GINGIVAL INDEX

PERIODONTAL CARE PLAN

Initial date: 09/19/2016
Gingival Area
M

12

19

25

28

TOTAL: 1.08 (FAIR)

Final date: 11/17/2016

Gingival Area
M

12

19

25

28

TOTAL: 0.33 (GOOD)

PERIODONTAL CARE PLAN
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Patient Name: Age: 38

Date of initial exam: 08/22/16

Date completed: 11/17/16

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.
My patient has some medical conditions that should be taken into consideration before, during and
after her treatment. She has a general physician, Dr. Kenneth Wilgers, whom she visits routinely for
check-ups. Her most recent check-up was in 2015 and she was in good general health. On May 29,
2015, my patient was hospitalized for the gastric sleeve surgery. With this surgery, her overall health
has improved drastically because of the significant weight loss. This surgery and her new positive
health changes will, in themselves, improve her prognosis. The only other surgery she has
undergone was a cesarean section on October 11, 2006. She does not require a medical clearance
before treatment. My patient had asthma as a child but no longer exhibits any signs or symptoms.
My patient does occasionally drink alcoholic beverages. I realize that alcohol use can contribute to
oral cancer and tooth decay or staining. I will explain how to monitor any changes in her oral
mucosa that may indicate a disease. During chairside patient education, I will educate my patient to
drink frequent sips of water between alcohol consumption in order to neutralize the pH in her saliva.
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)
My patient has come to our clinic for x-rays and a cleaning. Her last dental cleaning was in 2013.
My patient says that she has bad teeth, but I hope to teach her the importance of proper oral
hygiene and continuous recall visits. Her gingiva bleeds when she brushes and flosses her teeth.
This is likely due to plaque and calculus accumulation. My patient has had root canal therapy on
#30 in the past, which has since failed and there are remaining root tips. She also has four other
teeth (#13, 15, 19 & 31) with retained root tips that contain decay. Dr. Nantz has requested that she
be referred for those five teeth mentioned above along with #2, 3, 5, 14, 32 for caries. Because of
the missing/decayed crown on #19, the gingiva has receded on the buccal aspect of #20 by 2mm,
which makes her at greater risk for root caries. Due to my patient having recession, she technically
has periodontitis. She is willing to come to appointments for proper treatment. Frequent dental
cleanings and adequate home care are imperative in her case, in order to halt disease progression.
She also generally has several cavities whenever she goes to the dentist. This could be due to the
fact that she does not go to the dentist very often. Usually, she will only go to the dentist if she is
experiencing pain. She does clench her jaws as a rare habit and during her sleep, which could lead
to tooth damage, periodontium damage, and jaw pain. She also grinds her teeth at night which has
already led to attrition in the mandibular anteriors plus both first premolars on the mandible, and
further damage could cause exposure of the dentin. I also have recommended a night guard to help
with the attrition on the mandibular anteriors. My patient brushes with horizontal strokes (scrubbing
method), and uses a soft-bristled toothbrush. Using this method alone makes it difficult to get under
the sulcus to remove plaque and debris. During our first visit I briefly explained to her that in
addition to horizontal strokes, she can use small circular motions and angle her toothbrush about 45
degrees (Stillmans method), she will be able to remove more plaque. My patient also exhibited
several 4mm pocket depths and bleeding in most of those same areas. Overall, I believe that my
patient is willing to do what it takes to get her oral health back on the right track and halt the
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progression of her disease. I will give her the proper education and tools in which it takes to achieve
optimum oral health. Together, as a team, I know we can improve dramatically.
3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
While conducting the extraoral exam, I found that my patient exhibits generalized ephilides due to
sun exposure. I did inform my patient that we should continually monitor her freckles to make sure
they do not show signs of melanoma. She also had palpable submandibular bilateral
lymphadenopathy. She said that it was non-tender and I noted that each were mobile. The etiology
of her lymphadenopathy is due to typical southeast Texas sinus drainage. My patients TMJ pops
bilaterally upon opening. She stated that she realized that it pops but it does not bother her, give her
any pain, or headaches. During the intraoral exam, I discovered bilateral linea alba. This is due to
the patients habit of biting her cheeks. It is also apparent inside the oral cavity that she clenches and
grinds. This was confirmed when the patient admitted this to be true when she sleeps and sometimes
during the day. Along with clenching and grinding during sleep and occasional day-time habit, she
breathes through her mouth. In the occlusal examination, I found that on the right side of her mouth,
her molar region is unclassifiable because she no longer has the crown of #30. The canine
classification on the right is a class I occlusion. A similar situation presented itself on the left side of
her mouth. The molar is unclassifiable due to the crown of #19s extreme decay, and the canine
classification was I. Her overbite was about 3mm and overjet at 4mm. She has a 4mm mid-line shift
to the right. #11 and #20 are in cross bite. There are no open bites present in her mouth. Her
gingivas architecture was scalloped throughout the mouth. The color of her gingiva was red, but
mostly pronounced in the posterior regions. This indicated bacteria and inflammation. I listed the
consistency as edematous/spongy and the margins were thickened, both generalized throughout the
mouth. Her papillae were bulbous and more pronounced in the maxillary and mandibular anterior
region. There was no presence of suppuration. The surface texture in the papillary and the margins
were smooth and shiny in general. The attached surface texture was stippled in the anterior, but
smooth and shiny in the posterior. Looking at the full mouth of radiographs, there is mild bone loss
present in the upper anteriors (#6-11) and in the lower anteriors (#22-27) as well. Also, visible in the
radiographs is calculus in the interproximal area of all mandibular anterior teeth, plus #7-10. There
was a large suspicious area shown in radiographs on #32, and a defective restoration (Failed root
canal therapy) on #30. The roots ONLY of #13,15,19,30, and 31 were shown as well. My patient is a
LIT Periodontal Case 2 due to mild horizontal bone loss, and a Class 5 prophy patient. She presents
with generalized gingival inflammation in the papillary and margins.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification V
Periodontal Case Type II
b. Gingival Description: Generalized gingival inflammation in the papillary and margins.
App't 1:
My patients gingival architecture was scalloped throughout the mouth. The color of her gingiva
was red, but mostly pronounced in the posterior regions. This indicated bacteria and inflammation. I
listed the consistency as edematous/spongy and the margins were thickened, both generalized
throughout the mouth. Her papillae were bulbous and more pronounced in the maxillary and
mandibular anterior region. There was no presence of suppuration. The surface texture in the
papillary and the margins were smooth and shiny in general. The attached surface texture was
stippled in the anterior, but smooth and shiny in the posterior. My patient does have periodontitis
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because of her mild bone loss and 2mm of recession on #20. We both realize that periodontitis is
irreversible, but we are going to halt the disease process and obtain healthy gingival tissues through
thorough education and proper treatment in clinic, and at home.
App't 2:
During the second appointment, I observed my patients periodontal conditions and nothing has
changed from our first baseline appointment. Throughout the whole mouth, her gingival architecture
is scalloped like at her previous appointment, and the tissue color remains red. I used the ultrasonic
and fine scaled the mandibular left quadrant and there was slight bleeding throughout the treatment
which indicates inflammation and bacteria present. Her consistency remained edematous/spongy
and the margins thickened. Her papillae were still bulbous and more pronounced in the maxillary
and mandibular anterior region. There was no presence of suppuration. The surface texture in the
papillary and the margins were smooth and shiny in general. The attached surface texture was
stippled in the anterior, but smooth and shiny in the posterior. After ultrasonicing the mandibular
left, I did a 6 point perio chart. I measured 4mm pocket depths on: 27M, 27D and 26D. Following
todays patient education session about plaque removal and brushing, I still remain confident that
the patient wants to improve her oral health and halt the disease process, and together I believe we
can and will achieve this. During our next visit, I will evaluate the mandibular right quadrant and
begin on the mandibular left. Our next patient education session is about flossing and periodontitis,
and I will also do a follow up plaque and bleeding score. I am hoping that with treatment of each
quadrant we will see improvement. I feel as if once we get the bacteria and calculus removed from
the oral cavity, we will see a healthy gingiva.
App't 3:
At todays appointment, I observed the patients architecture and color of the mandibular right
quadrant, following last weeks cleaning of that area. Today, the tissues are not near as red as they
were previously. In fact, the presented pink in the anterior region! This indicates that she is
producing a positive tissue response following the removal of soft and hard deposits in the area. Her
papilla is pointed and scalloped, and the gingiva is tight around the cervical portions of the teeth. In
the posterior region, the color was slightly red, but with more time the tissue will continue to heal.
There was no bleeding upon probing was noted in this area at all, which leads me to believe that the
treatment is working. I believe that our previous patient education session about plaque and
brushing has influenced her to tighten up on her homecare. Adequate home care plus professional
deep cleanings will really aid in improving her tissue analysis. I began cleaning the mandibular left
quadrant, which is still red in color and more pronounced in the posterior region, and
edematous/spongy in consistency. The redness indicates bacteria and inflammation still present in
the area. Her gingival architecture was scalloped throughout the mouth. Her margins were
thickened. Her papillae were bulbous and more pronounced in the mandibular anterior region. There
was no presence of suppuration. The surface texture in the papillary and the margins were smooth
and shiny in general. The attached surface texture was stippled in the anterior, but smooth and shiny
in the posterior. After ultrasonicing the mandibular left, I did a 6 point perio chart. I measured 4mm
pocket depths on: 23FD, 22FM, 21D, 20MB, 18DB, 18DL and 21DL. My patient presents with
periodontitis because of her mild bone loss and 2mm of recession on #20. We both realize that
periodontitis is irreversible, but we are going to halt the disease process and obtain healthy gingival
tissues through thorough education and proper treatment in clinic, and at home. As for the right and
left maxilla, the conditions have not changed since the baseline appointment because there has not
been any treatment or removal of plaque, debris, and calculus. In the maxilla, her gingival
architecture was scalloped throughout. The color of her gingiva was red, but mostly pronounced in
the posterior regions. This indicated bacteria and inflammation. I listed the consistency as
4

