. Review of Systems
  3. Dental History
  4. Social History
  5. Extraoral and Intraoral Examination
  6. Radiographic Examination
  7. Diagnosis
  8. Treatment Plan
  9. Discussion
  10. Take‐Home Hints
  11. References
  12. Additional Resources
4. Case 4: Topical Drug Delivery (Local Drug Delivery, Oral Rinses, and Irrigation)
  1. Medical History
  2. Review of Systems
  3. Dental History
  4. Social History
  5. Extraoral and Intraoral Examination
  6. Diagnosis
  7. Treatment Plan
  8. Discussion
  9. Take‐Home Hints
  10. References
  11. Additional Resources
5. Case 5: Systemic Antibiotics and Enzyme Suppression Therapy
  1. Medical History
  2. Review of Systems
  3. Dental History
  4. Social History
  5. Extraoral and Intraoral Examination
  6. Diagnosis
  7. Treatment Plan
  8. Discussion
  9. Take‐Home Hints
  10. References
  11. Additional Resources
6 Surgical Periodontal Procedures
1. Case 1: Surgical Support Services
  1. Medical History
  2. Social History
  3. Extraoral Examination
  4. Intraoral Examination
  5. Periodontal Examination
  6. Occlusion
  7. Radiographic Examination
  8. Diagnosis
  9. Treatment Plan
  10. Discussion
  11. Postoperative Instructions
  12. Periodontal Dressing
  13. Suture
  14. Suture Removal
  15. Take‐Home Hints
  16. References
2. Case 2: Implant Procedures and Maintenance
  1. Medical History
  2. Social History
  3. Dental History
  4. Extra‐Oral Examination
  5. Intraoral Examination
  6. Radiographic Examination
  7. Diagnosis
  8. Treatment Plan
  9. Discussion
  10. Assessment
  11. Instrumentation
  12. Take‐Home Hints
  13. References
7 Preventive Therapies
1. Case 1: Plaque Removal; Individualized Patient Education
  1. Medical History
  2. Dental History
  3. Review of Systems
  4. Social History
  5. Extraoral/Intraoral Examination
  6. Radiographic Examination
  7. Periodontal Charting
  8. Dental Hygiene Diagnosis
  9. Dental Hygiene Treatment Plan
  10. Discussion
  11. Take‐Home Hints
  12. References
  13. Additional Resources
2. Case 2: Fluoride – Systemic and Topical
  1. Medical History, Review of Systems, Social History, Extra/Intraoral Examination, Occlusion, and Radiographic Examination
  2. Diagnosis
  3. Treatment Plan
  4. Discussion
  5. Take‐Home Hints
  6. References
  7. Additional Resources
3. Case 3: Pit and Fissure Sealants
  1. Medical History, Review of Systems, Social History, Extra/Intraoral Examination, Occlusion, and Radiographic Examination
  2. Diagnosis
  3. Treatment Plan
  4. Discussion
  5. Management of Occlusal Caries
  6. Take‐Home Hints
  7. References
  8. Additional Resources
8 Introduction to Biomaterials
1. Case 1: Biomaterials: Dental Implants and Peri‐implantitis
  1. Review of Symptoms
  2. Medical History
  3. Social History
  4. Extraoral Examination
  5. Intraoral Examination
  6. Occlusion
  7. Radiographic Examination
  8. Diagnosis and Prognosis
  9. Dental Hygiene Diagnosis/Treatment Plan
  10. Planned Interventions
  11. Discussion
  12. Take‐Home Hints
  13. References
  14. Additional Resources
2. Case 2: Polishing Restored and Natural Teeth
  1. Review of Symptoms
  2. Medical History
  3. Social History
  4. Extraoral Examination
  5. Intraoral Examination
  6. Occlusion
  7. Radiographic Examination
  8. Diagnosis and Prognosis
  9. Dental Hygiene Diagnosis
  10. Planned interventions
  11. Discussion: Polishing Restored and Natural Teeth
  12. Take‐Home Hints
  13. References
  14. Additional Resources
3. Case 3: Alginate Impressions
  1. Review of Symptoms
  2. Medical History
  3. Social History
  4. Extraoral Examination
  5. Intraoral Examination
  6. Occlusion
  7. Radiographic Examination
  8. Diagnosis and Prognosis
  9. Dental Hygiene Diagnosis
  10. Planned Interventions
  11. Discussion: Alginate
  12. Taking Alginate Impressions
  13. The Future of Impressions
  14. Take‐Home Hints
  15. References
  16. Additional Resources
4. Case 4: Dentinal Hypersensitivity
  1. Medical History
  2. Review of Systems
  3. Social History
  4. Extraoral Examination
  5. Intraoral Examination
