PERIODONTAL CARE PLAN

Patient Name ___________________________Age _48__

Date of initial exam___8-27-14____
Date completed__11-25-14_________________
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.
The Patient is currently under the care of a physician for type 2 diabetes. The patient is also being treated
for asthma, arthritis, and GERD/reflux. The patient has been unable to check her blood sugar due to her
glucometer breaking. The patient does take her medicine as prescribed however, without properly
controlling her diabetes it will result in periodontitis. The patient has periodontitis due to diabetes and
improper oral care. Diabetes that is not controlled can cause faster progression of periodontal disease
which results is more destruction. Diabetes also causes poor wound healing so caution must be taken not
to cause trauma along with reducing the risk of infection. The patients blood sugar should be checked
before every appointment. Short appointments are recommended to reduce risk of low blood sugar. Keep
glucose tablets on hand in case of emergency. Diabetes increases the risk for periodontal disease.
Periodontal disease can exacerbate diabetes by worsening gylcemic control. The patient has arthritis,
adjust the head rest for patient comfort. Arthritis also can cause dexterity issues, therefore, this could
cause the patient not to brush or floss accurately causing plaque formation that can link to periodontal
disease. A powered toothbrush can be recommended to help with brushing. Asthma is also a health
factor for the patient. The patient has not had an asthma attack since April 2014, however, and inhaler
should be on hand in case of an emergency. Stress reduction protocol should also be in play to reduce the
risk of an attack. GERD/reflux is also a health factor. The patient takes Nexium to control reflux. Gerd
can cause tooth erosion which lead to caries that can lead to periodontitis of not treated. The patient
should be placed in a semisupine chair position of G.I. problems occur.
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)
The patients chief complaint is cleaning. She has not had a cleaning in six years. From what I have
gathered from the patient money could possibly be an issue and she does not have dental insurance. This
could be a factor for the patient not going to the dentist in six years. She has four children two that are
grown and two who are school age. I believe that patient tends to her childrens needs before her needs.
The patient stated her brother has a lot of bone loss to the point that he cannot even use dentures. The
patient has a total of five amalgam restorations in the molar regions. Two carious lesions were also found
on the distal of #2 and distal of #15. The patient seems very willing to take care of the carious lesions.
She made the statement about pricing different dental offices to have them repaired. The patient has a
few oral habits such as grinding, clenching, mouth breathing, and cheek biting, The patient stated she has
headaches and had radiographs of her TMJ to see if that was the cause. She stated her TMJ was in good
condition. However, it seems the clenching and grinding could be the cause of her headache. She also
told the dentist #3 hurt when she bit down. He did not find a reason it was bothering her. He suggested it
could be due to clenching and grinding. The patient is unaware of proper oral hygiene and care.
Although her past oral history doesnt look pleasing she does however seem interested in repairing her
carious lesions and take proper steps in bettering her oral health. I believe since she has found an
affordable clinic for prophylaxis she will come routinely to maintain her oral health.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
The patient had two carious lesions one on the distal of #2 and one on the distal of #15. The
dentist wanted to watch #3 and #21. The patient has been informed to see a dentist to have the
lesion repaired. Untreated caries is a contributing factor that can increase the retention of plaque
which can lead to periodontitis. The patients occlusal was a class I on the right molar, right
canine, and left canine. She was a class II on the left molar. The patient shows attrition on every
tooth due to grinding and clenching. The increased pressure from her clenching and grinding has
caused bone resorption. She stated she bought a sports mouth guard but stated it was too big and
was unable to use it. She does clench during the day but stops as soon as she realizes she is
doing it. The patient also admitted to being a mouth breather which can dry out the tissues in the
anterior region of the mouth.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification ___6__ Periodontal Case Type___3___
b. Gingival Description:
App't 1:
The patients tissue was throughout the oral cavity was red in color with a edematous
consistency. The margins of the gingival were generalized rolled and the papilla appeared
blunted generalized. The architecture was scalloped generalize and the texture of the
gingival was generalized smooth and shiny. During the patients first appointment I was
unable to probe to check the patients bleeding score.
App't 2:
The patients tissue was red in color with a edematous consistency generalized throughout the
oral cavity. The margins of the gingival were rolled generalized and the papilla appeared
blunted throughout. The architecture was generalized scalloped and the texture of the
gingival was smooth and shiny generalized. The patient showed a decent amount of bleeding
upon probing and stated she had some sensitivity in the molar region. The patients bleeding
score was 11.5%.
App't 3:
The patients tissue was red in color with edematous consistency generalized throughout the
oral cavity. The margins were rolled and the papilla was blunted both generalized. The
gingiva was smooth and shiny and the architecture was scalloped both generalized. The
bleeding had been reduced to 5.5%.
App't 4:
The gingiva was red in all quadrants but did not seem as red in the maxillary left quadrant.
The molar region of the left quad seemed more red than any other area in the max left quad.
The papilla was blunted generalized. Her margins were rolled generalized but not as bad in
the maxillary left quad. The gingiva was smooth and shiny generalized and scalloped
generalized. The patients bleeding score was 5.5%.