edematous/spongy and the margins were thickened, both generalized throughout the mouth. Her
papillae were bulbous and more pronounced in the anterior region. There was no presence of
suppuration. The surface texture in the papillary and the margins were smooth and shiny in general.
The attached surface texture was stippled in the anterior, but smooth and shiny in the posterior. Also,
when probing, she had a repeat bleeding score of 2%. Even though there was not any bleeding on
the mandibular right quadrant, there were bleeding spots throughout the rest of the mouth. Our next
visit will be our third cleaning appointment and second patient education session. I plan to go back
over her brushing and flossing techniques, and discuss periodontitis in depth. I will also begin
cleaning her maxillary left quadrant, and evaluate the tissues on the mandible for improvement.
App't 4:
Today was my patients fourth appointment. I observed the patients architecture and color of the
entire mandible to see the difference periodontal debridement has made. Today, the tissues in the
mandible presented as pink in color! This indicates that she is producing a positive tissue response
following the removal of soft and hard deposits in the area. Her papilla is pointed, stippled and
scalloped, and the gingiva is tight around the cervical portions of the teeth. In the posterior region,
the color was slightly red, but with more time the tissue will continue to heal. There was no bleeding
upon probing was noted in this area at all, which leads me to believe that the treatment is working. I
believe that our previous patient education session about periodontitis and flossing has influenced
her to tighten up on her homecare. Adequate home care plus professional deep cleanings will really
aid in improving her tissue analysis. I began cleaning the maxillary left quadrant, which is still red
in color and more pronounced in the posterior region, and edematous/spongy in consistency. The
redness indicates bacteria and inflammation still present in the area. Her gingival architecture was
scalloped throughout the mouth. Her margins were thickened. Her papillae were bulbous and more
pronounced in the maxillary anterior region. There was no presence of suppuration. The surface
texture in the papillary and the margins were smooth and shiny in general. The attached surface
texture was stippled in the anterior, but smooth and shiny in the posterior. After ultrasonicing the
mandibular left, I did a 6 point perio chart. I measured 4mm pocket depths on: 9DF, 10MF, 10DF
and 11MF. My patient presents with periodontitis because of her mild bone loss and 2mm of
recession on #20. We both realize that periodontitis is irreversible, but we are going to halt the
disease process and obtain healthy gingival tissues through thorough education and proper treatment
in clinic, and at home. As for the right maxillary quadrant, the conditions have not changed since the
baseline appointment because there has not been any treatment or removal of plaque, debris, and
calculus. In the maxillary right, her gingival architecture was scalloped throughout. The color of her
gingiva was red, but mostly pronounced in the facial posterior and anterior regions. This indicated
bacteria and inflammation. I listed the consistency as edematous/spongy and the margins were
thickened, both generalized throughout the mouth. Her papillae were bulbous and more pronounced
in the anterior region. There was no presence of suppuration. The surface texture in the papillary
and the margins were smooth and shiny in general. The attached surface texture was stippled in the
anterior, but smooth and shiny in the posterior. Also, when probing, she had a lowered bleeding
score of 0.2%. Even though there was not any bleeding in the mandible, there were bleeding spots
throughout the rest of the mouth. Our next visit will be our fourth cleaning appointment and final
patient education session. I plan to go back over her brushing and flossing techniques, and discuss
caries prevention along with fluoride use. I will also begin cleaning her maxillary right quadrant,
and evaluate the tissues on the mandible for improvement.
App't 5:
Today was my patients fifth appointment. I observed the patients architecture and color of the entire
mandible and the maxillary left quadrant to see the difference periodontal debridement has made.
5