  6. Radiographic Evaluation
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Discussion
  10. Take‐Home Hints
  11. References
9 Management of Special Needs Patients
1. Case 1: Older Adult
  1. Medical History
  2. Social History
  3. Review of Systems
  4. Extraoral Examination
  5. Intraoral Examination
  6. Radiographic Examination
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Discussion
  10. Take‐Home Hints
  11. References
2. Case 2: Psychiatric Disability
  1. Medical History
  2. Social History
  3. Review of Systems
  4. Extraoral Examination
  5. Intraoral Examination
  6. Intraoral Pictures
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Discussion
  10. Take‐Home Hints
  11. References
3. Case 3: Abuse
  1. Medical History
  2. Social History
  3. Review of Systems
  4. Extraoral Examination
  5. Intraoral Examination
  6. Radiographic Examination
  7. Dental Hygiene Diagnosis
  8. Planned Interventions
  9. Discussion
  10. General Indicators Seen in Victims of Child Maltreatment Cases
  11. General Caregiver Indicators Seen in Maltreatment Cases
  12. Awareness and Identification
  13. Filing a Report
  14. References
4. Case 4: Substance‐Related Disorder
  1. Medical History
  2. Social History
  3. Review of the Systems
  4. Extraoral Exam
  5. Intraoral Exam
  6. Gingival Examination
  7. Radiographic Examination
  8. Odontogram
  9. Dental Hygiene Diagnosis
  10. Planned Interventions
  11. Treatment Plan
  12. Discussion
  13. Take‐Home Hints
  14. References
10 Management of Medically Complex Patients
1. Case 1: Patient with Diabetes
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Examination
  5. Treatment Plan
  6. Discussion
  7. Specific Considerations
  8. Take‐Home Hints
  9. References
  10. Additional Resources
2. Case 2: Patient with Asthma
  1. Medical History
  2. Social History
  3. Dental History
  4. Dental Examination
  5. Medical Considerations
  6. Dental Considerations
  7. Take‐Home Hints
  8. References
3. Case 3: Patient with Hypertension
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Examination
  5. Dental Considerations
  6. Medical Considerations: Hypertension
  7. Medical Considerations: Medications
  8. Specific Considerations
4. Case 4: Patient Taking Antithrombotic Drugs – Valve Replacement
  1. Medical History and Review of Systems
  2. Medications
  3. Allergies
  4. Dental History
  5. Social History
  6. Extraoral and Intraoral Mucosal Examination
  7. Clinical Dental Examination
  8. Radiographic Examination
  9. Treatment Plan and Management
  10. Medical Considerations
  11. Antibiotic Prophylaxis
  12. Take‐Home Hints
  13. References
5. Case 5: Patient with Kidney Disease
  1. Medical History and Review of Systems
  2. Dental History
  3. Social and Family History
  4. Extraoral and Intraoral Examination
  5. Panoramic Examination
  6. Problem List
  7. Treatment Plan
  8. Discussion
  9. Take‐Home Hints
  10. Additional Resources
11 Professional Responsibility
1. Case 1: Ethical Principles – Informed Consent
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Hygiene Diagnosis
  5. Planned Interventions
  6. Discussion
  7. American Dental Hygienists’ Association
  8. Take‐Home Hints
  9. References
  10. Additional Resources
2. Case 2: Regulatory Compliance
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Hygiene Diagnosis
  5. Planned Interventions
  6. Discussion
  7. Take‐Home Hints
  8. References
  9. Additional Resources
3. Case 3: Patient and Professional Communication
  1. Medical History
  2. Dental History
  3. Social History
  4. Dental Hygiene Diagnosis
  5. Planned Interventions
  6. Discussion
  7. Take‐Home Hints
  8. References
  9. Additional Resources
12 Community and Oral Health Promotion
1. Case 1: Participating in Community Programs
  1. Discussion
  2. Take‐Home Hints
  3. References
  4. Additional Resources
2. Case 2: Promoting Health and Preventing Disease within Groups
  1. Discussion
  2. Take‐Home Hints
  3. References
  4. Additional Resources
INDEX
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List of Tables