App't 5:
The patient maxillary arch is not as red as the mandibular arch however the posterior region
of the maxillary arch is redder than the anterior region. The consistency is
edematous/spongy generalized. The papilla is blunted generalized, architecture is scalloped
generalized, and the tissue is smooth and shiny generalized. The patients bleeding score is
0%. The margins are rolled generalized however, the maxillary arch is showing more
improvement than the mandibular arch.
App't 6:
The color is red generalized especially distal to 32 and the mandibular left quad. The
margins are rolled generalized with generalized blunted papilla. The patients tissue was
smooth and shiny generalized with edematous/spongy consistency generalized. The
maxillary arch is continuing to show improvement. The mandibular arch is worse in all areas
when compared to the maxillary arch. The bleeding score 0%. The architecture was
scalloped generalized.
Appt 7:
The color is red generalized around distal of 32 and is redder in the mandibular left quad.
The margins are rolled generalized with generalized blunted papilla. The tissue is smooth
and shiny generalized with generalized edematous/spongy consistency. The anterior teeth in
the maxillary arch show sign of health in a few areas, mainly the facial surfaces. The tissue
is generalized scalloped. The bleeding score was 5.5%.
Appt 8:
The patient had generalized scalloped architecture. The color was slightly red in the
posterior regions of the maxillary arch. It was red generalized in the mandibular arch
especially distal of 32 and 17 and more on the left than right. The papilla was blunted with
rolled margins generalized, more so in the mandibular left region. The consistency was
edematous/spongy generalized. The texture was smooth and shiny generalized. The bleeding
score is 0%.
Appt 9:
At the patients last appointment the patient had generalized scalloped architecture. The
patient showed healthy coloring in the facial regions of the anterior teeth. The patient had
slightly red tissue generalized. #32 and 17 were red along with most the all the molars. The
papilla remains blunted. The margins were rolled in the posterior regions the anterior teeth
were rolled in some areas but not all. The consistency was generalized edematous/spongy
mainly seen in the posterior region. The texture was generalized smooth and shiny. The
patients bleeding score was 1.56%.
c. Plaque Index:
7).5 good

Appt 1)N/A 2) 1.5 good 3)1.67 good 4)_1.3 good_ 5)_.6 good_ 6).67 good
8).5 good 9).3 good

d. Gingival Index: Initial 1.96 (9-4-14)

Final _.79 (11-25-14)__

e. Bleeding Index: Appt 1) N/A 2) 11.5% 3)5.5% 4)_5.5% 5)__0%_ 6) 0% 7)5.5%

8)0% 9) 1.56

GINGIVAL INDEX
PERIODONTAL CARE PLAN

Initial date _9-4-14__

Gingival Area
M

12

19

25

28

TOTAL __1.96__

Final date___11-25-14___
Gingival Area
M

12

19

25

28

TOTAL_ .79

f. Evaluation of Indices:
1. Initial: The patient has moderate periodontitis throughout the oral cavity. The patient has a
plaque score of 1.5 which had caused the patient to have a fair gingival score. With a gingival
score of fair means the patient shows a moderate amount of gingivitis which has cause the
patient to have a bit of bleeding upon probing which caused a bleeding score of 11.5%.
2. Final: The patient has moderate periodontitis throughout the oral cavity. The patients final
plaque score is .3. The patients gingival score was .79 which puts her in the good category.
The patients gingivitis has reduced greatly more to mild gingivitis. The patient had 3 areas of
bleeding when probing which gave her a bleeding score 1.56%. Due to the patient not having
her teeth cleaned on over 10 years on top of her diabetes are contributing factors to her having
gingivitis which ahs lead to periodontitis.
g. Periodontal Chart: (Record Baseline and First Re-evaluation data)
1.Baseline: All four quadrants were probed on the patient second visit. The patient had a moderate
amount of calculus. While my periodontal assessment was being checked it was stated that perhaps
I should probe by quadrant due to the amount of calculus. The patients pocket depths ranged from
10 mm to 4 mm with there being a few pockets that were 1mm. Most of the pockets that were
greater than 3mm were found in the molar regions. The patient showed some recession none
greater than 3mm in the molar region also. The patient may have more recession but due to the
calculus it cannot be determined. After viewing the radiographs some furcation was noted on #19,
2, and 31. The patient has had root resorption throughout the oral cavity which could be related to
the patient clenching and grinding. No mobility was located however, due to the calculus formation
it could be holding the teeth in place.