Today, the tissues in the mandible and maxillary left quadrant presented as pink in color! This
indicates that she is producing a positive tissue response following the removal of soft and hard
deposits in the area. Her papilla is pointed, stippled and scalloped, and the gingiva is tight around
the cervical portions of the teeth. In the posterior region, the color was slightly red in the maxillary
left quadrant, but with more time the tissue will continue to heal. There was no bleeding upon
probing was noted in this area at all, which leads me to believe that the treatment is working. I
believe that our previous patient education session about fluoride and caries prevention has
influenced her to tighten up on her homecare. Adequate home care plus professional deep cleanings
will really aid in improving her tissue analysis. I began cleaning the maxillary right quadrant, which
is still red in color and more pronounced in the posterior region, and edematous/spongy in
consistency. The redness indicates bacteria and inflammation still present in the area. Her gingival
architecture was scalloped throughout the mouth. Her margins were thickened. Her papillae were
bulbous and more pronounced in the maxillary anterior region (facial and lingual). There was no
presence of suppuration. The surface texture in the papillary and the margins were smooth and shiny
in general. The attached surface texture was stippled in the anterior, but smooth and shiny in the
posterior. After ultrasonicing the mandibular left, I did a 6 point perio chart. I measured 4mm pocket
depths on: 1DB, 1MB, 2DB, 2MB, 8DF, 7ML, 7DL, 4DL, 3DL, and 1 DL. I also found a couple of
5mm pockets in this quadrant, those areas are: 3DB and 7MF. There was one 6mm pocket on the
distal-facial of #7. The deepest pocket of this whole quadrant and entire mouth was a 7mm pocket
on the mesial-facial of #6. We realize that this localized area has a problem, and by periodontal
debridement, along with adequate homecare, we hope to reduce these higher pockets. If they are not
healed by the post-cal appointment, I will put Arestin in this area. My patient presents with
periodontitis because of her mild bone loss and 2mm of recession on #20. We both realize that
periodontitis is irreversible, but we are going to halt the disease process and obtain healthy gingival
tissues through thorough education and proper treatment in clinic, and at home. Also, when probing,
she had a lowered bleeding score of 0.2%. Even though there was not any bleeding in the mandible
or the maxillary left quadrant, there were bleeding spots on the maxillary right. Our next visit will
be our final appointment and our post cal evaluation. I will reevaluate the entire mouth.
App't 6:
Today I evaluated the over gingival assessment for the entire mouth. Overall, I noticed a significant
positive change in her oral cavity. The color of her gingiva throughout the mouth was pink with the
exception of #6M and the lingual of the mandibular anteriors. This told me that there was probably
some residual calculus or reformed calculus. That was exactly the case, too. Her general architecture
was scalloped. The surface texture in the papillary and margins are stippled except for the area noted
above (#6M and the lingual of the mandibular anteriors) which are smooth and shiny. All of the
gingiva is still healing from the previous periodontal debridement. Due to my patients daughter
being put in the hospital, I was not able to waiting the entire two weeks to have her back for postcal. When doing my 6-point perio charting I discovered that on the direct buccal of #14, there is
2mm of recession that has been uncovered. I made the patient aware of the new-found recession and
told her that we will work together to halt it from receding any further. All of our positive progress
in gingival description and shrunken pocket depths indicated that the tissues are healing, which in
turn, aids in halting the progression of her periodontitis.

c. Plaque Index: Appt 1- 2.83(FAIR) Appt 2- 1.33 (GOOD) Appt. 3- 1 (GOOD) Appt. 4- 0.16
(GOOD) Appt. 5- 0.16 (GOOD) Appt. 6- 0.16 (GOOD)
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d. Gingival Index: Initial 1.08 (FAIR)

Final 0.33 (GOOD)

e. Bleeding Index: Appt. 1- 2% Appt 2- 2% Appt. 3- 1.5% Appt. 4- 0.2% Appt. 5- 0.2%
Appt. 6- 0%
f. Evaluation of Indices:
1. Initial: Plaque index is fair; gingival index is fair. The plaque index is important in judging how
the quality of her plaque removal changes from the first appointment to the last. Her home care
is overall decent but it could use a little work which is obvious looking at her plaque score
(2.83). Plaque and bacteria can build up in the deeper periodontally involved pockets and
worsen the severity of her periodontitis. The gingival index assesses the severity of her gingival
condition based on color, consistency, and bleeding on probing. Generally, the condition of her
tissues was generally inflamed in the papillary and the margin. Bleeding upon probing indicates
inflammation and disease. Her initial bleeding score was 2%. We hope to achieve one of our
short-term goals, reduce bleeding score by 0.5% (or more), at each appointment. With correct
treatment and home care, we can improve her oral health by our final appointment.
2. Final: Just over the past couple of months, we have seen MAJOR progress since our initial
appointment. The plaque score has decreased significantly from our first score of 2.83 (fair) to
our final plaque score of 0.16 (good). I am very impressed with my patients progress in plaque
score. She is just 0.6 points away from the long-term goal I had set for her. Not only did my
patients plaque score improve, so did her bleeding score! Her initial bleeding score was 2%
and after our final visit, we determined that her bleeding score was 0%! And if all of that was
not enough improvement, she also reduced her gingival index. The initial evaluation read a
1.08 (fair), but at her post-cal appointment, it was only 0.33 (good)! This makes me so proud of
my work and my patients work as well. I know that she took to my suggestions and her tissue
responded to the treatment. I know that over time we will see even more progression for my
patient and her periodontitis is and will continue to be stopped in its tracks!
g.

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

1. Baseline: My patient did present with several 4mm pocket depths at her first appointment. The
4m pockets depths are as follows and were present of the facial/buccal area: 1M, 2M, 3D, 7M,
8D, 9D, 10M and 10D, 11M, 22M, 23D, 26D, 27M and 27D. These pockets listed above may it
incredibly easy for plaque and bacteria to build up. Because the pockets exceed 2-3mm, it is
difficult to remove it entirely with brushing and flossing. Hopefully, with the help of my
instrumentation and removal of plaque, debris and calculus, we can achieve more shallow
pocket depths. There was only one tooth with recession and that was #20 facial and the
recession measured at 2mm. Her recession is due to the fact that the crown of #19 is missing so
the gums have receded. This damage/recession is not reversible. We can however, halt this
recession by teaching the patient to care for her missing teeth.
2. First evaluation: Today my patient presented with very few 4mm pockets. Those pockets
include: 6MF, 7DF, 7MF, 8DF, 6ML, 2ML, 32L, and 32DB. All of these pockets have shown
improvement from our initial pocket depth readings. Unfortunately, deeper pockets are harder to
clean, so periodontal pathogens can get into those deeper areas and cause destruction, potentially
leading to more areas of periodontitis. These readings indicated that periodontal disease is still
present. It may be active or inactive, but looking at the rest of her progress, I would say that it is
becoming inactive and healing. All of the rest of the pocket depth reading are within normal limits
(1-3mm). I found a few spots of recession, which is periodontitis, but it was very localized. Tooth
7

#14 had 2mm of recession that revealed itself on the direct buccal surface. It was not shown
initially because the tissue was so inflamed and the enamel was coated with calculus. The other
areas of recession are on tooth #20, and there was 2mm on the direct buccal surface and 1mm on
the distal-buccal surface. Overall my patient does still have periodontal disease because it is not
reversible. Hopefully, now that she has had a thorough dental cleaning, she will be able to
maintain good home care and keep up with regular dental check-ups and we can continue to see
an improvement in her overall oral health. I placed three Arestin capsules in some localized areas
to help promote healing in the deeper pockets. Those areas of placement were 6M, 7D, and 2M.
These areas had definite 4mm pockets and could really benefit from the antimicrobial action of
Arestin. She also still has four teeth (#13, 15, 19 & 31) with retained root tips that contain decay
along with along with #2, 3, 5, 14, 32 for caries. Dr. Nantz had requested that she be referred for
those teeth mentioned above, which I did, but my patient has not received treatment for them yet.
5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions)
My patient has five teeth that are left with retained root tips that contain decay (#13,15,19,30,31).
She has had root canal therapy on #30 in the past, which has since failed hints the remaining root
tips. Dr. Nantz has requested that she be referred for those five teeth mentioned above. #2, 3, and 5
all have suspicious areas on the occlusal surface. Decay has a negative effect on the periodontium
(within the root tips or not). When a tooth is decayed, that surface then displays as roughened. A
surface that is rough and rugged will accumulate plaque and can lead to a carious lesion that extends
into the nerve chamber and causes pain to the patient. #15 is partially erupted. #16 is unerupted. Dr.
Nantz also told me to note the suspicious area on #17 as a watch. Hopefully with a fluoride
treatment and proper homecare we will be able to remineralize that tooth. There is attrition present
on #21-28. Because of the missing/decayed crown on #19, the gingiva has receded on the buccal
aspect of #20 by 2mm, which makes her at greater risk for root caries. There is a fracture on the
disto-occlusal of #32 which contains decay. There is not any furcation involvement in her entire
mouth. In the occlusal examination, I found that on the right side of her mouth, her molar region is
unclassifiable because she no longer has the crown of #30. The canine classification on the right is a
class I occlusion. A similar situation presented itself on the left side of her mouth. The molar is
unclassifiable due to the crown of #19s extreme decay, and the canine classification was I. Her
overbite was about 3mm and overjet at 4mm. She has a 4mm mid-line shift to the right. #11 and #20
are in cross bite. There are no open bites present in her mouth. My patient needs to be aware of her
malocclusion because it can affect her natural bite, causing lateral pressure on opposing teeth,
leading to abfraction and more severe periodontitis.
6. Treatment Plan: (Include assessment of patient needs and education plan)
All appointments will include:
-Reviewing medical and dental history
-Pre-Rinse
-New plaque and bleeding scores
-Gingival assessments and notes
-Ultrasonic scaling 1 quad / wk
-Full perio charting per quad
-fine scaling 1 quad / wk
-Chair side patient education
LTG 1: Bring plaque score down to .1 or less. (reduce plaque score by 0.5 each appt.)
STG: Define plaque
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STG: Define and demonstrate proper brushing