Chapter 01-c
1. Table 1.3.1: Suggested methodology for reading radiographic images.
2. Table 1.3.2: Findings in patients with Gardner Syndrome.
Chapter 01-e
1. Table 1.5.1: Examples of disease processes involving the gingiva.
2. Table 1.5.2: Suggested stepwise methodology for performing a gingival exam.
Chapter 01-f
1. Table 1.6.1: Periodontal examination: a suggested methodology.
Chapter 02-c
1. Table 2.3.1: A medication summary form for reviewing patients medications and summarizing drugs reactions, side effects, and dental considerations to be used in formulating a dental hygiene care plan.
Chapter 03-a
1. Table 3.1.1: Individuals with high risk for HCV.
2. Table 3.1.2: There are three categories of patient‐care items depending on their intended use and the potential risk of disease transmission.
Chapter 03-b
1. Table 3.2.1: Clinical features suggestive of specific causes of syncope.
Chapter 03-c
1. Table 3.3.1: Pre‐transplantation dental care guidelines.
2. Table 3.3.2: Post‐transplantation dental care guidelines.
Chapter 03-e
1. Table 3.5.1: Indicators for increased risk of dental caries.
2. Table 3.5.2: Caries Risk Assessment Form — Children Age 6 and Over/Adults. Featherstone et al. (2007).
3. Table 3.5.3: Clinical guidelines for patients age six and older. Jenson et al. (2007).
4. Table 3.5.4: SAFER Protocol: An example of clinical guidelines based on caries risk for patients 6 years through adult.
Chapter 05-a
1. Table 5.1.1: Commonly used systemic analgesics.
2. Table 5.1.2: Effects of cyclooxygenase inhibition by aspirin and NSAIDs (“4 A’s of NSAIDs”).
3. Table 5.1.3: Potential drug interactions due to cyclooxygenase inhibition and prostaglandin reduction.
4. Table 5.1.4: Special patient populations that may complicate the choice of an analgesic.
5. Table 5.1.5: OTC products that may contain acetaminophen.
Chapter 05-b
1. Table 5.2.1: Common topical anesthetic products.
2. Table 5.2.2: Commonly used local anesthetics in dentistry.
3. Table 5.2.3: Concerns associated with dental anesthetic products.
Chapter 05-c
1. Table 5.3.1: Properties of nitrous oxide.
2. Table 5.3.2: Indications for nitrous oxide use.
3. Table 5.3.3: Contraindications to nitrous oxide use.
4. Table 5.3.4: Safety features of contemporary nitrous oxide‐oxygen units.
Chapter 05-d
1. Table 5.4.1: Requirements for a chemotherapeutic agent for use in periodontitis.
2. Table 5.4.2: Oral antimicrobial rinses.
3. Table 5.4.3: Local chemotherapeutics agents.
Chapter 05-e
1. Table 5.5.1: Considerations prior to initiating antibiotic therapy.
2. Table 5.5.2: Antibiotics used to treat periodontal diseases.
3. Table 5.5.3: Unique adverse drug reactions (ADRs) of antibiotics.
4. Table 5.5.4: Features of subantimicrobial dose doxycycline (SDD).
Chapter 07-a
1. Table 7.1.1: Self‐care aid options and their use.
Chapter 09-a
1. Table 9.1.1: Dental hygiene diagnosis.
2. Table 9.1.2: Planned interventions.
Chapter 09-b
1. Table 9.2.1: Dental hygiene diagnosis.
2. Table 9.2.2: Planned interventions.
Chapter 09-c
1. Table 9.3.1: Dental hygiene diagnosis.
2. Table 9.3.2: Planned interventions.
3. Table 9.3.3: General indicators seen in victims of child maltreatment cases.
4. Table 9.3.4: General caregiver indicators seen in maltreatment cases.
Chapter 10-a
1. Table 10.1.1: Oral health concerns as they relate to risks and etiology.
2. Table 10.1.2: Medical management considerations: antihypertensive medications.
3. Table 10.1.3: Common antidiabetic medications.
4. Table 10.1.4: Signs and symptoms of hypoglycemia.
Chapter 10-b
1. Table 10.2.1: Specific Considerations for this Case.
Chapter 10-c
1. Table 10.3.1: Blood pressure categories defined by the American Heart Association.
2. Table 10.3.2: Special considerations during dental treatment regarding blood pressure values.
3. Table 10.3.3: Side effects and interactions of high blood pressure medications.
Chapter 10-d
1. Table 10.4.1: Cardiac prophylaxis.
2. Table 10.4.2: Antibiotic dosage.
3. Table 10.4.3: Dental management.
Chapter 10-e
1. Table 10.5.1: Selected laboratory values.
Chapter 11-b
1. Table 11.2.1: Top reasons dental hygienists are sued.
Chapter 12-a
1. Table 12.1.1: Patient care vs. community health programs.
Chapter 12-b
1. Table 12.2.1: Indices and purposes.

