Meet Kay
Background
Kay is a 33 year old Caucasian women who moved to California from Washington about 5 years ago. She is an established patient who is usually very friendly and outgoing. She enjoys reading, snowboarding, running, and knitting. She considers herself a healthy individual and was devastated when she was recently diagnosed with Multiple Sclerosis.
Physical Assessment
Kay frequently experiences fatigue, vertigo and weakness after participating in activities that do not require much energy. More recently she has noticed that her memory is not as strong as it once was and that she has experienced visual impairment that has progressively been worsening. She recently had to give up knitting due to impaired mobility in her arm and shoulder and has noticed that she is not able to control bladder and bowel function like she should be able to.
Mental Assessment
Kay who is usually very open, talkative, and bubbly seems much less talkative and withdrawn. Though, Kay seems to be trying to have a positive outlook on her recently diagnosed condition, it is obvious that she is depressed, irritable, embarrassed and tired.
Social Assessment
She mentions that she has a great support system between family and friend, but since diagnosis, she tends to find herself wanting to stay home in bed with her dog, because she is embarrassed that she will have issues controlling her bladder when she is out with friends.
Medical Assessment
Upon diagnosis she was prescribed oral prednisone which she took for about 2 months, but could no longer take due to gastrointestinal problems in response to the medication. She is currently taking Glatiramer to help block immune system attacks on the myelin surrounding her nerve axons and Betaseron which helps to slow the rate at which symptoms worsen over time. Kay states that the medications help with her MS, but they make her feel awful most of the time.
Dental History
Kay has excellent at-home oral care. She has a small occlusal composite fillings on #3 and #18, and veneers from #6-#11.
Extra-oral & Intra-oral Exam
Extra-orally the patient's face and neck are clear and smooth, generalized macules, and lymph nodes were non-palpable.
Intra-orally xerostomia is evident due to interferon Betaseron medication. The salivary glands are slightly enlarged. It looks as if she has the start of oral candidiasis also from medications being taken.
Communication
Q: "what medications are you currently taking for control of your MS?"
A: "interferon betaseron and Glatiramer"
> We would want to make sure to thoroughly discuss at-home oral care instructions despite that the patient already has great at-home practices and make sure that she understands the effects her medications can have on her oral health.
> We would want to offer her pamphlets as needed.
> We would advise frequent professional care appointments to reduce oral infection and prevent exacerbation of the disease. It would also be important to inform the patient that see may see a decrease in her at-home care due to the impaired movement she is experiencing in her arm and shoulder.
>Inform her that it is best to keep the temperature in her home cool, so that she doesn't risk exacerbation or flare ups from arising.
Appointment Planning
It would be best to see Kay for short early morning appointments, because this is when she will be least fatigued. We would want to see her on 4 month re-care appointments to monitor and minimize oral infections. We want the environment in the office to be cool in temperature, calm, comfortable, and relaxing to reduce stress. Scheduling will be arranged to included bathroom breaks as needed.
Client Positioning
Kay states that it is most comfortable for her to be in a semi-supine position with the use of a bite block.
Dental Hygiene Procedures
If the patient is experiencing a relapse, elective procedures will not be done. If emergency care is needed, the patient can be seen, but a consultation with her physician may be needed.
Safety Precautions
Nitrous oxide will not be administrated, because patient is unable to express if she can feel numbness or tingling.
OHI
>Biotene is being recommended to help with xerostomia
>Xylitol products
>alcohol free mouth rinses with fluoride
>Oral-B electric toothbrush being recommended due to auscultation and vibration movement due to limited dexterity in dominant arm in order to help with at-home care
>Patient is already using traditional floss, also recommended floss holders in case limited dexterity becomes an issue
Personal Reflection
I chose to discuss Multiple Sclerosis for this case study, because I honestly had no idea what the disease was. I have heard commercials on TV about MS, but never fully understood what it was or how it worked. Upon learning it in Special Needs, I was shocked at the devastation and impact it has on an individuals life. I feel that it is very important to be knowledgeable about this condition in order to help our patients that we see who have or will develop MS during our career as Dental Hygienists.