STG: Evaluate (and correct if needed) patients brushing method with typodont and also on self.
LTG 2: Halt disease progression of periodontitis
STG: Define periodontitis
STG: Define and demonstrate correct flossing technique. Continue flossing each night, just work on
technique.
STG: Reduce bleeding score by 0.5% (or more) at each appointment. Total bleeding score should be
0% by end of treatment.
LTG 3: See dentist for suspicious areas and retained root tips within 6 months-1 year
STG: Define caries and explain process
STG: Discuss diet counseling and how a lower pH effects enamel and caries process
STG: Discuss and educate on benefits of fluoride use
App't 1:
At my patients first periodontal appointment I will take a new plaque and bleeding score and also
do a gingival assessment and make thorough notes. I will ultrasonic and fine scale the mandibular
right quadrant at this appointment and have everything checked by my instructors. After the
quadrant is clean, I will thoroughly perio chart the quadrant with 6 pocket depths, tissue heights, and
clinical attachment levels, per tooth. If time allows, I would like to get through our first patient ed
session about plaque. I will define plaque which is a white sticky film that is made up of bacteria
and food debris. I will educate her on how plaque demineralizes the tooth surface and leads to
eventual decay, gingivitis, and possible periodontitis and tooth loss. I will demonstrate proper
brushing which includes angling a soft toothbrush 45 degrees towards the gingiva and removing
plaque from all surfaces. Last, I will evaluate my patients knowledge of brushing by watching him
at the sink. Our long-term goal is to reduce the plaque score to .1 or less by end of treatment.
App't 2:
At my patients second periodontal appointment I will take a new plaque and bleeding score and
also do a new gingival assessment and make thorough notes. I will ultrasonic and fine scale the
mandibular left quadrant at this appointment and have everything checked by my instructors. After
the quadrant is clean, I will thoroughly perio chart the quadrant with 6 pocket depths, tissue heights,
and clinical attachment levels, per tooth. If time allows, I would like to get through our second
patient education session about periodontitis. I will define periodontitis which is bone loss and
tissue destruction due to bacteria being present for a period of time. I will educate her on how
periodontitis progresses over time and cannot be reversed, but it can be stopped. I will demonstrate
proper flossing which includes making a C shaped loop around each interproximal tooth surface and
getting down into the sulcus (space between tissue and tooth) in order to effectively remove as
much bacteria as possible. Last, I will evaluate my patients knowledge of flossing by watching her
on the typodont and at the sink. Our short-term goals are to continue flossing each night before bed,
but to correct the technique in order to remove as much bacteria as possible; and to reduce the
bleeding score by 0.5% at each appointment. Our long-term goal is to halt the progression of the
disease process by end of treatment. I believe all of our goals are achievable.
App't 3:
At my patients third periodontal appointment I will take a new plaque and bleeding score and also
do a new gingival assessment and make thorough notes. I will ultrasonic and fine scale the
maxillary right quadrant at this appointment and have everything checked by my instructors. After
9

the quadrant is clean, I will thoroughly perio chart the quadrant with 6 pocket depths, tissue heights,
and clinical attachment levels, per tooth. If time allows, I would like to get through our third and
final patient ed session about caries. I will define caries which are areas of decay due to plaque
being left on the tooth surface for too long. I will describe what it looks like which is brown/black
and sticky. Diet and effective plaque removal are imperative in avoiding decay and eventual tooth
loss. I will educate her on how the caries progress over time and can cause other issues such as
broken teeth, or painful abscesses (both of which she has/or has had personal experiences with).
Also, sugar or fermentable carbs being left on the tooth or in the mouth for too long, lower the pH
which causes demineralization and/or caries. Proper brushing and flossing are critical but I will also
educate on the importance of fluoride to remineralize the tooth structure before decay occurs. Our
short-term goals are to make sure my patient has enough knowledge to understand effective plaque
removal and caries prevention. Our long-term goal is for her to see a dentist regarding the failed
root canal therapy, retained root tips and also for evaluation of several suspicious areas.
App't 4:
At my patients fourth periodontal appointment I will take a final new plaque and bleeding score
and also do a final gingival assessment and make thorough notes. I will ultrasonic and fine scale the
maxillary left quadrant at this appointment and have everything checked by my instructors. After the
quadrant is clean, I will thoroughly perio chart the last quadrant with 6 pocket depths, tissue heights,
and clinical attachment levels, per tooth. I will reinforce all of the previous patient education
sessions, answer any questions my patient may have, and commend her for areas of improvement
that are clinically obvious. I will plaque free and provide a fluoride treatment for my patient.
App't 5:
Two weeks after our last quadrant scaled will be our final appointment. I will take new probe
depths, measure new tissue heights, and calculate CAL accordingly on the entire mouth (6 points) to
determine if there were any changes from the first appointment. I will then recheck and fine scale all
areas and have this checked by an instructor. If there are any pocket depths that exceed 5mm, I will
place Arestin in the deep periodontal pockets. I will answer any questions and let her know her
progression in health. She will be placed on a frequent 3-month recall.
7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony crests,
thickened lamina dura, calculus, and root resorption)
Looking at the full mouth of radiographs, there is mild bone loss present in the upper anteriors (#611) and in the lower anteriors (#22-27) as well. Bone loss is an indication on periodontitis. We will
need to monitor her bone levels via radiographs at each appointment to make sure that we are
halting the disease. Also, visible in the radiographs is calculus in the interproximal area of all
mandibular anterior teeth, plus #7-10. Calculus that is visible on the radiographs tells me that I need
to be thorough in my instrumentation because it is a large piece. Calculus left untreated or
unremoved will help aid in the progression of periodontitis. There was a large suspicious area
shown in radiographs on #32, and a defective restoration (Failed root canal therapy) on #30. The
roots ONLY of #13,15,19,30, and 31 were shown as well. Decay has a negative effect on the
periodontium (within the root tips or not). When a tooth is decayed, that surface then displays as
roughened. A surface that is rough and rugged will accumulate plaque and can lead to a carious
lesion that extends into the nerve chamber and causes pain to the patient. The more plaque in the
oral cavity, the deeper the periodontal pockets, and the better chances of periodontitis progressing.
8. Journal Notes: (Record in detail the treatment provided, oral hygiene education, patient response,
complications, improvements, diet recommendations, learning level, progress towards short and
10

