Periodontology (DHYG 1311)

Fall, 2017
PERIODONTAL CARE PLAN

Patient Name: Age: 45

Date of initial exam: 10-17-17 Date completed: 12-1-17

1. Medical History: (systemic conditions altering treatment, pre-medication, medical clearance) explain steps to
be taken to minimize or avoid occurrence, effect on dental hygiene diagnosis and/or care.

Overall, patient is in good health and his last physical was in October of 2015. He does have high blood pressure
and is prescribed Lisinopril. He has had his wisdom teeth removed in 1990, a vasectomy in 2002, and knee
surgery in 2011. All of which do not need premedication for treatment. He is a smoker of 20 years using about 1
pack a day. He drinks alcoholic beverages weekly. His teeth are sensitive to hot, cold, sweets, and pressure and he
also clenches. His blood pressure reading today was 130/88 which is considered pre hypertension. His vitals were
within normal limits. Smoking can be a contributing factor to periodontal disease and also alcohol can contribute
to decay. Clenching can lead to damage to the periodontium, tooth damage, and TMJ pain.

Lisinopril- treatment of mild to moderate hypertension. Possible side effects are headache, dizziness, and postural
hypotension. It is contraindicated with history of angioedema from previous treatment with ACE inhibitors.
Patient may have drug interactions with increased hypotension, alcohol phenothiazine, and decreased
hypotensive effects: indomethacin and possibly other NSAIDS. For dental considerations I need to monitor
vitals, sit patient upright for two minutes to avoid orthostatic hypotension, be aware of infection, bleeding, and
poor healing, assess salivary flow, limit sodium use, and use vasoconstrictors with caution.

For this medication, I must be very aware of his blood pressure at every appointment and make sure he feels
comfortable. I need to assess salivary flow at every appointment because xerostomia could lead to decay,
periodontal disease, and candidiasis. This medication could be a cause of periodontal disease due to delayed
healing and poor salivary flow. If anesthesia is needed, I will communicate with the dentist to use
vasoconstrictors with caution.

2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief complaint, present
oral hygiene habits, effect on dental hygiene diagnosis and/or care)

Patient’s teeth do not bleed when he brushes and flosses. He brushes once a day and flosses sometimes, about
once every 2 months. He does not use any mouth rinse. Patient’s teeth are very sensitive to hot, cold, sweets, and
pressure and this could be due to his grinding and root exposure. His salivary flow is normal. I will teach my
patient the importance of brushing twice daily and flossing at least once a day to prevent plaque buildup from
turning into calculus. I will also teach him the use of fluoride to help protect his teeth and to help with sensitivity.
I will also teach my patient that roots are more prone to decay and sensitivity. He clenches and grinds which can
cause damage to the teeth, periodontium and also TMJ.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
Patient shows visible lamina dura which is a sign that he clenches his teeth. He stated that he clenches
and grinds but he no longer wears his night guard because it does not fit properly. The occlusal
examination shows overbite, overjet, and molar/canine placement are within normal limits. I noted that
tooth #7 and #26 are cusp to cusp which can cause an attrition issue. Grinding unknowingly can cause
excessive forces on the teeth and to the periodontium. The architecture of his tissues is scalloped with a
generalized red color. The consistency overall is edematous and spongy. The margins are rolled on tooth
#5, 6, 7, 11, 12, 26-29 facially and mandibular and maxillary lingual. The papilla is slightly bulbous on
tooth #4-5, 22-26 facially. There is no suppuration present. The surface texture of the papillary and
marginal gingiva is smooth and shiny and the attached gingiva is stippled. The radiographic findings
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Periodontology (DHYG 1311)
Fall, 2017
show generalized moderate bone loss and localized severe bone loss on the mesial of tooth #14. There is
also localized vertical bone loss between tooth #3-4, 4-5. There is radiographic furcation involvement
between teeth #3, 15, 18, 19, 30. There is a foreign object in the gingiva between #13 and 14 that could
be causing inflammation. There is also a suspicious area on the distal of #15. Dental charting shows
generalized major attrition on the maxillary and mandibular anterior teeth as a result from grinding.
There are localized 4 mm pockets on tooth #2, 12, 14 facials #2, 12 lingual, #6, 7, 19 facials and #4
lingual. There are 5 mm pockets located on tooth #3 facial, #11 and 14 lingual, #3 facial and #2, 3 and
20 lingual. There is one 6mm pocket on #3 lingual. There are 7mm pockets on #6 and 15 facial and #6,
15 lingual. There is 1mm recession on the lingual of #4, 5, 23, and 26. There is 2 mm recession on #13,
15, 19, 24, 25 lingual, and #18 and 20 facial. There is 3 mm recession on #2, 4, 6, 13, 14, 31, 20 facial
and # 2, 3, and 14 lingual. There is 4mm recession on #5 and 28 facial. There is 5mm recession on # 12
and 28 facial. Recession indicates bone loss which is periodontitis. He is a prophy class seven which
means he has extensive, residual calculus built up on his teeth. Calculus can lead to plaque biofilm
retention which is difficult or impossible for a patient to remove and also lead to inflammation of the
gingiva. It is difficult to bring periodontitis under control with the presence of calculus. He is a
periodontal case four due to the severe bone loss around tooth #14. This patient is a possible candidate
for sealants.