List of Illustrations

Chapter 01-a
1. Figure 1.1.1: Assessment as detective work.
2. Figure 1.1.2: Five parts of the clinical examination.
3. Figure 1.1.3: Standards for clinical dental hygiene practice.
Chapter 01-b
1. Figure 1.2.1: Extraoral image of neck with erythematous areas.
2. Figure 1.2.2: Sternocleidomastoid muscle.
3. Figure 1.2.3: Steps in the head and neck examination.
4. Figure 1.2.4: Lateral borders of the tongue.
Chapter 01-c
1. Figure 1.3.1: Panoramic radiograph demonstrating adolescent patient with a right mandibular osteoma, multiple odontomas, and impacted teeth.
2. Figure 1.3.2: Clinical image of an epidermoid cyst of the skin. An elevated nodule demonstrating a darker hue compared to the adjacent skin. The nodule was doughy in consistency upon palpation.
3. Figure 1.3.3: Clinical image of an epidermoid cyst of the skin. An elevated nodule demonstrating a darker hue compared to the adjacent skin. The nodule was doughy in consistency upon palpation.
4. Figure 1.3.4: Low power histopathology corresponding to the epidermoid cyst of the skin seen in Figure 1.3.2 and Figure 1.3.3. The section shows an intact epidermis composed of orthokeratinized stratified squamous epithelium (black arrow), a dermis of dense fibrous connective tissue (blue arrow), a cystic structure showing orthokeratinized stratified squamous epithelium and a lumen with keratinaceous debris (red arrow).
5. Figure 1.3.5: High power histopathology corresponding to the epidermoid cyst of the skin. The section shows the dermis comprising the cyst wall (black arrow) the cystic lining of orthokeratinized stratified squamous epithelium and a lumen with keratinaceous debris (blue arrow).
Chapter 01-d
1. Figure 1.4.1: Patient profile image.
2. Figure 1.4.2: Patient intraoral palate.
3. Figure 1.4.3: Patient intraoral floor of mouth.
4. Figure 1.4.4: Malocclusion right.
5. Figure 1.4.5: Malocclusion left.
6. Figure 1.4.6: Malocclusion facial.
7. Figure 1.4.7: Radiographic image.
8. Figure 1.4.8: Relative mandibular retrognathia.
9. Figure 1.4.9: (A) Managing patients who gag during dental treatment. (B) Transformer puzzle toy.
10. Figure 1.4.10: Risk factors for malocclusion.
11. Figure 1.4.11: Distal terminal plane in determining primary occlusion. (A) mesial and (B) flush steps predict class I, (C) distal step predicts class II, extreme mesial step predicts class III.
Chapter 01-e
1. Figure 1.5.1: Clinical image of the patient from the anterior showing multiple erosions and white striated plaques of the gingiva and accumulation of plaque and calculus.
2. Figure 1.5.2: Clinical image of the patient from the right side showing multiple erosions and white striated plaques of the gingiva and accumulation of plaque and calculus.
3. Figure 1.5.3: Clinical image of the patient from the left side showing multiple erosions and white striated plaques of the gingiva and accumulation of plaque and calculus.
4. Figure 1.5.4: Histopathology of biopsied specimen demonstrating hyperparakeratosis, lymphocytic infiltration of the epithelium, degeneration of the basal layer, saw‐toothing of the rete ridges and a band‐like infiltrate of lymphocytes.
Chapter 01-f
1. Figure 1.6.1: Panoramic radiograph demonstrating multiple large, unilocular radiolucencies.
2. Figure 1.6.2: Periodontal charting.
Chapter 02-a
1. Figure 2.1.1: Note the plaque accumulation around the gingival margin and associated inflammation.
2. Figure 2.1.2: Plaque control record for initial and second appointments note the decrease in PCR score from the initial appointment.
Chapter 02-b
1. Figure 2.2.1: Note the edematous papilla between teeth #29 and #30 indicative of a pyogenic granuloma.
2. Figure 2.2.2: (A) Periodontal charting for non‐plaque‐induced gingivitis. (B) Periodontal charting summary for a patient with non‐plaque‐induced gingivitis – note the total sites and the bleeding sites compare with the plaque control record in Figure 2.2.3.
3. Figure 2.2.3: Plaque control record for a patient with non‐plaque‐induced gingivitis – note the low plaque score and compare with the bleeding points in Figures 2.2.2A and B.
Chapter 02-c
1. Figure 2.3.1: Phenytoin‐induced gingival enlargement (Darby and Walsh 2015, p. 882).