long term goals, expectations, etc.) The progress notes should be written by appointment date.
08-22-16
Today my patient came in for the first time this semester and was screened as a
prophy Class 5 patient. We started with medical/dental history to determine any background history
or information that may be supplemental to my patients treatment. My patient used pre-rinse and
the we headed back to radiology to begin a FMX (with vertical bitewings) for irregular dental care.
Her learning level was involvement and I briefly educated her on flossing. She qualified as my
perio patient and since she is my aunt, and only works part time, I am going to use her as my
primary perio patient. We discussed the number of appointments and she said it was fine, that she
would continue to come. I am going to see her every Monday for 4 hours until treatment and patient
education is complete. This should be just enough time to get everything done before the deadline.
At our next appointment, we will finish her FMX and the appropriate paperwork that is required for
a complete treatment plan for a periodontally involved patient.
09-19-16
Today we started with updating her medical/dental history and pre-rinse. We then
finished her FMX, head and neck/intraoral exam, periodontal assessment, dental charting with xrays, risk assessment, and informed consent. We determined that her periodontal case was a type II.
Her plaque score was 2.83 (fair). Her bleeding score was a 2%. We did a little bit of chairside/sink
side education while I watched her brushing method. I briefly suggested that she should try small
circular motions while brushing. The dentist, Dr. Nantz, referred her for caries/retained root tips on
#2,3,5,14,30,31, 32. Her gingival index was 1.08 fair and her bleeding score was 2%, and we will
reevaluate each of those at her last appointment. We also used the intraoral camera and took 6
different photographs demonstrating calculus and her specific site of periodontitis.
10-03-16
Today we started by updating her medical/dental history and pre-rinsing. I took a new
plaque score and bleeding score. Her plaque score had already improved from the first appointment
to a 1.33! Her bleeding score remained the same at 2%, which is not a surprise to me because we
had not cleaned any areas at the last appointment. We then began using the ultrasonic scaler to clean
the mandibular right quadrant. Since this was the first time for my patient to experience the
ultrasonic scaler, I explained to her in detail what it does, how it does it, and the benefits of it. I also
told her that some people are sensitive to it and require anesthesia, but some can handle it without. I
told her that once I began scaling I would let her decide what she felt most comfortable with. After
scaling a few posterior teeth she told me that it did not bother her or cause her any discomfort, so we
collectively decided that we would proceed without anesthesia but that at any time she became
uncomfortable, she would let me know. After getting my first ultrasonic check, we went to the
patient education room. We spent about 10-15 minutes teaching about brushing and plaque. I
defined plaque, demonstrated brushing, and had the patient show me how she brushes on the
typodont and at the sink. After she brushed herself, I disclosed him to show any areas that had been
missed. I asked her a few review questions and she was able to answer them correctly and she seems
interested in changing her brushing habits. When we got back to the chair I did a 6-point periodontal
charting on the quadrant I had just cleaned. Then, I moved on to fine scaling that quadrant.
Unfortunately, at my fine scale check I missed the maximum number of spots that are allowed. After
removing the remaining spots, I got my teacher to check again and they were all gone. My patient
was so happy with the appearance and new feel of the quadrant that I cleaned. She could not wait to
come back for her next appointment to finish the mandibular left quadrant. Her learning level is
self-interest at this point.
10-10-16
Today, just like every appointment before, we began by updating her medical/dental
history and I had her pre-rinse. We then went straight into the formal patient education session. This
11

second sessions, we discussed periodontitis and flossing. Her long-term goal for this session that is
to halt the progression of periodontitis. I started by defining periodontitis with the help of my
flipbook. Then, I defined and demonstrated correct flossing technique. I used her x rays and
intraoral pictures to show bone loss and recession and taught her about making a C shape when
flossing to get in between the teeth and clean the adjacent tooth surfaces. I first demonstrated the
flossing C-shape technique on the typodont and then my patient demonstrated flossing at the sink.
Our last short term goal related to this session would be to reduce the bleeding score by 0.5% (or
more) at each appointment with an overall short term goal to having bleeding cease by the end of
treatment. Her bleeding score at this appointment had reduced to 1.5%, which is achieving her
short-term goal. She reached another short-term goal because at this appointment her plaque score
had also reduced to 1 (good)! At the end of our patient education session, I encouraged her to ask
questions and ensured her that we would work as a team to continue our journey to overall oral
health. We then went back to my operatory and began ultrasonicing the mandibular left quadrant.
After getting this checked by an instructor, I proceed to completing a 6-point perio chart for that
quadrant. Finally, I fine-scaled the mandibular left quadrant to complete our appointment for the
day. I did better at removing all of the spots compared to last time, so I know that I am improving in
my instrumentation. My patients learning level is noted as action during this appointment. She is
highly motivated and impressed with her thorough cleaning.
10-20-16
Today was our third cleaning appointment. Just like in previous appointments we
started with updating medical/dental history, which had no changes, and she pre-rinsed. Following
that, I took an updated plaque score and bleeding score. She had improved on both which tells me
that she is interested in a healthy mouth and continuing to achieve her short-term goals, leading to
achieving her long-term goals. Her new plaque score was 0.33 (good) and her new bleeding score
was 0.2%. I also evaluating her gingival conditions and noted improvements in the mandible (as
explained above). We then started our third, and final, patient education session. Her long-term goal
discussed this session was to see dentist for suspicious areas and retained root tips within 6 months1 year. I defined caries and explain the caries process. We also discussed diet counseling and how a
lower pH effects enamel and caries process. Then I discussed and educated her on benefits of
fluoride use. I asked her if we she had any questions regarding any of our previous or current patient
education sessions. She was confident in her new learnings and was comfortable applying them to
her homecare. We then went back to my chair and I began to ultrasonic the maxillary right quadrant.
After the quadrant was ultrasoniced, I thoroughly perio charted the quadrant with 6 pocket depths,
tissue heights, and clinical attachment levels, per tooth. Lastly, I performed a fine scale. She said
that she was becoming sensitive and uncomfortable in the anterior region and on #12, so I placed
0.1mL of Cetacaine in these areas (facial and lingual) and she felt comfortable again. I continued
with fine-scaling and then had everything checked by my instructors. At the end of the appointment,
my patient informed me that her daughter was going to Texas Childrens Hospital soon and she
would likely be admitted for approximately 14 days. She wanted to be sure that we could make
arrangements for upcoming appointments, so that she could be finished before the end of the
semester but not have to leave her daughters side. After speaking with Mrs. Demoss, we agreed that
this was something out of our control and that her post cal evaluation would need to be one week
after the final appointment, rather than the original projected time of two weeks.
11-10-16
Today was our final cleaning appointment and we did not have any formal patient
education sessions to do. We began by updating medical and dental history, pre-rinse, and taking a
new plaque and bleeding score (0.16 and 0.2% respectively). I also did a gingival assessment of the
mandible and the maxillary left quadrants and noted the changes. I began using the ultrasonic on the
maxillary right quadrant and she told me that she was sensitive and uncomfortable in the whole
12