4. Periodontal Examination: (color, contour, texture, consistency, etc.)

a. Case Classification: prophy 7 Periodontal Case Type: 4

b. Gingival Description: generalized papillary and marginal gingival inflammation

Appointment Overview-See full Journal Notes on Page 6

App't 1:
 Review medical/dental history
Pre-rinse
Vertical bitewings to assess bone level
Intraoral pictures to compare to final appointment
Periodontal assessment
Head and neck/ intra oral examination
Dental charting with radiographs
Plaque score (3.1 fair)
Bleeding score (2%)
Home care routine
Patient education

App't 2:
 Update medical/dental history
 Pre-rinse
 Plaque score (3.1 fair)
 Bleeding score (0%)
 Local anesthetic
 Ultrasonic mandibular right quadrant
 Fine scale mandibular right quadrant
 Full periodontal chart mandibular right quadrant
 Patient education
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Periodontology (DHYG 1311)
Fall, 2017

App't 3:
 Update medical/dental history
 Pre rinse
 Plaque score (3.1 fair)
 Bleeding score (0%)
 Patient education session #1- LTG, STG, plaque and brushing
 Local anesthetic
 Ultrasonic mandibular left
 Fine scale mandibular left
 Full periodontal charting mandibular left

App't 4:
 Update medical/dental history
 Pre rinse
 Plaque score (1.5 good)
 Bleeding score (0%)
 Patient education session 2- review, periodontal disease, flossing
 Local anesthetic
 Ultrasonic, fine scale, full periodontal chart maxillary right
 Ultrasonic, fine scale, full periodontal chart maxillary left
 Fluoride varnish 5%
 Prescription- Prevident Boost

App't 5:
 Update medical/dental history
 Pre-rinse
 Plaque score (1.1 good)
 Bleeding score (0%)
 Patient education session 3- review, fluoride and oral cancer exam
 Post calculus scale
 Post calculus full periodontal charting
 Plaque free
 Arestin
 Fluoride varnish 5%

c. Plaque Index: App’t 1: 3.1 (fair) 2: 3.1 (fair) 3: 3.1 (fair) 4: 1.5 (good) 5: 1.1 (good)

d.Gingival Index: Initial: 1 (fair) Final .125 (good)

e. Bleeding Index: App’t 1: 2% 2: 0% 3: 0% 4: 0% 5: 0%

f. Evaluation of Indices:
1. Initial
Plaque score is fair and gingival index is good. The plaque score will be used to compare the baseline date

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Periodontology (DHYG 1311)
Fall, 2017
to the final date to hopefully see improvement. The gingival index assess the severity of his gingivitis
based on color, consistency, and bleeding on probing. The patient had generalized inflammation with
minimal bleeding. The reduced bleeding could be a cause of smoking. If the inflammation continues,
this could lead to attachment loss or periodontitis. Also, a high plaque score is an indicator of bacteria
present, which is another precursor of attachment loss or periodontitis.