Chapter 02-d
1. Figure 2.4.1: Generalized recession and abfractions causing tooth sensitivity.
2. Figure 2.4.2: Calculus accumulation on the mandibular anterior teeth.
3. Figure 2.4.3: Periodontal charting note probing depths and bleeding points on the posterior teeth associated with deeper pockets.
Chapter 02-e
1. Figure 2.5.1: During the visual examination of the gingiva the dental hygienist would interpret the gingival changes and further conduct a thorough periodontal examination.
2. Figure 2.5.2: Periodontal charting for patient with aggressive periodontitis. Note the deep pockets and multiple bleeding sites.
3. Figure 2.5.3: Periapical image of the maxillary left premolars. Note both vertical and horizontal bone loss.
4. Figure 2.5.4: Amalgamated assessment data allow the dental hygienist to analyze and interpret the information to provide a diagnosis.
Chapter 02-f
1. Figure 2.6.1: Note the plaque accumulation around the crown margin and associated gingival inflammation. Source: Photo courtesy of Rio Salado College.
2. Figure 2.6.2: Calculus formation around anterior crowns. Note the crowns are fused and the margin on the distal of the lateral incisor are local contributing factors.
3. Figure 2.6.3: Gingival inflammation around anterior crowns, may be a result of a tissue reaction to biomaterials used in the fabrication or bulky crown margins.
4. Figure 2.6.4: A broken tooth with plaque accumulation and gingival inflammation.
5. Figure 2.6.5: Crowding on the mandibular incisors resulting in difficulty in plaque removal and root debridement procedures.
6. Figure 2.6.6: Calculus formation on the lingual of the mandibular incisors note the edematous papilla and rolled margins.
7. Figure 2.6.7: Heavy subgingival calculus preventing daily plaque removal and contributing to plaque retention.
Chapter 03-a
1. Figure 3.1.1: Schematic representation of the major steps of HCV life cycle.
Chapter 03-b
1. Figure 3.2.1: Movement to upright posture reduces intravascular volume in the thorax and diminishes venous return to the heart. Systemic pressure at the level of the brain is placed at risk in the absence of appropriate cardiovascular compensatory responses
Chapter 03-c
1. Figure 3.3.1: Severe oral mucositis showing epithelial destruction.
2. Figure 3.3.2: The dental hygienist as an oral health‐care manager.
Chapter 03-d
1. Figure 3.4.1: Cobalamin metabolism and corresponding causes of deficiency. Causes of cobalamin deficiency are shown in blue. The metabolic pathway starts when (1) dietary cobalamin (Cbl), obtained through animal foods, enters the stomach bound to animal proteins (P). (2) Pepsin and HCL in the stomach sever the animal protein, releasing free cobalamin. Most of the free cobalamin is then bound to R‐protein (R), which is released from the parietal and salivary cells. IF is also secreted in the stomach, but its binding to cobalamin is weak in the presence of gastric and salivary R‐protein. (3) In the duodenum, dietary cobalamin bound to R‐protein is joined by cobalamin–R‐protein complexes that have been secreted in the bile. Pancreatic enzymes degrade both biliary and dietary cobalamin–R‐protein complexes, releasing free cobalamin. (4) The cobalamin then binds with IF. The cobalamin–IF complex remains undisturbed until the distal 80 cm of the ileum, where (5) it attaches to mucosal cell receptors (cubilin) and the cobalamin is bound to transport proteins known as transcobalamin I, II and III (TCI, TCII, and TCIII). TCII, although it represents only a small fraction (about 10%) of the transcobalamins, is the most important because it is able to deliver cobalamin to all cells in the body. The cobalamin is subsequently transported systemically via the portal system. (6) Within each cell, the TCII–cobalamin complex is taken up by means of endocytosis and the cobalamin is liberated and then converted enzymatically into its two coenzyme forms, methylcobalamin and adenosylcobalamin.
2. Figure 3.4.2: The small intestine connects the stomach and the colon. It includes the duodenum, jejunum, and ileum.
3. Figure 3.4.3: Angular cheilitis and depapillation of the tongue in a patient with pernicious anemia.