Additional Information
Photos from Google images
Video from Youtube
Kay is a 33 year old Caucasian women who moved to California from Washington about 5 years ago. She is an established patient who is usually very friendly and outgoing. She enjoys reading, snowboarding, running, and knitting. She considers herself a healthy individual and was devastated when she was recently diagnosed with Multiple Sclerosis.
Physical Assessment
Kay frequently experiences fatigue, vertigo and weakness after participating in activities that do not require much energy. More recently she has noticed that her memory is not as strong as it once was and that she has experienced visual impairment that has progressively been worsening. She recently had to give up knitting due to impaired mobility in her arm and shoulder and has noticed that she is not able to control bladder and bowel function like she should be able to.
Mental Assessment
Kay who is usually very open, talkative, and bubbly seems much less talkative and withdrawn. Though, Kay seems to be trying to have a positive outlook on her recently diagnosed condition, it is obvious that she is depressed, irritable, embarrassed and tired.
Social Assessment
She mentions that she has a great support system between family and friend, but since diagnosis, she tends to find herself wanting to stay home in bed with her dog, because she is embarrassed that she will have issues controlling her bladder when she is out with friends.
Medical Assessment
Upon diagnosis she was prescribed oral prednisone which she took for about 2 months, but could no longer take due to gastrointestinal problems in response to the medication. She is currently taking Glatiramer to help block immune system attacks on the myelin surrounding her nerve axons and Betaseron which helps to slow the rate at which symptoms worsen over time. Kay states that the medications help with her MS, but they make her feel awful most of the time.
Dental History
Kay has excellent at-home oral care. She has a small occlusal composite fillings on #3 and #18, and veneers from #6-#11.
Extra-oral & Intra-oral Exam
Extra-orally the patient's face and neck are clear and smooth, generalized macules, and lymph nodes were non-palpable.
Intra-orally xerostomia is evident due to interferon Betaseron medication. The salivary glands are slightly enlarged. It looks as if she has the start of oral candidiasis also from medications being taken.
Communication
Q: "what medications are you currently taking for control of your MS?"
A: "interferon betaseron and Glatiramer"
> We would want to make sure to thoroughly discuss at-home oral care instructions despite that the patient already has great at-home practices and make sure that she understands the effects her medications can have on her oral health.
> We would want to offer her pamphlets as needed.
> We would advise frequent professional care appointments to reduce oral infection and prevent exacerbation of the disease. It would also be important to inform the patient that see may see a decrease in her at-home care due to the impaired movement she is experiencing in her arm and shoulder.
>Inform her that it is best to keep the temperature in her home cool, so that she doesn't risk exacerbation or flare ups from arising.
Appointment Planning
It would be best to see Kay for short early morning appointments, because this is when she will be least fatigued. We would want to see her on 4 month re-care appointments to monitor and minimize oral infections. We want the environment in the office to be cool in temperature, calm, comfortable, and relaxing to reduce stress. Scheduling will be arranged to included bathroom breaks as needed.
Client Positioning
Kay states that it is most comfortable for her to be in a semi-supine position with the use of a bite block.
Dental Hygiene Procedures
If the patient is experiencing a relapse, elective procedures will not be done. If emergency care is needed, the patient can be seen, but a consultation with her physician may be needed.
Safety Precautions
Nitrous oxide will not be administrated, because patient is unable to express if she can feel numbness or tingling.
OHI
>Biotene is being recommended to help with xerostomia
>Xylitol products
>alcohol free mouth rinses with fluoride
>Oral-B electric toothbrush being recommended due to auscultation and vibration movement due to limited dexterity in dominant arm in order to help with at-home care
>Patient is already using traditional floss, also recommended floss holders in case limited dexterity becomes an issue
Personal Reflection
I chose to discuss Multiple Sclerosis for this case study, because I honestly had no idea what the disease was. I have heard commercials on TV about MS, but never fully understood what it was or how it worked. Upon learning it in Special Needs, I was shocked at the devastation and impact it has on an individuals life. I feel that it is very important to be knowledgeable about this condition in order to help our patients that we see who have or will develop MS during our career as Dental Hygienists.
Additional Information
Photos from Google images
Video from Youtube