2. Final
My patient definitely has had improvement in his plaque, bleeding, and gingival indices. His plaque score
lowered by 2 points from his first appointment and his last. He demonstrated proper brushing and
flossing so he is becoming more active with his home care and it is evident. His gingiva was scalloped
and normal in color except it was just slightly still inflamed on the mandibular anterior facials. He is
only brushing once daily still but he said he is trying to get on a normal routine since he works shift
work. He does use fluoride in his rinse and paste now which is an improvement. His gingival index
improved to a .125 which is great. His bleeding score remained 0% throughout his treatment, which
most likely is due to decreased blood vessels from smoking.

g. Periodontal Chart: (Record Baseline and First Re-evaluation data)

1. Baseline (10-17-17)
There are localized 4 mm pockets on tooth #2, 12, 14 facials #2, 12 lingual, #6, 7, 19 facials and
#4 lingual. There are 5 mm pockets located on tooth #3 facial, #11 and 14 lingual, #3 facial and
#2, 3 and 20 lingual. There is one 6mm pocket on #3 lingual. There are 7mm pockets on #6 and
15 facial and #6, 15 lingual. There is 1mm recession on the lingual of #4, 5, 23, and 26. There
is 2 mm recession on #13, 15, 19, 24, 25 lingual, and #18 and 20 facial. There is 3 mm
recession on #2, 4, 6, 13, 14, 31, 20 facial and # 2, 3, and 14 lingual. There is 4mm recession on
#5 and 28 facial. There is 5mm recession on # 12 and 28 facial. Once his inflammation recedes
and the calculus is removed, I hope to find smaller pockets. His recession could be from a
series of factors like horizontal brushing, inadequate dental cleanings and buildup of plaque,
clenching and grinding, and smoking. Bleeding was slight but this could also be due to
smoking. The pockets present show an already loss of attachment and if we don’t clean the
bacteria up it could lead to further attachment loss, or even tooth loss.

2. First evaluation (12-1-17)

There are 4mm pockets localized to teeth #2, 5, 7, 8, 11-14, 18, 19, 23, and 26 facial and # 2, 3, 6, 14, 18-
20, 22, 29, and 30 lingual. There are 5 mm pockets localized to teeth #2, 14, and 30 facial and # 13, 31
lingual. There are 6 mm pockets localized to tooth #3 facial and #3 lingual. There is a 7mm pocket #15
facial and lingual. There is an 8mm pocket on #3 facially. There is generalized recession ranging from 1 to
3mm throughout. There was not a significant reduction of pocket depths, but there was a significant change
is color so I know his oral health did improve some. The pocket depths measured at the first appointment
could have been misread due to calculus so the final pocket depths are probably more accurate. Arestin was
placed in any pockets that are 5mm or greater to try to kill the bacteria that is deep down in there where an
instrument cannot reach.

5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions)
He has attrition throughout on mainly the maxillary and mandibular anterior teeth due to clenching and grinding.
These habits can exert excessive forces on the teeth and the periodontium. Occlusal examination for molar
and canine are class 1 and midline is 2 mm to the right. Numbers 7 and 26 are cusp to cusp which can cause
wear on both teeth. He is missing all four 3rd molars. He has one suspicious area on distal of #15 and if not
taken care of, he could potentially lose that tooth or need a root canal.