4. Figure 3.4.4: The mucosa becomes atrophic in pernicious anemia and easily ulcerated. Note ulcer on left lateral aspect of the tongue.
Chapter 03-e
1. Figure 3.5.1: The caries “imbalance.” The balance among disease indicators, risk factors, and protective factors determines whether dental caries progresses, halts, or reverses. Cavities/dentin refers to frank cavities or lesions to the dentin by radiograph. Restorations < three years means restorations placed in the previous three years. This figure has been updated from previous versions of the “caries balance” with the very important addition of the disease indicators. If these indicators are present they weigh heavily on the side of predicting caries progression unless therapeutic intervention is carried out. The abbreviations that help recall of the imbalance (WREC; BAD; SAFE) are shown as well as sealants as a protective factor. Dietary habits (poor) indicate frequent ingestion of fermentable carbohydrates (greater than three times daily between meals).
Chapter 04-a
1. Figure 4.1.1: Radiograph showing heavy subgingival calculus deposits #31 – Mesial.
2. Figure 4.1.2: Bitewing radiograph of right side showing heavy interproximal subgingival calculus deposits.
3. Figure 4.1.3: Bitewing radiograph of left side showing heavy interproximal subgingival calculus deposits. Note the slight periodontal ligament widening on the distal of the maxillary premolar.
4. Figure 4.1.4: Bitewing radiograph of left side showing heavy interproximal calculus.
Chapter 04-b
1. Figure 4.2.1: Radiograph showing severe bone loss between #7 and 8.
2. Figure 4.2.2: Implant supported bridge for teeth #5 to #7. Note the vertical bone loss occurring on the mesial of implant #7.
3. Figure 4.2.3: Reassessment and maintenance for dental hygiene process of care.
Chapter 04-c
1. Figure 4.3.1: Panoramic radiograph.
2. Figure 4.3.2: Lower left radiograph of teeth #18 and #19 revealing furcation involvement.
3. Figure 4.3.3: Bitewing radiograph of left side showing advanced horizontal bone loss.
4. Figure 4.3.4: Bitewing radiograph of right side showing interproximal calculus with horizontal bone loss.
Chapter 05-a
1. Figure 5.1.1: Full mouth series.
Chapter 05-b
1. Figure 5.2.1: Pyogenic granuloma.
Chapter 05-c
1. Figure 5.3.1: Panoramic radiograph.
2. Figure 5.3.2: Contemporary nitrous oxide‐oxygen unit.
Chapter 05-d
1. Figure 5.4.1: Full mouth series.
2. Figure 5.4.2: Deep probing depth mesial #3.
Chapter 05-e
1. Figure 5.5.1: Radiographs of tooth #19.
2. Figure 5.5.2: Periodontal abscess #19.
3. Figure 5.5.3: 9 mm vertical component of defect.
4. Figure 5.5.4: Horizontal component of defect.
Chapter 06-a
1. Figure 6.1.1: Before osseous surgery (A), notice the spacing between the bone to the tooth that created a crater defect. After osseous recontouring (B), the bony craters have been removed this will allow for better flap adaptation and pocket reduction.
2. Figure 6.1.2: Negative architecture too severe to allow for osseous surgery.
Chapter 06-b
1. Figure 6.2.1: Clinical (A) and radiographic (B) images of implant #13 with peri‐implantitis. Note the erythema and edema in the peri‐implant mucosa (A) and the crater formed destruction around the implant (B).
2. Figure 6.2.2: After crown removal and reflection of the gingival flap, the extent of the bone loss is observed.
3. Figure 6.2.3: Bone graft placed to restore defect.
Chapter 07-a
1. Figure 7.1.1: Odontogram of Mrs. A’s current oral restoration status. Green color indicated “Existing Other,” restorations completed by patients previous Doctor of Dental Surgery (DDS), blue color indicated existing restorations completed with current DDS. W indicated “watches.”
2. Figure 7.1.2: Oral photo using cheek retractors. Note uneven anterior wear from bruxism, #9 thinning enamel near the cervical third of tooth. Gingival color and texture are visible in the photo.
3. Figure 7.1.3: Full mouth series radiographs, updated vertical bitewings to reveal bone loss.
4. Figure 7.1.4: Periodontal charting indicated chronic periodontitis.
Chapter 07-b
1. Figure 7.2.1: Dental charting options for caries depth and activity in axiUm™ electronic health record.