2.First Re-evaluation:
The patient has heavy calculus causing me to probe by quadrant. The patients pockets showed
improvement compared to the first charting. There were pocket depths ranging from 1-7 mm. The
posterior regions showed pockets of 4-7 mm with only a few pockets of 1-3mm. The anterior teeth
ranged from 1-4mm with only a couple of 4mm pockets. The patient showed 3mm of recession on
#31 which was the greatest area of recession found in the mouth. There were a few places on
recession found in the posterior regions that were no great than 1mm. The mandibular anterior
teeth showed recession of 1-2mm on most of the teeth. The patient has class 1 furcation on #18, 19,
1, 2, and 31. #25 was mobile. There was no suppuration. The patient shows root resorption on
throughout the mouth. The patient has caries on # 2,3, and 15 that need to be repaired. The patient
has occlusal restorations on # 14,15,18,19, 30, and 31 all amalgam. Her CAL's ranged from 5mm to
1mm. With the patient being a diabetic can be a factor to her having periodontitis. The 1mm
CAL's, furcations, pocket depths greater than 3mm and her grinding/clenching all pertain to her
having periodontitis. Not to mention, the patient has not had her teeth cleaned in over 10 years.

5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions) Attrition was found on all 32 teeth, this being related to the patient clenching and
grinding. Clenching and grinding can cause bone resorption. The patient has carious lesions on the
distal of #2 and the distal of #15. # 3 and #21 are to be watched. Tooth decay is a contributing factor
that increases plaque biofilm retention. Caries acts as a protective environment for bacteria to grow
and cause gingivitis and periodontitis. If bacteria is not removed from the tooth surface the enamel
will weaken and a cavity will form. The midline position was within normal limits. The patients
occlusal was a class I on the right molar and canine and left canine. The patient was a class II on the
left molar. No abfractions were noted.

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

App't 1:
I plan to complete all of the patients paperwork and full mouth radiographs within that patients
2 hour appointment. The first thing I will do is review the patient medical/dental history and
note any positive finding along with taking the patients vitals. The paperwork including
intra/extra oral exam, periodontal assessment without full periodontal charting, dental charting,
bleeding score and plaque score. I will discuss periodontal disease with the patient and let her
know how severe it can be and the effects if it is left untreated.
App't 2:
I plan to take the update the patient medical/dental history and take her vitals. Then I will
proceed to take the patient gingival index and plaque score. I then plan to start full periodontal
charting. After completing full periodontal charting I will do my first patient education session
over plaque and brushing. During the patient education session I will demonstrate to the patient
the bass method of brushing and I will explain to the patient what plaque is and the negative
effects it has on the oral cavity, I will also go over long term and short term goals for the patient.
I will then proceed to ultrasonic and fine scale one quadrant on the patient.
App't 3:
I plan to updated the patient medical/dental history and take her vitals. Next, I will take the
patients plaque score and bleeding score. I then plan to ultrasonic and fine scale the patients
second quadrant. Once completed, I will do my second patient education session over
periodontitis and flossing. I will begin with asking the patient to review plaque and brushing
from the previous patient education session. Then I will go into detail about periodontitis and
flossing. We will go over long term and short term goals again and see what the patient has
accomplished by this point.
App't 4:
On the fourth appointment I plan to review the patient medical/dental history and updated any
new information and take the patients vitals. Next, I will take that patients plaque score and
bleeding score. I will then proceed to ultrasonic and fine scale that patients third quadrant. After
completion, I will do my third patient education session over caries and review brushing and
flossing. I will also review information from the first and second session. We will review the
short and long term goals and see what the patient has accomplished and see what the patient can
do differently to accomplish other goals.

App't 5:
On the fifth appointment I plan to start by updating the patient medical/dental history and
updated any changes and take the patients vitals. Next, I will take that patients plaque score and
bleeding score. Then I will proceed to ultrasonic and fine scale the patients fourth and final
quadrant. I will ask the patient at chair side how she is doing managing her longer term and
short term goals. I will give suggestions about how she can reach her goals. I will also remind
the patient that now all of the calculus has been removed so properly brushing and flossing is the
only way to keep the calculus from reforming. Also, I would stated how important it is for her to
come in every 3 months for a cleaning to keep her periodontitis from progressing and for plaque
control.
App't 6:
Seeing that this is that patients final appointment I will review the patients medical/dental
history, update any changes, and take her vitals. I will then take the final gingival index. Then I
will take the patients plaque score. Next I will do post periodontal charting and note the patient
bleeding score. I will proceed to polish the patients teeth and give the patient a fluoride
treatment. If it is recommended for the patient to be given Arestin I will also place that. At the
very end of the appointment I will go over the importance of home care and how she should
come for a cleaning every 3 months to reduce the risk of progression of her periodontitis. I
would recommend she go see a periodontist and go to a dentist to get her carious lesions
repaired.
7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony
crests, thickened lamina dura, calculus, and root resorption)
The patient demonstrates moderate horizontal bone loss throughout the entire oral cavity
which is a result of periodontitis. The patient also shows generalized calculus throughout.
Calculus has a layer of bacteria living on top of it which can cause caries and periodontal
disease. The patient has crestal bone loss throughout along with thickened lamina dura
particularly in the molar regions and the anterior mandibular region. The patient also
demonstrates root resorption in all regions of the oral cavity. The patients crown root ratio
is very poor due to the root resorption. The root resorption can be caused from the patient
clenching and grinding. There are also three places noted for possible furcation involvement
which are #19, #2, and #31. The furcation is a factor of bone resorption that can be linked to
the patients diabetes and poor plaque control causing periodontitis.