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Periodontology (DHYG 1311)
Fall, 2017

6. Treatment Plan: (Include assessment of patient needs and education plan)

LTG 1: Bring plaque score down to a .1 or less by the final appointment
STG: Define plaque by end of appointment
STG: Demonstrate brushing by end of appointment
STG: Lower plaque score by .5 at each appointment

LTG 2: Halt periodontitis and its progression by final appointment and reduce bleeding score to 0 by
final appointment.
STG: define periodontitis by the end of appointment
STG: define and demonstrate proper flossing technique by end of appointment
STG: floss once a day

LTG 3: daily use of fluoride

STG: define fluoride and its benefits by end of appointment
STG: educate on using fluoride daily especially with the added effects of smoking
STG: use fluoride daily by final appt. and learn oral cancer exam

App’t 1:
At the first appointment, I will take a new plaque and bleeding score and also a gingival assessment. I
will start with the ultrasonic on the mandibular right. Patient will most likely need local anesthesia.
After I ultrasonic I will full perio chart that quadrant and then get checked by and instructor. After that, I
will fine scale to remove any remaining calculus. We will also have our first patient education session
over plaque. Our long term goal of this session is to reduce his plaque score to a .1 or less by the final
appointment date. Our short term goals will be to define plaque, learn brushing technique, and
demonstrate proper brushing on himself and also the typodont. I will teach my patient that plaque is a
sticky white film that is made up of bacteria and debris. I will teach my patient that plaque can cause
demineralization which can cause decay, gingivitis, and possible periodontitis. My patient will learn that
correct brushing consists of holding the brush at a 45 degree angle and brushing softly in a small
circular motion. We will end patient education by watching the patient brush his teeth properly at the
sink with disclosing solution applied.

App't 2:
At the second appointment I will take a new plaque and bleeding score and also a gingival assessment. I
will ultrasonic mandibular left and then full perio chart. After I get checked I will remove the remaining
calculus I missed. Our second patient education session will be over periodontitis. Before we learn
about periodontitis, we will review plaque and brushing. Our long term goal for this session is to halt
the disease and its progression. I will explain that periodontitis is bone loss caused by tissue destruction
and bone migration away from bacteria that is present for a long period of time. I will educate my
patient about how periodontitis is irreversible but it can be halted. I will teach my patient proper
flossing and then he will demonstrate on himself and also the typodont. My goal for him is to reduce his
bleeding score to 0.

App't 3:
At the third appointment, I will take a plaque and bleeding score and also gingival assessment. I will
ultrasonic the entire maxillary this appointment then do a full perio chart. The patient cannot return any
sooner to separate the maxillary quadrants. After ultrasonic and full perio chart, I will fine scale the
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Periodontology (DHYG 1311)
Fall, 2017
remaining calculus. The third patient education session will be over fluoride and smoking. First, we will
review plaque and brushing, and periodontitis and flossing. Our long term goal for this session will be
to use fluoride daily. I will explain that fluoride is a chemical compound added to water, toothpaste and
mouth rinse and it helps remineralize tooth surfaces and strengthens the enamel. Fluoride also helps
with sensitivity on recession and to protect those exposed roots because they are more prone to decay
and sensitivity. I will also talk about the effect of smoking and how it contributes to bone loss. If patient
is willing, we will plan to slowly quit smoking by the recall date next semester. My goal for my patient
is to use daily fluoride by our final appointment.

App't 4:
This will be the patent’s final appointment two weeks after scaling. I will take a final plaque and
bleeding score and a final gingival assessment. I will do a final full periodontal charting to compare to
my baseline findings. I will reinforce all our patient education sessions and answer any questions he
may have. I will acknowledge all the areas he has improved in. I will polish and plaque free and finish
with a fluoride varnish. I will place arestin at this appointment and place patient on a three month recall.

7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony crests,
thickened lamina dura, calculus, and root resorption)
Third molars are missing (removed). He has generalized moderate horizontal bone loss and severe
localized bone loss on #14. He also has localized vertical moderate bone loss between #3-4 and 4-5.
He has furcation involvement on #3, 15, 18, 19, and 30. There is a foreign object located in the
gingiva between #13-14. Calculus is visible throughout. There is a suspicious area on the distal of
#15. He is already at risk of losing teeth because of his moderate bone loss and furcation
involvement, so he must halt this disease and begin good home care in order to keep his remaining
teeth for as long as possible.