2. Figure 7.2.2: Bitewing radiograph displaying approximal caries of varied severity (E1, E2, and D1).
3. Figure 7.2.3: Bitewing radiograph.
Chapter 07-c
1. Figure 7.3.1: Dental charting.
2. Figure 7.3.2: Bitewing radiograph.
3. Figure 7.3.3: (A) Sound enamel (note the smooth shiny surface). (B) Sound enamel (note the smooth shiny surface).
4. Figure 7.3.4: (A) Initial caries with active demineralization. (B) Initial caries with no demineralization.
5. Figure 7.3.5: (A) Moderate caries (visible caries on distal). (B) Bitewing radiograph to confirm that occult caries is present at or below the dentoenamel junction.
6. Figure 7.3.6: Extensive caries.
7. Figure 7.3.7: Noncoalesced leaving a gap to the dentin (Ripa and Wolff 1992).
Chapter 08-a
1. Figure 8.1.1: Tooth #20, implant with peri‐implantitis.
2. Figure 8.1.2: Bone grafting: allograft (cortical/cancelous) with collagen membrane.
3. Figure 8.1.3: Implant guidance.
4. Figure 8.1.4: Implant placement.
5. Figure 8.1.5: Implant with healing cap.
Chapter 08-b
1. Figure 8.2.1: Intraoral photograph of Cl IV MI with mesial‐incisal chip.
2. Figure 8.2.2: Periapical radiograph of #8, Class III, distal composite, Class IV MI composite with chip, #9 Class IV MI composite with fracture and irregular margins and CL III distal with excess composite.
3. Figure 8.2.3: Veneers.
4. Figure 8.2.4: Veneer/composite polishing bur.
Chapter 08-c
1. Figure 8.3.1: Radiographic image teeth #8 and #9.
2. Figure 8.3.2: Proper spatulation technique.
3. Figure 8.3.3: Placement of mandibular tray.
4. Figure 8.3.4: Placement of maxillary tray.
5. Figure 8.3.5: Acceptable maxillary and mandibular impressions.
Chapter 08-d
1. Figure 8.4.1: Intraoral pictures (left to right) show maxillary and mandibular arches, and occlusion on the lower left side, noting the significant recession on #19.
2. Figure 8.4.2: Horizontal bitewing of the left side.
Chapter 09-a
1. Figure 9.1.1: Front view.
2. Figure 9.1.2: Mandibular occlusal view.
3. Figure 9.1.3: Right side.
4. Figure 9.1.4: Left side.
5. Figure 9.1.5: Maxillary occlusal view.
6. Figure 9.1.6: Panoramic radiograph.
Chapter 09-b
1. Figure 9.2.1: Maxillary incisors palatal view 01.
2. Figure 9.2.2: Maxillary incisors palatal view 02.
Chapter 09-c
1. Figure 9.3.1: Upper lip.
Chapter 09-d
1. Figure 9.4.1: Lower left vestibule view 01.
2. Figure 9.4.2: Lower left vestibule view 02.
3. Figure 9.4.3: Periodontal Chart.
4. Figure 9.4.4: Full mouth series.
5. Figure 9.4.5: Odontogram.
Chapter 10-a
1. Figure 10.1.1: Periapical radiographic series showing generalized moderate horizontal bone loss, with localized severe vertical bone loss on tooth #22.
2. Figure 10.1.2: A1C and fasting plasma glucose normal values.
3. Figure 10.1.3: The A1c test score (%) on left as compared to the fasting blood sugar (mg/dl).
Chapter 10-c
1. Figure 10.3.1: Panoramic image of the patient.
Chapter 10-d
1. Figure 10.4.1: Clinical dental examination.
Chapter 10-e
1. Figure 10.5.1: Panoramic radiograph showing “ground glass” appearance of trabeculae and loss of lamina dura.
Chapter 11-a
1. Figure 11.1.1: Staff members can be utilized as certified translators.
2. Figure 11.1.2: If you can't understand a patient’s response then they can't understand you.
3. Figure 11.1.3: A patient cannot give informed consent unless they know the facts and can ask questions.
Chapter 11-b
1. Figure 11.2.1: It is imperative that a dental hygienist is familiar with the laws governing practice.
2. Figure 11.2.2: One way State Boards of Dentistry protect the public is by holding disciplinary hearings.
Chapter 11-c
1. Figure 11.3.1: HIPAA protects patients’ personal information from being shared to unauthorized entities.
2. Figure 11.3.2: Dental hygienists must be aware of the pros and cons of all social media.
Chapter 12-a
1. Figure 12.1.1: (A) Hospital setting. (B) Patient completing needs assessment. (C) Dental hygienist conducting face to face interview. (D) Dental hygiene process of care. (E) Dental hygiene program planning paradigm.
Chapter 12-b
1. Figure 12.2.1: (A) Children in elementary school. (B) Elementary school setting. (C) Children with signs of demineralization. (D) Variety of fluoride varnish products.