mouth. Just like the previous appointment, we chose to use Cetacaine. We placed 0.2mL of
Cetacaine on the entire maxillary right quadrant (facial and lingual). After I felt like I had completed
this area with my universal and slim-line, I signed up to have it checked by my instructors. Then, I
completed the final quadrant of periodontal charting. Once this was checked, I missed a couple
spots with ultrasonic but still passed the quadrant. This quadrant actually presented with the deepest
pockets of any charted before. There were some pockets of 5,6, and 7mm depths. I then proceeded
to fine scale. Here I was able to remove the spots missed from ultrasonic and this was my best
quadrants of spots missed. This is personally exciting because I am finally comfortable with
periodontal debridement. She did have one large, tenacious piece of calculus on the distal of #7 that
I fought with for a good while before I had to seek help from Mrs. Brown. Once she helped me get
the piece off, she told me that she had to use advanced instrumentation to remove it (Gracey 11-12).
After that quadrant was completely clean, I began plaque-free. I used a fine-grit polish because there
was not any staining in the entire mouth. After that was completed and checked by an instructor, I
reviewed and educated her on fluoride and then proceeded to give her a fluoride treatment. We used
topical fluoride trays (NaF 2%). Before releasing my patient, and since I had plenty of time, I
thought it would be a good idea to get after intraoral pictures. She seemed very impressed and
pleased with her new oral appearance. She will return in one week (approved by Demoss) for her
post-cal evaluation. I am excited to see our final product and see how well we worked as a team
to achieve her optimum oral health!
11-17-16
Today was our post-cal evaluation. Typically, you would want to wait 2-6 weeks after
periodontal debridement to analyze the tissue response, but because we are a school and my
patients daughter was placed in the hospital during our treatment, that just was not realistic. We
started by our usual update of medical/dental history and prerinse. Then, I took a new plaque score,
bleeding score, and a final gingival index. All three of those assessments had improved dramatically.
I praised my patient and let her know just how good her progress was. Her plaque score was only
0.6 away from our long-term goal of reducing her plaque score to 0.1 or less. She did reach her
bleeding score short-term goal of 0%! She reached her second goal of halting the progression of her
periodontitis as well. However, my patient has not met our third long-term goal of seeing a dentist
for referrals, but she still has a few months to meet that goal. I encouraged her to call a dentist to see
about repairing the referrals before they get out of hand and increase her periodontitis. She still has
four teeth (#13, 15, 19 & 31) with retained root tips that contain decay along with along with #2, 3,
5, 14, 32 for caries. Dr. Nantz had requested that she be referred for those teeth mentioned above,
which I did, but my patient has not received treatment for them yet. I also took new probe depths,
measured new tissue heights, and calculated CAL accordingly on the entire mouth (6 points) to
determine if there were any changes from the first appointment, which there were! Today my patient
presented with very few 4mm pockets. Those pockets include: 6MF, 7DF, 7MF, 8DF, 6ML, 2ML,
32L, and 32DB. All of these pockets have shown improvement from our initial pocket depth
readings. Unfortunately, deeper pockets are harder to clean, so periodontal pathogens can get into
those deeper areas and cause destruction, potentially leading to more areas of periodontitis. These
readings indicated that periodontal disease is still present. It may be active or inactive, but looking
at the rest of her progress, I would say that it is becoming inactive and healing. All of the rest of the
pocket depth reading are within normal limits (1-3mm). I found a few spots of recession, which is
periodontitis, but it was very localized. Tooth #14 had 2mm of recession that revealed itself on the
direct buccal surface. It was not shown initially because the tissue was so inflamed and the enamel
was coated with calculus. The other areas of recession are on tooth #20, and there was 2mm on the
direct buccal surface and 1mm on the distal-buccal surface. Overall my patient does still have
periodontal disease because it is not reversible. Hopefully, now that she has had a thorough dental
cleaning, she will be able to maintain good home care and keep up with regular dental check-ups
13

and we can continue to see an improvement in her overall oral health. I placed three Arestin
capsules in some localized areas to help promote healing in the deeper pockets. Those areas of
placement were 6M, 7D, and 2M. These areas had definite 4mm pockets and could really benefit
from the antimicrobial action of Arestin. For patient education, this appointment, I went over all of
our previous patient education topics. Her final learning level is considered habit because I believe
that flossing and brushing is a daily normal, routine for her now. I offered to answer any questions
that she may have and I placed her on a 3-month recall, so I will be seeing her again in February.
9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth
morphology, periodontal examination, recare availability)
My patient has a good attitude about halting the disease process. She is already brushing twice per
day and flossing 3 times each week, so I know she has some knowledge of maintaining oral health. I
think she will strive to change her current habits to avoid any progression of periodontitis, tooth
loss, and any chance of systemic disease once she is fully aware of how oral manifestations and
disease can affect you systemically. If she is willing to correct her brushing and flossing techniques
and visit the dentist initially for the referred items and frequently for thorough cleanings, her
gingivitis can be reversed and periodontitis can be stopped. She will likely be placed on a 3-month
recall for thorough cleanings and fluoride treatments, however, continued adequate home care is
essential for successful treatment. With further education, I think my patient and I can achieve
optimal oral health.
10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule.
(Note: Include date of recall appointment below.)
My patient will return two weeks after her last scaling appointment to reassess her gingiva and
healing. At this appointment, all quadrants will be fine scaled and evaluated. I will place this
patient on a 3-month recall visit for dental cleanings to stop any disease progression from
occurring. If my patient does not comply, the risk of periodontal disease progressing, is inevitable.
She was referred to a dentist by Dr. Nantz for evaluation of suspicious areas and retained root tips.
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing
depths)
We started by our usual update of medical/dental history and prerinse. Then, I took a new plaque
score, bleeding score, and a final gingival index. All three of those assessments had improved
dramatically. I praised my patient and let her know just how good her progress was. Her plaque
score was only 0.6 away from our long-term goal of reducing her plaque score to 0.1 or less. She
did reach her bleeding score short-term goal of 0%! She reached her second goal of halting the
progression of her periodontitis as well. However, my patient has not met our third long-term goal
of seeing a dentist for referrals, but she still has a few months to meet that goal. I encouraged her to
call a dentist to see about repairing the referrals before they get out of hand and increase her
periodontitis. She still has four teeth (#13, 15, 19 & 31) with retained root tips that contain decay
along with along with #2, 3, 5, 14, 32 for caries. Dr. Nantz had requested that she be referred for
those teeth mentioned above, which I did, but my patient has not received treatment for them yet. I
also took new probe depths, measured new tissue heights, and calculated CAL accordingly on the
entire mouth (6 points) to determine if there were any changes from the first appointment, which
there were! Today my patient presented with very few 4mm pockets. Those pockets include: 6MF,
7DF, 7MF, 8DF, 6ML, 2ML, 32L, and 32DB. All of these pockets have shown improvement from
our initial pocket depth readings. Unfortunately, deeper pockets are harder to clean, so periodontal
14

pathogens can get into those deeper areas and cause destruction, potentially leading to more areas
of periodontitis. These readings indicated that periodontal disease is still present. It may be active
or inactive, but looking at the rest of her progress, I would say that it is becoming inactive and
healing. All of the rest of the pocket depth reading are within normal limits (1-3mm). I found a few
spots of recession, which is periodontitis, but it was very localized. Tooth #14 had 2mm of
recession that revealed itself on the direct buccal surface. It was not shown initially because the
tissue was so inflamed and the enamel was coated with calculus. The other areas of recession are
on tooth #20, and there was 2mm on the direct buccal surface and 1mm on the distal-buccal
surface. Overall my patient does still have periodontal disease because it is not reversible.
Hopefully, now that she has had a thorough dental cleaning, she will be able to maintain good
home care and keep up with regular dental check-ups and we can continue to see an improvement
in her overall oral health. I placed three Arestin capsules in some localized areas to help promote
healing in the deeper pockets. Those areas of placement were 6M, 7D, and 2M. These areas had
definite 4mm pockets and could really benefit from the antimicrobial action of Arestin.