8. Journal Notes: (Record in detail the treatment provided, oral hygiene education, patient response,
complications, improvements, diet recommendations, learning level, progress towards short and long term
goals, expectations, etc.) The progress notes should be written by appointment date.

The first appointment today on October 17, 2017 was to gather all the information I could about my
patient’s periodontal disease. I began with reviewing his medical and dental history to make sure
there were no changes in his health. I took vertical bitewings to assess his bone level which was
generalized horizontal moderate bone loss with one area of severe bone loss on tooth #14. There is
visible calculus on his radiographs and also furcation involvement on tooth #3, 15, 18, 19, and 30. I
also took intraoral pictures to use for patient education to show plaque, calculus, recession, and
stain. There were no extra and intra oral findings that pose a risk to his periodontal disease. My
patient does clench and grind due to stress, but his night guard no longer fits so I recommended he
get it fixed. His gingiva was scalloped, generalized red and edematous and spongy. He has
generalized recession ranging from 1mm to 5mm. He does have pockets ranging from 4 to 7mm
throughout. The pockets are a result from bone loss and also inflammation creating pseudopockets.
My patient states that he does not go to the dentist because he is so sensitive, which explains his
heavy buildup of calculus. Once my patient is free of calculus, I will reevaluate to see if any pockets
have shrunk. Being a heavy smoker, his bleeding score was only 2%. I explained to my patient that
he has reduced bleeding from smoking because smoking causes restriction of blood vessels in the
tissue. His plaque score was 3.1 which is fair. He uses a soft toothbrush but brushes horizontally
which can cause wear to the teeth. He only brushes once a day and flosses about every two months.
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Periodontology (DHYG 1311)
Fall, 2017
He does use sensodyne toothpaste for his very sensitive teeth. I plan to educate my patient about
proper brushing and flossing and also use of fluoride. We talked briefly today about what calculus
and recession means, but I plan to teach more about each in our patient education sessions. Smoking
is also a huge contributing factor to his disease. We must halt his disease before it could lead to loss
of teeth. I taught my patient the reason for his sensitivity is because of his exposed root surfaces
which present open tubules that are sensitive to stimuli such as cold, hot, sweets, and pressure, and
also because of the bacteria hidden under his gums leading to inflammation and pain. My patient
was attentive listening about some of his complications, but he’s still weary of getting a cleaning
because of his painful past events at his dental office.

The second appointment was on October 19, 2017. I updated the patient’s medical and dental history
and pre-rinsed to reduce the microbes in the mouth. His plaque score was still 3.1 which is fair and his
bleeding score was 0%. Before I began with the ultrasonic, Dr. Wiggins injected two carpules of
Lidocaine 2% with epinephrine because of sensitivity. I used the ultrasonic on the mandibular right and
then followed up with a fine scale. I full perio charted the quadrant. There were pockets ranging from 1
to 6 in this quadrant and also 1 to 2 mm of recession throughout. I explained to my patient what a
pocket is and the reason I perio chart is to measure his healing after the calculus is removed. His
gingiva was still generalized red in the quadrant but once the calculus is gone, I will record any
changes. I removed heavy stain from the lingual of the anteriors and was able to show my patient the
difference with my mirror compared to his intra oral pictures. My patient and I did not get to do the first
patient education session over plaque and brushing due to timing issues.