8. Journal Notes: (Record in detail the treatment provided, oral hygiene education, patient response,
complications, improvements, diet recommendations, learning level, short and long term goals,
expectations, etc.) The progress notes should be written by appointment date.
8-27-14
First appointment, started extra/intra oral exam, started periodontal assessment, and started dental
charting. Took bite wing survey. Two hour appointment.
The patient was able to be at the appointment for a total of two hours due to getting home to get her
children off of the school bus. I was able to go over the patient medical/dental history and note all the

patient health problems such as diabetes, arthritis, and reflux. I also took the patient blood sugar
because she was unaware what it was. Her blood sugar was 268, she stated she had just eaten and
took her medicine after her meal. I was given permission by my instructor to proceed with treatment.
Next, I took a bitewing survey because the patient stated she had recently taken a pan at a dentist
office. I completed the extra/intra oral exam along with dental charting and started the periodontal
assessment but did not get a chance to probe. The patient had to leave before an instructor was able
to check the paperwork. I did however; get the patient classed and was told she would make a good
periodontal patient. She was a class 6 and perio 3. I did not take a plaque score on the patient
because I thought we may have time for some of the paperwork to get checked but the patient had to
leave. I was able to educate the patient that plaque is bacteria which leads to gingivitis. If gingivitis
is left untreated it will turn into periodontitis which is irreversible. The patient learning level was
unaware. I did not meet my treatment plan because I did not have all of my paperwork checked nor
did I take a full mouth survey. I was unable to take the patient plaque score, bleeding score and
gingival index.
9-4-14
Second appointment, FMX, extra/intra oral exam checked, periodontal assessment checked, dental
charting checked, full periodontal charting, risk assessment, gingival index, informed consent, plaque
score, four hour appointment.
I started the appointment by reviewing her medical/dental history and checking her blood sugar.
However, before I started reviewing her information she had to take a phone call from her son. The
patient thought she had a pan at a dentist office, however, after calling the office to see if we could
get a copy, they stated she had had bitewings and a only images of her TMJ taken. So I talked to the
patient about completing a full mouth survey. She complied so I proceeded to take the survey. The
FMX showed two carious lesions one on the distal of #2 and one on the distal of #15. After the FMX
was complete I was told to start doing my full periodontal charting before having any of my paper
work checked. I moved on to the periodontal charting. After completion I signed up to have the
intra/extra oral exam, dental charting, periodontal assessment, along with full periodontal charting
checked. While checking my full periodontal charting the instructor informed it would be best to
probe by quadrant because of the patient having so much build up. The appointment was coming to
an end so I took the patient plaque score which was 1.5 (good). The patients bleeding score was
11.5% and the gingival index was 1.96 (fair). The informed consent was completed along with the
risk assessment. The patient stated she uses a hard bristled toothbrush. I was able to educate that
patient that using a hard bristle brush can cause tissue damage which can lead to gingival recession. I
also informed the patient about using the bass method instead of the scrub brush method. The patient
learning level was unaware. She was unaware when I explained the trauma a hard bristle brush can
do. She also was unaware of the proper brushing method to use. Her attitude at this point seems vert
positive and willing to change. She does show a concern for her health because she asked me at the
start of the appointment if our instruments were sterilized because she is scared of getting an infection
due to her diabetes. I did not meet my treatment plan for her second appointment. I got behind from
taking time to probe when I should have started to ultrasonic and probe one quadrant. I also did not
get to do my first patient education session. I now know what direction I need to take for future
treatment on the patient.