12. Patient Attitudes and Cooperation:

My patients attitude toward this whole experience was phenomenal. It was so exciting to see and
go through these changes together. She applied all of the techniques that I taught her. From
incorporating the Stillmans method in her brushing, to flossing daily, she really took ahold of her
oral health. The reason I know for a fact that she is cooperative is all in the numbers. Her plaque
score, bleeding score, gingival index AND pocket depths have all reduced significantly. I turned
her on to Glide, waxed, flat floss and she loves it (especially after he popcorn and kale). She is now
flossing daily. She knows that she needs to find a dentist in her network that is accepting new
patients to get those referrals taken care of and I told her that if she would like help with that I
would be more than willing to assist her. I know that she will continue to heal and keep up with her
homecare, and I am very pleased to have her as my aunt and patient. I cannot wait to see the
progress she has made at her 3-month recall appointment.
13. Personal Evaluation/Reaction to Experience:
What an experience this has been. It was so nice to go on this journey with my aunt/perio patient.
She spent 22.5 hours in my dental chair! That is serious dedication, and whether it was to help me
and my grade out or for her overall oral health, I am so pleased with her loyalty. I was happy to be
able to provide her with thorough treatment at a price no one in their right minds could pass up. It
has shaped me into a better clinician than I ever thought I could be, and gave me knowledge that
you can only get from practice, trials, and tribulations. I will continue to check on her and her
progress and being that she is my aunt; I know she will give me positive and negative feedback if
need be. I could not be more proud of my patient and her treatment results. My only hope is that
she remains motivated, gets her referrals taken care, and continues to have optimum homecare.

15

DATE________________________

NAME_________________________________________
PERIODONTAL CARE PLAN EVALUATION
PART 1
LIT Dental Hygiene
PC.9
Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
Competency
PC.10
Use critical decision making skills to reach conclusion about the patients dental hygiene needs based on all available
assessment data.
PC.12
Provide specialized treatment that includes preventive and therapeutic services designed to achieve and maintain oral health.
PC.13
Evaluate the effectiveness of the implemented clinical, preventive, and educational services and modify as needed.
All information should evaluated and correlated to periodontal disease; the progression of, the healing of, and the prevention of. Failure to evaluate and
correlate to periodontal disease on this write-up will constitute loss of points.
Topic area
Points
Excellent
Good
Fair
Unacceptable
5
4
3
2
Identifies many systemic conditions
Identifies several systemic
Identifies at least one relevant systemic
Fails to identify any relevant systemic
Medical
altering treatment, steps taken to avoid
conditions altering treatment, steps
condition altering treatment, steps taken to
conditions altering treatment, steps taken
History
medical problem, effect on dental hygiene
diagnosis and/or care. Relates many
medical history findings to periodontal
disease: its progression, healing, and
prevention

taken to avoid medical problem,

effect on dental hygiene diagnosis
and/or care. Relates several
medical history findings to
periodontal disease: its progression,
healing, and prevention
Identifies several elements of the
dental history, its effect on dental
hygiene diagnosis and/or care.
Relates several dental history
findings to periodontal disease: its
progression, healing, and
prevention
Identifies several findings of the
oral exam, steps taken to avoid a
medical problem, effect on dental
hygiene diagnosis and/or care.
Relates several oral exam findings
to periodontal disease: its
progression, healing, and
prevention

avoid medical problem, effect on dental

hygiene diagnosis and/or care. Relates at
least one relevant medical history finding to
periodontal disease: its progression, healing,
and prevention

to avoid medical problem, effect on

dental hygiene diagnosis and/or care.
Fails to relate any medical history
finding to periodontal disease: its
progression, healing, and prevention

Identifies at least one relevant element of the

dental history, its effect on dental hygiene
diagnosis and/or care. Relates at least one
relevant dental history finding to periodontal
disease: its progression, healing, and
prevention

Fails to identify any elements of the

dental history, its effect on dental
hygiene diagnosis and/or care. Fails to
relate any medical history finding to
periodontal disease: its progression,
healing, and prevention

Identifies at least one relevant finding of the

oral exam, steps taken to avoid a medical
problem, effect on dental hygiene diagnosis
and/or care. Relates at least one oral exam
finding to periodontal disease: its
progression, healing, and prevention

Fails to identify any finding on the oral

exam, steps taken to avoid a medical
problem, effect on dental hygiene
diagnosis and/or care. Fails to relate any
oral exam finding to periodontal disease:
its progression, healing, and prevention

Describes many characteristics of the

gingival exam by quadrant. Evaluates
many of the indices and relates to
periodontal disease

Describes several characteristics of

the gingival exam by quadrant.
Evaluates several of the indices and
relates to periodontal disease

Describes at least one characteristic of the

gingival exam by quadrant. Evaluates one
index and relates to periodontal disease

Fails to describe any characteristics of

the gingival exam by quadrant. Fails to
evaluate any index and relate to
periodontal disease

Describes many of the findings of the

periodontal examination and relates many
findings to periodontal disease.

Describes several of the findings of

the periodontal examination and
relates several to periodontal
disease.

Describes at least one of the findings of the

periodontal examination and relates any to
periodontal disease.

Fails to describe any of the findings of

the periodontal examination. Fails to
relate any to periodontal disease.

Dental History

Identifies many elements of the dental

history, its effect on dental hygiene
diagnosis and/or care. Relates many
dental history findings to periodontal
disease: its progression, healing, and
prevention

Oral Exam

Identifies many findings of the oral exam,

steps taken to avoid a medical problem,
effect on dental hygiene diagnosis and/or
care. Relates many oral exam findings to
periodontal disease: its progression,
healing, and prevention

Periodontal
Exam
Gingival
Exam &
Dental
Indices
Periodontal
Chart

16

Topic area
Dental Exam

Treatment Plan
Plans
Treatment
& Patient
Education

Points

Excellent
5

Good
4

Fair
3

Describes many of findings of the dental

examination and relates many to
periodontal disease and the disease
process.

Describes several of findings of the

dental examination and relates
several to periodontal disease and
the disease process. .

Describes at least one of the findings of the

dental examination and relates any to
periodontal disease and the disease process..

Fails to describe any of the findings of

the dental examination. Fails to relate
any to periodontal disease and the
disease process.

Assesses many of the patient education

needs. Accurately plans many of the
treatment and patient education sessions.
Many of the patient education topics are
appropriate.

Assesses several of the patient

education needs. Accurately plans
several of the treatment and patient
education sessions. Several of the
patient education topics are
appropriate.
Several of the long and short term
goals are developed with the
patient. Goals are provided to the
patient.
Describes several findings of the
radiographic examination and
relates many findings to
periodontal disease.
Thoughts are generally organized
and logically presented; word usage
is adequate and sets a professional
tone; several errors in spelling,
grammar, punctuation,
capitalization, and sentence
structure.
Plan is submitted within 96 hours
with grading sheet. Many records
are updated and properly identified.

Assesses at least one of the patient education

needs. Plans at least one of the treatment and
patient education sessions. At least one of the
patient education topics are appropriate.

Fails to assess any of the patient

education needs. Fails to plan any of the
treatment and patient education sessions.
Patient education topics are not
appropriate.

At least one of the long and short term goals

are developed for the patient. At least one
goal is provided to the patient.

Fails to develop any of the long and short

term goals. Goals are not provided to the
patient.

Describes at least one finding of the

radiographic examination and relates any
finding to periodontal disease.

