Client Analysis

Client #13 proved to be a difficult case from start to finish. I met this client in a class that we took together in the spring/summer term and asked her to be my client as I was in dire need to fill appointments. This client is a “healthy” 50-year-old women who recently moved to the Niagara region and does not receive regular medical or dental care. She had a clear medical history and does not take any prescription or over-the-counter medications. Her last dental appointment of any sort was a cleaning in January of 2019 – making this her first cleaning in three and a half years.

Although this client was considered medically healthy, she presented with high blood pressure upon taking her vitals at almost every appointment. Each time this happened, I would send her home with a medical consult which advised her to see a doctor about this. When she returned for care, I would ask if she looked in it and she replied “no” each time. Upon first glance in her mouth, everything looked okay clinically, aside from dark calculus buildup on her lower anterior linguals. When Dr. Filice prescribed 4 bitewing’s and 2 periapicals, I discovered extensive bone loss and heavy chunks of subgingival calculus. Her indices were as follows: BI’s of 1-2, GI’s of 2-3, and CI’s of 2-3 with very tenacious subgingival/interproximal calculus and bulbous inflammation around areas of heavy calculus buildup. Her periodontal exam revealed PPD’s of 4-6 and CALs of 4-5 with extensive bleeding upon probing making her a periodontitis client. All things considered, this client’s classification was identified as a 4-3, making her my most difficult client that I have seen thus far.

My first struggle with this client was that she was a friend to me which made it difficult for me to convey the seriousness of her oral health and overall health condition without sugar-coating it. This client is in school to become a nurse and knows about hypertension and its seriousness, however, when I presented the findings of her high blood pressure at several appointments, she did not seem to think it was an issue that needed to be addressed. Although I followed all the protocols for high blood pressure, I wish I had more conversations with this client about what is setting her back from seeing a doctor. I think that if I was able to have this serious conversation, I may have been able to allow her to reflect on her own thoughts/opinions and possibly see a doctor of this potentially threatening condition. Oral health and physical health are commonly a bi-directional relationship, and I feel as though I should have done more to guide this client to better overall health. Additionally, during oral hygiene coaching (OHC), I know that this needed a lot of attention from my client as her former knowledge and oral hygiene routine were severely deficient. During each OHC session, I could tell that my client was not completely present as she saw me as a friend rather than a clinician. It was difficult to set this boundary but allowed me to learn that even when I know my clients on a personal level, it is extremely important to set a boundary which allows them to see me as their clinician while in the dental chair.

My second and biggest struggle with this client was debridement. I started debridement in my first term of client care and struggled to remove tenacious calculus using hand-scalers. This coupled with the fact that her mouth was divided into 10 areas really frustrated me as I was only able to complete about 4 teeth per appointment. Fast forward to this semester, at this client’s fifth appointment, I was completing ultrasonic debridement of sextant five. Due to extensive bleeding, I found it difficult to remove the deep tenacious pieces of calculus as well as the extensive supragingival pieces on the lingual side. When I am feeling this frustration, I need to remain patient and remember that I working as hard as I can with the client’s best interest in mind. Even though I may be moving slow, I am providing this client with the highest quality of care and learning a lot about debridement while doing so.

Overall, this was a difficult client to work with in my first and second term of client care. My key takeaway from working with this client is although it was challenging, I am a better clinician because of it. This client taught me to set boundaries, be patient, and improved my use of the ultrasonic scalers. I am so proud of the care I have provided to her, and I am excited to see her oral health progress at her next continuing care appointment.