10-2-14
The patient was schedule for an appointment 8:00 am and was a no show. I called the patient around
8:30 and she stated her son took her truck keys to school and she had no way of getting to the clinic.
She stated she was sending her daughter to get her keys and she would be on her way. By 10:30 the
patient had not shown up to her appointment. I texted her and she stated she was not coming. I
explained the importance of her coming to her appointments and she stated she would not miss again.
10-9-14
The patient was 20-30 minutes late for her 4 hour appointment. I proceeded to take her vitals and
blood sugar. I took her plaque score (1.67 good) and bleeding score (5.5 %). Next, we went to our
first patient education session and discussed plaque and brushing. I explained the bass method to the
patient (angle the brush 45 degrees toward the gum line; short horizontal strokes; light pressure). I
also discussed the importance of brushing twice a day for 2 minutes at each brushing, I demonstrated
the bass method on the typodont then she demonstrated the technique. We then went to the sink
where she brushed her teeth practicing the bass method. We disclosed her teeth after she completed
brushing to see area that needed improvement. She then went back over those areas. We also
discussed plaque and how it is a bacteria and that it develops every 24 hours. The patient was
unaware of all the information she learned in the session. We also went over all of the patients short
term and long term goals for all 3 patient education sessions. We focused on her goal for brushing
and plaque. Her long term goal is to reduce plaque score by .2 at every appointment until she reaches
.2. Her short term goals included to define plaque, correctly demonstrate the bass method, choose to
floss every other day, and to purchase a powered toothbrush. She stated all of those goals seem
obtainable and she would be willing to reach them. After patient ed, I started to ultrasonic the patient
maxillary left quadrant. She refused anesthesia because she was scared of needles and her last
experience with a shot at the dental office was unpleasant. She stated if she received a shot at this
appointment she would not come back. I had to use cetacaine, however, the ultrasonic was still
painful. After using the ultrasonic, the maxillary left quadrant I went on to perio chart the quadrant.
Once that was checked I started fine scaling but did not finish for time would not permit. The patient
did agree to come for another appointment but had some reservations due to this treatment being
painful. She stated she would opt for anesthesia next time. With the patient being late I was pushed
further back on my treatment plan.
10-16-14
The patient was 30 minutes late for her 4 hour appointment. I took the patients vitals and blood
sugar. I took her plaque score(1.3) and bleeding score(5.5%). I then proceeded to scale the maxillary
left quadrant since I had ran out of time at the last appointment. After scaling her maxillary left
quadrant I signed up for 2 scale checks, patient education session 2, and anesthesia. The instructors
were all very busy with other patient ed sessions and checking other patients. I was able to get
anesthesia and started scaling her maxillary right quadrant. She agreed that the shot was not as bad as
she remembered and she was a lot more comfortable when the ultrasonic was used. I started to
ultrasonic her maxillary right quad while waiting for scale checks and to do patient ed 2. I completed
my ultrasonic. At this point my scale checks had been completed and I had missed spots. Time was
running low so I started to perio chart the maxillary right quad while waiting for my ultrasonic check.
I was able to complete my charting and had the ultrasonic checked along with my perio charting. I
was not able to do my patient education session because the instructors had a lot going that day and I
was also busy trying to at least get perio charting complete on the second quad. I did not have enough
time to start scaling her maxillary right quad or remove the spots off of her maxillary left quadrant. I
did review with her plaque and brushing chair side. The patient was able to tell me that plaque was

bacteria and that the bass method included angling the brush 45 degrees toward the gum line and use
short horizontal strokes. She stated she had started practicing the bass method and had even
instructed her daughter to do so. Her learning level was involvement. At this appointment her plaque
score had decreased and she was able to define plaque. She was well on her way to reaching her long
term goal of reducing her plaque score to .2.
10-30-14
The patient was an hour late for her 4 hour appointment. She called and stated that the bus did not
pick up her daughter but she would be at the clinic by 9:00. She arrived a few minutes after 9:00 and
I took her vitals and blood sugar. I then took her plaque score(.6) and bleeding score (0%). After
doing so we went to the second patient education session where we first reviewed information from
the first patient education session. She had started saving for a powered toothbrush, she had started
flossing every other day, she had even reduced her plaque score. She was very pleased with herself
and even stated again that she had taught her daughter the bass method. We then reviewed all of the
patients long term/short term goals. We focused this session on periodontitis and flossing. The
patient long term goal for periodontitis/flossing is that the patient will halt the progression of
periodontitis by the next three month appointment. Her short term goals included that she will define
periodontitis, complete treatment, reduce bleeding score, reduce plaque score, consult a periodontist
at the end of treatment, and will return in 3 months for prophy. The patient did not have any
bleeding when I took the patients bleeding score therefore that was a improvement. We went on to
discuss that periodontal disease starts as gingivitis and it can progress into periodontitis. Periodontitis
is caused by bacteria and diabetes can heighten the severity of periodontitis. We also discussed that
gingivitis is reversible but periodontitis is not, however, it can be stopped. I then demonstrated
flossing on the typodont. I let the patient practice on the typodont. We then went to the sink; I had
the patient demonstrate flossing on herself. I told her it is important to make a c-shape around each
tooth to help remove bacteria from under the gum line. She then demonstrated the bass method. I
disclosed her teeth to see find areas of improvement and there were only a couple areas that needed to
be improved. The patient was also told about other possible alternatives of flossing such as floss/
plastic toothpick and interdental brushes. The patients learning level was unaware to the new
information presented in the patient education session, however, she was showing involvement with
the information presented in the previous patient ed session. She interested in knowing that diabetes
put her at higher risk of periodontitis. After patient ed, I proceeded to scale the patient maxillary right
quadrant and attempted to remove the spot on the maxillary left. Time was running short. I signed up
for a two scale checks, a spot check and for anesthesia. I was able to get anesthesia and began to
ultrasonic her mandibular right quadrant. I had my ultrasonic checked began to periodontal chart that
quadrant. I when the instructor conducted the spot check and scale check on the maxillary arch I still
had missed spots in both quadrants. Due to time I was unable to complete scaling the maxillary arch
and the mandibular right quad. I did not expect the patient's plaque score to be so improved.