Fails to describe any finding of the

radiographic examination and relates any
finding to periodontal disease.

Thoughts are somewhat disorganized, vague

and difficult to follow; word usage is
sometimes inappropriate and detracts from
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, and sentence structure.
Plan is submitted within 120 hours with
grading sheet. Not all records are updated
and properly identified.

Thoughts are very disorganized,

extremely vague, and difficult to follow;
word usage is often inappropriate and
detracts significantly from the
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, sentence structure. Plan is
submitted after 120 hours. Many records
are not updated or properly identified

Long and
Short Term
Goals
Radiographic
Findings

Many of the long and short term goals are

developed with the patient. Goals are
provided to the patient.

Writing &
Basic
requirements

Thoughts are highly organized and

logically presented; easy to follow; word
usage is correct and sets a very
professional tone; correct spelling,
grammar, punctuation, capitalization, and
sentence structure.
Plan is submitted within 72 hours with
grading sheet. All records are updated and
properly identified.

Describes many findings of the

radiographic examination and relates
many findings to periodontal disease.

TOTAL
POINTS
(50 points possible)

Comments:

17

Unacceptable
2

DATE________________________

NAME_________________________________________
PERIODONTAL CARE PLAN EVALUATION
PART 2
LIT Dental Hygiene
PC.9
Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
Competency
PC.10
Use critical decision making skills to reach conclusion about the patients dental hygiene needs based on all available
assessment data.
PC.12
Provide specialized treatment that includes preventive and therapeutic services designed to achieve and maintain oral health.
PC.13
Evaluate the effectiveness of the implemented clinical, preventive, and educational services and modify as needed.
All information should evaluated and correlated to periodontal disease; the progression of, the healing of, and the prevention of. Failure to evaluate and
correlate to periodontal disease on this write-up will constitute loss of points.
Topic area
Points
Excellent
Good
Fair
Unacceptable
5
4
3
2
Periodontal Exam
Gingival Exam
& Dental Indices
Periodontal
Chart

Describes many characteristics of

the gingival exam by quadrant.
Evaluates many of the indices
and relates to periodontal disease
Describes many of the findings of
the periodontal examination and
relates many findings to
periodontal disease. Compares
many of the findings to the initial
periodontal examination.

Describes several characteristics of

the gingival exam by quadrant.
Evaluates several of the indices and
relates to periodontal disease
Describes several of the findings of
the periodontal examination and
relates several to periodontal
disease. Compares several of the
findings to the initial periodontal
examination.

Describes any characteristics of the gingival

exam by quadrant. Evaluates an indices and
relates that indices to periodontal disease
Describes any of the findings of the
periodontal examination and relates any to
periodontal disease. Compares any of the
findings to the initial periodontal
examination.

Fails to describe any characteristics of

the gingival exam by quadrant. Fails to
evaluate any indices and relate to
periodontal disease
Fails to describe any of the findings of
the periodontal examination. Fails to
relate any to periodontal disease. Fails to
compare any of the findings to the initial
periodontal examination.

Describes many of the treatment

procedures provided, OH
education, pt. response, and
complications by appt date.
Describes many of the pt.
improvements, diet
recommendations, and learning
level. Descriptions are kept by
appt date.
Describes many of the STG &
LTG attained, and expectations.
Descriptions are kept by appt
date.
Describes many prognosis
characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability,
and periodontal examination.

Describes several of the treatment

procedures provided, OH
education, pt. response, and
complications by appt date.
Describes several of the pt.
improvements, diet
recommendations, and learning
level. Descriptions are kept by appt
date.
Describes several of the STG &
LTG attained, and expectations.
Descriptions are kept by appt date.

Describes any of the treatment procedures

provided, OH education, pt. response, and
complications by appt date.

Fails to describe any of the treatment

procedures provided, OH education, pt.
response, and complications by appt date.

Describes any of the pt. improvements, diet

recommendations, learning level, STG &
LTG attained, and expectations. Descriptions
are kept by appt. date.
Describes any of the STG & LTG attained,
and expectations. Descriptions are kept by
appt date.

Fails to describe any of the pt.

improvements, diet recommendations,
learning level, STG & LTG attained, and
expectations. Descriptions are not kept
by appt. date
Fails to describe the STG & LTG
attained, and expectations. Descriptions
are not kept by appt date.

Describes several prognosis

characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
periodontal examination.

Describes any prognosis characteristic by

attitude, age, number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
periodontal examination.

Fails to describe any prognosis

characteristics by attitude, age, number
of teeth, systemic background,
malocclusion, tooth morphology, recall
availability, and periodontal examination.

Journal Notes kept

by appt. date
Treatment provided,
OH education, pt.
response,
complications
Improvements, Diet
recommendations,
learning level
STG & LTG
attained,
Expectations

Prognosis

18

Topic area
Supportive therapy

Assessment of
changes
Pt. Attitudes and
cooperation
Personal
evaluation/reaction
to experience
Writing & Basic
requirements

Points

Excellent
5

Good
4

Fair
3

Describes many of the

suggestions made to patient
regarding re-evaluation, referral,
and recall schedule. Includes date
of recall appt.
Describes many of the changes
occurring from trt including
plaque control, bleeding, gingival
health, probing depths.
Evaluates comprehensively
patients attitude and cooperation
including patients mental and
emotional status, temperament
and attitude. Comments on
personal evaluation/reaction to
experience.
Thoughts are highly organized
and logically presented; easy to
follow; word usage is correct and
sets a very professional tone;
correct spelling, grammar,
punctuation, capitalization, and
sentence structure.
Plan is submitted within 72 hours
with grading sheet. All records
are updated and properly
identified.

Describes several of the

suggestions made to patient
regarding re-evaluation, referral,
and recall schedule. Includes date
of recall appt.
Describes several of the changes
occurring from trt including plaque
control, bleeding, gingival health,
probing depths.
Evaluates patients attitude and
cooperation including patients
mental and emotional status,
temperament and attitude.
Comments on personal
evaluation/reaction to experience

Describes any of the suggestions made to

patient regarding re-evaluation, referral, and
recall schedule. Date of recall not included.

Fails to describe any of the suggestions

made to patient regarding re-evaluation,
referral, and recall schedule. Date of
recall not included

Describes any of the changes occurring from

trt including plaque control, bleeding,
gingival health, probing depths.
Fails to evaluate patients attitude and
cooperation including patients mental and
emotional status, temperament and attitude.
Comments on personal evaluation/reaction to
experience

Fails to describe any of the changes

occurring from trt including plaque
control, bleeding, gingival health,
probing depths.
Fails to evaluate patients attitude and
cooperation including patients mental
and emotional status, temperament and
attitude. No comments on personal
evaluation/reaction to experience

Thoughts are generally organized

and logically presented; word usage
is adequate and sets a professional
tone; several errors in spelling,
grammar, punctuation,
capitalization, and sentence
structure.
Plan is submitted within 96 hours
with grading sheet. Many records
are updated and properly identified.

Thoughts are somewhat disorganized, vague

and difficult to follow; word usage is
sometimes inappropriate and detracts from
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, and sentence structure.
Plan is submitted within 120 hours with
grading sheet. Not all records are updated
and properly identified.

Thoughts are very disorganized,

extremely vague, and difficult to follow;
word usage is often inappropriate and
detracts significantly from the
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, sentence structure. Plan is
submitted after 120 hours. Many records
are not updated or properly identified

TOTAL POINTS
(50 points possible)

Comments:

19

Unacceptable
2

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