LIST OF CONTRIBUTORS

Kim Attanasi RDH, MS, PhD
Adjunct Clinical Associate Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Shirley S. Birenz, RDH, MS, FAADH
Clinical Assistant Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Marija L. Cahoon, RDH, MS
Adjunct Clinical Instructor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Stephanie E. Cruz, DMD
Former Postgraduate Student
Diplomate, American Board of Periodontology
New York University College of Dentistry
New York, NY, USA

Edgard S. El Chaar, DDS, MS
Clinical Associate Professor
Director, Advanced Education Program in Periodontics
Diplomate, American Board of Periodontology
New York University College of Dentistry
New York, NY, USA

Debra Ferraiolo, DMD, FAGD
Clinical Assistant Professor
Department of Oral and Maxillofacial Pathology,
Radiology and Medicine
New York University College of Dentistry
New York, NY, USA

Winnie Furnari, MS, RDH
Adjunct Clinical Professor, Former Clinical Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Holly S. Harper, RDH, CDA, MEd
Faculty Chair, Dental Programs
Rio Salado College
Tempe, AZ, USA

Rosemary D. Hays, RDH, MS
Clinical Associate Professor
Coordinator, Bachelor of Science Program
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Cynthia J. Howard, RDH, MS, CCRC
Adjunct Clinical Assistant Professor
Dental Hygienist
Certified Clinical Research Coordinator
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Sarah Yoon Kang, RDH, MEd
Former Clinical Instructor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Analia Veitz‐Keenan, DDS
Clinical Associate Professor
Department of Oral and Maxillofacial Pathology,
Radiology and Medicine
New York University College of Dentistry
New York, NY, USA

Kellie R. Kennedy, RDH, MA
Clinical Assistant Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Lorilei Kirby, BSDHE, RDH
Clinical Assistant Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Judith Kreismann, RDH, MA
Adjunct Clinical Associate Professor
Former Clinical Associate Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Ronald J. Lehane, DDS, MS
Clinical Assistant Professor
Diplomate, American Board of Periodontology
Department of Periodontology and Implant Dentistry
New York University College of Dentistry
New York, NY, USA

Angelita L. Leon, RDH, MS
Clinical Instructor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Eva M. Lupovici, RDH, MS
Adjunct Clinical Professor
Former Clinical Associate Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Joan A. Phelan, DDS
Former Professor and Chair
Department of Oral and Maxillofacial Pathology,
Radiology and Medicine
New York University College of Dentistry
New York, NY, USA

Miriam R. Robbins, DDS, MS, FACD
Chair, Department of Dental Medicine
New York University Winthrop Hospital
Mineola, NY, USA

Dianne L. Sefo, RDH, MEd
Clinical Associate Professor
Pre‐Clinical Coordinator
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Stuart L. Segelnick, DDS, MS
Diplomate, American Board of Periodontology
Diplomate, International Congress of Oral Implantologists
Adjunct Clinical Professor
Department of Periodontology and Implant Dentistry
New York University College of Dentistry
New York, NY, USA

Silvia Spivakovsky, DDS
Clinical Associate Professor
Department of Oral and Maxillofacial Pathology,
Radiology and Medicine
New York University College of Dentistry
New York, NY, USA

Lisa B. Stefanou, RDH, BS, MPH
Clinical Associate Professor, Associate Director
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Mea A. Weinberg, DMD, MSD, RPh
Clinical Professor
Diplomate, American Board of Periodontology
Department of Periodontology and Implant Dentistry
New York University College of Dentistry
New York, NY, USA

Cheryl M. Westphal Theile, EdD, RDH
Clinical Professor
Associate Dean for Allied Dental Programs
Director, Dental Hygiene
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Stefania Moglia Willis, DMH, RDH
Clinical Associate Professor
Dental Hygiene Programs
New York University College of Dentistry
New York, NY, USA

Mark S. Wolff, DDS, PhD
Former Professor and Chair
Department of Cariology and Comprehensive Care
Former Associate Dean for Pre‐Doctoral Education
New York University College of Dentistry
New York, NY, USA

Aaron E. Yancoskie, DDS
Associate Professor of Dentistry
Diplomate, American Board of Oral and Maxillofacial Pathology
Director of Pathology
Touro College of Dental Medicine at New York Medical College
Hawthorne, NY, USA

Yung Cheng Paul Yu, DDS
Clinical Assistant Professor
Department of Periodontology and Implant Dentistry
New York University College of Dentistry
New York, NY, USA

Clinical Cases Series

Clinical Cases in Dental Hygiene

LIST OF CONTRIBUTORS

PREFACE

1
Patient Examination