11-4-14
I asked the patient to come in for three hours so I can finish scaling the three quadrants I had start
cleaning. I took the patients vitals and blood sugar. Next I took the patients plaque score (.67 good)
and bleeding score (0%). I then scaled the spots I missed on the maxillary arch. I finally removed all
of the spots. I then started fine scaling the mandibular left quadrant. The patient was complaining of
pain distal of 32. The dentist stated that I should not scale that tooth due to it hurting her and he
called out a z-pack for the patient to take seeing that she could have a possible abscess. I did not
completely finish scaling the mandibular right quadrant because I ran out of time. I did get it checked

but missed a couple of spots. The patient was on time for this appointment. The only complication
was that she was having pain. I explained to the patient that since I was unable to scale the
mandibular right quadrant after I used the ultrasonic could have been a cause for her developing an
infection. I told the patient to use warm salt water rinses to help with the healing. I also stressed the
importance of using proper oral health care to help reduce bacteria in the mouth. The patient was
aware that brushing and flossing would help reduce the bacteria. Her learning level is aware. The
patient stated she would go pick up her antibiotics and do the salt water rinses. The patients bleeding
score and tissue had greatly improved in the areas that have been ultrasoniced and scaled.
11-6-14
Going into this appointment I was still behind on where I needed to be with my patient. I intended to
go into this appointment with only the mandibular left quadrant left to clean. The patient arrived late
to the appointment again. When she made it I took her vitals and blood sugar. I then took her plaque
score (.5 good) and bleeding score(5.5%). After doing so we did our final patient education session.
This session was over caries and reviewing brushing and flossing. We first reviewed the previous
two sessions. The patient was able to tell me what plaque was, how to utilize the bass method, that
periodontitis is irreversible but can be stopped, gingivitis is reversible, and to make a c-shape around
each tooth to remove plaque. We then reviewed all of the long term and short term goals. The
patient had reached several of her goals which included reducing her plaque and bleeding score, to
use the bass method, to floss every other day, she is working toward completing her treatment, she
was also able to define plaque and periodontitis. We then reviewed our goals for caries. The Long
term goal was for the patient to have regular dental check up every three months. Her short term goal
was to explain the caries process, to save $5 every week to pay toward caries repair, to purchase a
mouth guard, and to have the caries repaired. She stated she had already started saving money to
have her caries repaired. She also stated she is looking for a mouth guard that she likes. She stated
she has a mouth guard but it is very bulky. We discussed that sugary high carb foods cause caries if
there is a susceptible tooth host. I told the patient that proper brushing and flossing along with using
a mouthwash can help reduce caries risk. She then went to the sink and demonstrated flossing and
brushing. I disclosed the patient and she had done very well with using her technique. I referred the
patient to have her caries repaired and told her she was on a three month recall for prophylaxis. After
the final patient ed session we went to the chair for me to complete scaling the mandibular right
quadrant. I then started to ultrasonic the final quad after she received anesthesia. After getting
checked off on ultrasonic I began to perio chart the mandibular left quad. After getting everything
checked I had ten minutes left to scale. I had also had spots to remove from the mandibular right
quad. I was not able to finish scaling like I had planned. One complication was that I had waited an
hour for anesthesia and the patient was 20 minutes late. I tried to scale #32 but she stated it still hurt
even though the dentist numbed just that area on that right quad. She stated she had finished her
antibiotic that she had received on the 4th. The patients learning level is involvement.

11-13-14
The patient had to come back for me to complete her scaling on the mandibular arch. I took the
patients vitals and blood sugar. I then took her plaque score (.5 good) and bleeding score (0%). She
has done well reaching her goal of reducing her bleeding score and plaque score. The patient started
having problems over the weekend with her mandibular left side hurting. She stated her top teeth
even hurt. She had come in on the 10th to have the dentist to look to see if she still had an infection.
The dentist stated it is probably due to her sinuses and he called her out clindamycin and peridex. By
13th she felt a little better and was able to tolerate treatment. The dentist did give her anesthesia on