The third appointment was on October 25, 2017. I updated his medical and dental history and took his
vital signs. I then had him pre-rinse before the procedure. I took a plaque score which was 3.1 (fair) and
a bleeding score which was 0%. We started out with the first patient education session over plaque and
brushing. I began with reviewing all the long term and short term goals and also the patient’s personal
plaque and bleeding score thus far. My patient learned the definition of plaque and how to properly
brush on the typodont. He then practiced on himself at the mirror with disclosing solution showing the
plaque that needs to be removed. We reviewed the session and followed up with our next appointment’s
goals. My patient seemed aware about the new techniques I taught him and I hope he continues this new
routine at home. Before I began scaling, Dr. Boudreaux injected two carpules of Lidocaine 2% with
epinephrine, which was needed for extreme sensitivity. I used the ultrasonic on the mandibular left and
then fine scaled. The patient’s gingiva on the left was still generalized red but the mandibular right
quadrant had healed to a light pink/white color. The gingiva healed to a white color because of the
reduced blood vessels in this patient’s gingiva. I full perio charted the quadrant finding pockets ranging
from 1-5 mm and recession ranging from 1-3 mm.I also removed heavy stain on the anterior linguals
and showed my patient the success. During chairside, I suggested my patient start using a fluoride
mouth rinse to help with sensitivity. I didn’t go into too much detail since we will be talking about
fluoride in our last patient education session.

Today’s appointment was on November 15, 2017. We began by updating medical and dental history
and taking vital signs. After pre rinse and taking plaque and bleeding score, we did our second
patient education session. His plaque score this time was 1.5 which is good and his bleeding score
was still 0%.We first reviewed from our first session along with long term and short term goals. My
patient described to me the definition of plaque and also showed me correct brushing. I applauded
him on decreasing his plaque score and remembering what he learned from our first session. We
talked about periodontal disease, what causes it, risk factors of periodontal disease and how we need
to halt it. I showed my patient his own radiographs and the bone loss present versus where healthy

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Periodontology (DHYG 1311)
Fall, 2017
bone should be located. Along with periodontal disease, my patient learned proper flossing on the
typodont, then practiced on himself at the mirror. My patient would prefer using a floss pick so we
reviewed the proper so he will not damage his gingiva. We used disclosing solution so he could
actually see the plaque he was removing when he flossed. We reviewed what he learned and
previewed our topic for next session. Back at the chair, Dr. German injected two carpules of
Septocaine before using the ultrasonic on maxillary right. After ultrasonic, I full perio charted and
finished up with a fine scale. Pocket depths ranged from 1 to 6mm and recession ranged from 1 to 4
mm. Dr. German then came back to inject two and a half carpules of Septocaine to ultrasonic
maxillary left. I full perio charted and finished with a fine scale. Pocket depths ranged from 1 to 6
and recession ranged from 1 to 4 mm. The gingiva on the mandibular quadrants had healed nicely to
a whitish pink color. But, the stain was starting to form again. I will need to ultrasonic and polish
the stain off at his final appointment. The maxillary gingiva was generalized red and it had slightly
more bleeding during cleaning than the mandibular did. My patient did actually purchase a fluoride
mouth rinse that he had been using once a day, which is great. He is becoming aware and using
action to try to halt his problems. Dr. Mendoza and I applied a fluoride varnish 5% at this
appointment to help with sensitivity and it will also be applied again at his final appointment. My
patient learned the benefits and post instructions of fluoride varnish. Dr. German prescribed a
toothpaste called Prevident 5000 Boost for him to use once a day, right before he goes to bed
without rinsing it off. My patient will return next for his final reevaluation appointment.

Today was the final appointment on December 1, 2017. We reviewed medical and dental history and
pre-rinsed before we began. I took a final plaque score which was 1.1 (good) and a final bleeding
score which was still 0%. We did our final and third patient education session first. We reviewed
plaque, brushing, flossing, and periodontal disease. Our session today was over fluoride use and its
benefits. I also showed my patient a self-oral cancer exam along with examples of pictures of oral
cancer he can be aware of. He actually has been using a mouth rinse with fluoride and also his
prescription paste that contains fluoride since his last appointment. We reviewed his progression of
his first plaque score which was 3.1 to his plaque score today which was 1.1 and I applauded his
success. Even though we didn’t get his plaque score below .1, he still made great improvements. We
ended the session reviewing his long term and short term goals. After that, I post calculus scaled and
full periodontal charted to compare to my baseline findings. Then plaque free and Arestin was
placed between #2 and 3, #14 and 14, #12 lingual, and #30 and 31. I explained to my patient that the
Arestin will help kill the bacteria down deep in the pockets where I couldn’t get my instrument and
hopefully the pockets will shrink up. His gingiva looked great except it was slightly red on the
mandibular anterior facials. He did continue to build up stain but polishing removed it. I applied
fluoride varnish 5% to help with sensitivity and to help remineralize. My patient was very attentive
with his patient education and he became involved to try to help his sensitivity. He also started
flossing more than he did before he started treatment so we are just taking baby steps towards
success. Overall, this treatment was much needed and with my patient’s knowledge now, I think he
can halt periodontitis.