the left quadrant so I could scale the posterior teeth. She stated she felt pain running down her neck.
He stated it could be due to infection but the antibiotic that had been prescribed should take care of it.
I was able to finish scaling all of the mandibular arch and plaque free and give my patient a fluoride
treatment. The patient was not there for the full 4 hours. She learned that the fluoride strengthens
enamel and can help to prevent caries. Her learning level was unaware. The main complication I had
was her having pain but that was taken care of with the anesthesia. She stated she would be back for
post perio and post cal in 2 weeks. It seems she will complete treatment. The patient even stated to
the instructor that even though I will be graduating soon she will still be coming to the clinic for
routine treatment. I was not able to stay on schedule with my appointment plan but I was able to
complete my patient in time for her to come back for her 2 week evaluation.
11-25-14
This is the final appointment for my patient. I started by reviewing the patients medical/dental
history. I then took her blood sugar. After doing so I took the patients gingival index. Her plaque
score was .3 and her bleeding score was 1.56%. I then perio charted all four quads. The patients
pocket depths have greatly improved along with her gingival tissue. After post perio I did post cal.
Post cal included removing plaque from her mandibular anterior teeth and a few other teeth in the
posterior region. The instructor checked the probing and post cal. After doing so I placed Arestin in
the 8 regions of the mouth that had deep pockets. The patient was them released. The patient was
eager to receive the Arestin so she could hopefully regain some attachment. Patient education
included that Arestin is an antibiotic that can help regain attachment. I also told the patient to make
sure to make c-shapes around each tooth when flossing because she did have build up in the
mandibular anterior teeth. The patients learning level is aware. I praised that patient for reducing
her plaque score to .3 which was .1 from her long term goal. She and I both were thrilled to see a
reduction in her pocket depths. I did finish my patient however; I had expected to finish her earlier
than now.

9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth
morphology, periodontal examination, recare availability)

The patient had a willing attitude to better her oral health, however; she was always late and
at times seemed she did not make her appointments a priority. The patient still has all 32
teeth with class1 furcation involvement on 5 teeth. She does have a lot of attrition due to
grinding, She also has generalized root resorption. I feel that she will have a good prognosis
because she seems to be interested in taking care of her teeth so she will not lose them. She
is now aware of the severity of her periodontal condition and understand the importance of
taking care of periodontium. She is trying to find a mouth guard that will better suit her but
if she does not get a mouth guard I am afraid her periodontal health will turn poor. She also
stated she was saving to have her caries repaired. Not to mention, she told an instructor that
she would be a regular at the clinic even after I graduate. The periodontal pocket depths have
improved from the initial probe depths. She is a middle aged woman and to have as much
perio as she does could be related to her not having her teeth cleaned in over 10 years and her
being diabetic, I believe as of now she had a good prognosis. She is ready to come back in 3
months for her next cleaning.

10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule.
(Note: Include date of recall appointment below.)

The patient has mentioned that her brother has such a severe case of periodontitis that he
cannot even wear dentures. This opened an opportunity to explain to the that it is important
to keep up with her oral health so she does not lose her teeth also. I suggested that the
patient should save to get her caries repaired to help save her teeth. I also suggested to the
patient to come back in 3 months for routine prophylaxis which would be around February
25, 2015. I recommended the patient start flossing every other day for a couple of weeks
then trying to floss every day. I informed the patient that if she continues with routine
treatment her next cleaning would not be so extensive and it would help in halting her
periodontitis.
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing
depths)

The patient has greatly reduced her plaque score from the initial 1.67 to .3. Her bleeding
score also improved from 11.5% to 0, however; her bleeding score at the last visit was 1.56.
Her overall gingival health has also greatly improved. She went from having generalized
edematous and red gingiva to still having generalized gingivitis but the inflammation is not
as bad and the color is not a red. Her probing depths have also improved for 1-10mm to 17mm. I did have to remove plaque off of her mandibular anteriors when I did post cal other
than that the patients plaque control was good.

12. Patient Attitudes and Cooperation:

The patients attitude started out great. She arrived on time to her first couple of
appointments and was very willing to come whenever I needed her. Then things started to
change. The patient was a no show for her scheduled third appointment. She then was late
for all of her other appointment except one. Also, she refused anesthesia when I started
using the ultrasonic on the first quadrant. She even stated she would not come back if she
was given anesthesia. However, at the end of the appointment she stated she would be back
and would be willing to use anesthesia. She has come in for every appointment except that
specific one at which she stated her son had a truck keys and she did not have a way to get
to the clinic. The patients attitude was always positive but her cooperation was not always
the best.
13. Personal Evaluation/Reaction to Experience:
My first reaction was being afraid to take on such a big project. I had fear that a couple of
time that my patient was going to bail on me. However, she pulled through for me. I feel
that I handle my patient in the best manner that I could. Even though I was unhappy with
her tardiness and missing an appointment I was able to fight through my anger and be nice
and helpful to my patient. I did learn that it is hard to trust someone when it is your grade a
stake. People are not as caring as I thought. If it does not benefit them they do not care. I
had to stress several time how important she was to me and my grade. I helped her anyway

I could even outside of the clinic setting. My overall reaction to this experience is
somewhat shocked because I found out just how people can blow off such important things
such as oral health.