9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth morphology,
periodontal examination, recare availability)
My patient has a positive attitude in learning about his oral health but he still needs to be more proactive
at home. He is 46 years old and has 27 natural teeth, with his third molars removed and his maxillary
lateral congenitally missing. He does have restorative work but he has not lost any teeth due to
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Periodontology (DHYG 1311)
Fall, 2017
periodontitis. He is only brushing once daily, so he needs to improve to twice daily for better
involvement. He did begin flossing more with a floss aid pick which is good. Some flossing is better
than none. My patient began using fluoride which will help his teeth be less sensitive and he also won’t
be so sensitive for his next cleaning. He does not have any malocclusion issues. He does have severe
attrition on basically every tooth, so I stressed to him about getting his night guard fixed. I am placing
my patient on a three month recall in order to maintain his oral health and try to prevent his
periodontitis from progressing. With the addition of smoking around one pack of cigarettes daily, his
prognosis will be considered poor. If by next recall appointment he has ceased smoking, his prognosis
would be considered good because he has no systemic issues.

10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule. (Note:
Include date of recall appointment below.)
I suggested to my patient to start using fluoride mouth rinse daily, along with his prescription tooth
paste (Prevident 5000 Boost) once daily at night. I suggested he start trying to brush twice daily and
also try to floss a little more every week so that way he can reach the goal of once daily. I set my
patients next appointment for March of 2018. He has a referral for a suspicious area on the distal of #15
that I recommended he get taken care of. If my patient does not comply with his home care routine, his
periodontal disease progression is inevitable.

11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing depths)
We have seen great change in the color and consistency of his gingiva. We did not reach our goal of
reducing plaque score to a .1 but it did continue to decrease at each appointment. His bleeding score
remained 0% for every appointment which was great because that shows no sign of inflammation. He
does have altered bleeding due to smoking. Probing depths ranged from 1-8mm so there was really only
slight improvement. Once he gets on a routine cleaning, along with continuing his home care, I really
think his pockets will lessen. A new evaluation will be conducted at his recall appointment in March
2018.
12. Patient Attitudes and Cooperation:

My patient is attentive with new information and also active applying his techniques and advice at
home, such as with using fluoride and flossing more. He is willing to listen and knows the answer to all
the review questions I ask him but he just needs to work harder on applying his home care more
routinely. I think we reached our goals, maybe not completely, but made huge improvements.

13. Personal Evaluation/Reaction to Experience:

My patient spent around 20 hours in the chair, which really shows me how much goes into quality
treatment. Although, long hours are not practical in private practice, this care plan helped me to better
understand the steps in thorough treatment. I became more aware of my patient’s likes and dislikes, and
also concerns from his point of view. I became more knowledgeable in periodontal charting and also
using the ultrasonic. This project helped me experience treating someone with severe sensitivity and
also severe periodontitis, which is very hard work and will benefit me for future patients.

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Periodontology (DHYG 1311)
Fall, 2017

GINGIVAL INDEX
PERIODONTAL CARE PLAN

Initial date 10-17-17

Gingival Area

M F D L

3 1 1 1 1

9 1 1 1 1

12 1 1 1 1

19 1 1 1 1

25 1 1 1 1

28 1 1 1 1

TOTAL 1 (fair)

Final date 12-01-17

Gingival Area

M F D L

3 0 0 0 0

9 0 0 0 0

12 0 0 0 0

19 0 0 0 0

25 1 1 1 1

28 0 0 0 0

TOTAL .125 (good)

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