Patient Education Session 1

Plaque
Long Term Goal:
The patient will reduce plaque score by .2 at every appointment until she reaches .2.
Short Term Goals:
1) The patient will define plaque and how it forms by next appointment.
2) The patient will correctly demonstrate the bass method by third appointment.
3) The patient will choose to floss every other day by fourth appointment.
4) The patient will purchase a powered toothbrush to help with dexterity due to arthritis to
help remove plaque by next three month appointment.

Outline of patient ed session:

Long term goal- to reduce plaque score to .2
Short Term goals:
o Define plaque
o Practice Bass method
o Discuss flossing
o Powered toothbrush
Ask the patient what they know about plaque.
Define Plaque- is a Biofilm, white, forms daily, it is a bacteria
Discuss how to reduce plaque
o Brushing/tongue brushing
o Flossing
o Mouth rinses
Brushing technique- Bass method- angle apically 45 degrees, light pressure, vibrate short
horizontal strokes (Demonstrate brushing method on typodont)
Have patient practice the bass method on typodont and on self
Discuss ways to reach goal:
o Brush twice daily
o Practice bass method
o Floss daily
o Use mouth rinse
Ask questions:
o What can you recall about plaque?
o Why is this brushing method more effective?
o If plaque is not removed what can it lead to?
o What are the benefits of a powered toothbrush?

We are a Team!!! I will do my job as a dental professional and you must do your job at
home so treatment will not fail.

Patient Education Session 2

Periodontitis
Long Term Goal:
The patient will halt the progression of periodontitis by the next 3 month appointment.
Short Term Goals:
1) The patient will define periodontitis and it effects by next appointment.
2) The patient will understand the relationship between periodontitis and diabetes.
3) The patient will complete treatment.
4) The patient will reduce bleeding score at every appointment,
5) The patient will reduce plaque score by .2 at every appointment.
6) The patient will consult a periodontist at the end of treatment.
7) The patient will return in 3 months for prohylaxis.

Outline of patient ed session:

Review plaque and brushing from previous patient ed session
Review all goals
See what goals the patient has reached
Ask the patient what they know about periodontal disease.
Long term goal: halt progression of periodontitis
Short term goals:
o Define periodontal disease and its effects
o Periodontitis and diabetes
o Complete treatment
o Reduce bleeding score
o Reduce plaque score
o Consult periodontist
o Return for prophy in 3 months

Define Periodontal Disease (periodontitis) - bone loss, not reversible, can be

stopped
Effects of periodontal disease (periodontitis)
o Causes gingival recession
o Bone loss can result in tooth loss
o Irreversible
o Periodontal disease is considered a complication with uncontrolled
diabetes.
Discuss ways to reach goal:

o Floss
o Mouth rinse
o Bass method- twice daily
o Treat caries
o Control diabetes
Demonstrate flossing technique on typodont
o Wrap floss around both middle fingers and use pointer finger to push floss
between teeth
o Second option use floss holder
Have patient demonstrate flossing on the typodont and on self
Discuss advantages of flossing and how it reduces plaque
o Removes plaque between interproximal surfaces
o Reduces caries
Ask the patient:
o What they learned about periodontal disease?
o Why is plaque removal important?
Review next patient ed session
We are a Team!!! I will do my job as a dental professional and you must do your
job at home so treatment will not fail.

Patient Education Session 3

Caries
Long Term Goal:
The patient will have regular dental check-ups every 3 months.
Short Term Goals:
1) The patient will describe the caries process by the next appointment.
2) The patient will save $5 a week to pay toward caries repair.
3) The patient will purchase a mouth guard by next 3 month appointment.
4) The patient will have caries repaired by the next 3 month appointment.
Outline patient ed session:
Review brushing and flossing
Review periodontitis session
Review all goals
See what goals the patient has accomplished
Ask the patient what they know about caries
Define caries process- Cavity, host (tooth surface), substrate (food), Oral bacteria
(weakens enamel), time
Discuss effects of caries
o Cause loss of tooth
o Periodontal disease
Discuss ways to reduce the risk of cavities
o Fluoride treatments
o Bass method twice daily

o Flossing
o Mouth rinse
Discuss long term goals: The patient will have regular 3 month check-ups.
Discuss short term goals:
o Define caries process
o Save $5 per week to repair caries
o Purchase mouth guard
o Repair caries
Discuss ways to reach goals
o Bass method
o Flossing
o Mouth rinses that contain fluoride
o Ways patient can save money
Review patients brushing and flossing methods
Ask questions about the caries, plaque, and periodontitis.
Recall every 3 months
Referral for Caries
We are a Team!!! I will do my job as a dental professional and you must do your
job at home so treatment will not fail.