PERIODONTAL CARE PLAN

Patient Name:
Student Name: Jennifer Shoemaker
Date of initial exam: Thursday September, 8, 2016

Age: 43
Date Completed: __________

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.
Pt is a 43 year old white male. He is currently not under any physician care at this time. He is aware that
he needs a cleaning because it has been over 25 years since his last dental visit. He does not have any
recent hospitalizations and overall is in good health. He does however have high blood pressure. He states
that a few years back he went to a Dr. that put him on blood pressure medication (Lisinopril he thinks)
and they monitored him. He kept a bp log and at the end of the time period was able to stop taking his
medication. His bp at this appointment was 130/90 putting him at Stage 1 hypertension. I explained to
him that this was slightly elevated and he and his wife stated that he has extreme anxiety of any medical
offices. He had a physical back in 2007 and got a great report. Pt did list that he takes Zyrtec 10mg as
needed for seasonal allergic rhinitis. I explained to pt that this medication can cause overly dry mucous
membranes, nose or throat and to hydrate regularly. Especially since this medication can decrease salivary
flow which is a big factor in caries, periodontal disease and candidiasis. He has smoked a pack or more of
cigarettes a day for over 25 years and drinks at least a 30 pack of beer per week. Smoking is directly
associated with oral conditions such as dental staining, dry mouth, halitosis, periodontal disease, and
cancer. Cigarette smoking is associated with a low oxygen tension in the periodontal pockets making
growth of anaerobic bacteria more prevalent. Smoking will cause a decreased sense of inflammation and
decreased GCF fluid that would normally be indicative of periodontal disease. This is due to the nicotine
in cigarettes which is a vasoconstrictor. A recent study shows that smokers have a higher number of
neutrophils, but neutrophils have shown a decreased adherence, chemotaxis, and phagocytosis in
smokers. Also, smoking decreases production of IgG2 antibody which in turn leads to decreased serum
immunoglobulin G (IgG) concentration. So, smoking enhances the formation and accumulation of
advanced glycation end products (AGEs) in the periodontal tissues, which leads to the overall periodontal
health being jeoparadized. Smoking also affects the alveolar bone. Although the mechanisms of how
nicotine contributes to alveolar bone damage are not completely understood, there are several different
proposals. Smoking not only alters normal bone remodeling by increasing the release of matrix
metalloproteinases, it suppresses osteoblasts and increases the secretion of certain chemicals which have
tumor necrosis factors. Smoking not only increases pts risk for progressing his periodontal disease, but it
also will affect his response to our proposed treatment. Smokers exhibit less reduction in probing depths
and CAL after periodontal therapy. In order for his treatment to have its full potential of success, pt must
be willing to quit smoking. When I asked pt if he has attempted to quit in the past, he stated that he had
and really tried 2 times. I explained to him that each time is different and that it is never too late to quit.
He understands the risk associated with his oral health, increase for cancer and decrease in treatment
success. He says he is open to trying to quit again and would be willing to attempt this. Pt also states that
he drinks up to 30 beers per week. Alcohol also increases the risk of oral cancer because alcohol breaks
down into acetaldehyde, which can combine with proteins in the mouth. This can trigger an inflammatory
response from the body and possibly develop cancerous cells. This risk is SIGNIFICANTLY impacted
and increased when alcohol consumption is combined with the use of tobacco. If pt is able to stop
smoking, decrease his alcohol consumption, begin frequent dental care visits while continuing to practice
proper oral hygiene care, his chances of halting his active progression of periodontal disease would
increase substantially. Also, his risk for developing cancer would greatly decrease. His wife who was with
him at this appointment was a former smoker and quit almost 6 years ago. So he has the support system,
we just need to give him the tools. He has a daughter who is 15 years old, so he has the motivation. He

needs to find a full time dentist, and I intend on putting together a packet of info for tobacco cessation.
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)
Pts last dental cleaning was 25 years ago. He was formerly in the United States Navy, and since he got out
has not been back for a cleaning. He did however have tooth #20 extracted in 2007 due to deep decay
with no complications. He states that he has not had any serious problems associated with his previous
dental treatment. He did state that when his maxillary 3 rd molars were extracted in boot camp it was
painful and he had trouble getting numb. He does not have any complaints listed on his dental history
other than wanting a check-up to make sure he does not have any cavities. Pt says he feels good about his
teeth/smile appearance. He does not drink any sugar containing beverages and does not chew gum. He
uses a soft bristled toothbrush and his method is the Bass in combination with Leonard. He brushes twice
a day with fluoride toothpaste (Crest). I made the recommendation to floss and he states that when he has
something in between his teeth uses plackers flossers. I explained to him the importance of flossing in
the beginning a few times (2-3) per week and progressing to every night. He seems to be very interested
in his overall oral health. He uses an antiseptic mouth rinse with fluoride in it. He thinks it is Listerine. I
explained to him switching to an alcohol free mouth rinse (ACT) would be much gentler on his gingival
tissue and would be beneficial for his areas of recession and demineralization. His bleeding score was not
bad (9.2%) but that can be masked because of his tobacco use constricting the vessels, leading to
decreased BOP. Pts plaque score was good (0.33) and he does effectively remove plaque. After applying
the disclosing solution, I was able to show him areas he missed (mostly Lingual) and taught him proper
techniques to improve his brushing angles. His dental IQ is moderate due to socioeconomic circumstances
and infrequent dental visits. He states that when he was growing up, his parents were very big on dental
hygiene. I believe the main factors that contribute to his periodontal disease level are tobacco and alcohol.
He does not have dental insurance or financial status to purchase insurance at this time. His learning level
I have to say is awareness and self-interest. He has the information about the negative effects of
tobacco/alcohol on his general and oral health but does not apply them, and he does have a mild
inclination to act or he would not be at the dental office. He shows interest in improving his oral health
and seems very interested in tobacco cessation. All in all, I am really excited to have pt as my Periodontal
Patient.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
During pts extra oral examination, I noted under his right eye a red macule 2x2 mm in diameter.
The borders were perfectly uniform and round. He stated that it has been there for as long as he
can remember and had never noticed any change in size, shape or color. The etiology is
developmental. I explained to him that if it did begin to change in those categories to have it
looked at by a physician or a dermatologist. I also noted bilateral lymphadenopathy along Pts
submandibular glands. These sit just below the jaw toward the back of the mouth and he states he
has had sinus drainage for the last few days. There were no other atypical or pathological
findings in the extra oral exam. During the intraoral exam, the patients oropharynx area was red.
This etiology is smoking which in turn causes sinus drainage. The patient has bilateral linea alba.
He occasionally grinds at night as he has attrition along the incisal edge of his anteriors. Pt does
not know if he clenches, but due to the linea alba I am inclined to believe he does. I explained to
pt that clenching his jaw during the day or at night puts continuous force on his maxillary and
mandibular teeth. This can lead to damage of the teeth and periodontium. I explained to him (as
did the Dentist also) that grinding will cause the teeth to wear down exposing dentin and making

them weaker and more susceptible to caries and fracture. I recommended a Night guard to
protect his teeth from occlusal force and wear. I did notice heavy staining along the lingual areas
of pts dentition from years of tobacco use. His occlusal examination was class I molar right/left
and canine on the right side was class II and left side was class I. He has an overbite of 4 mm and
an overjet of 3mm, and his midline shift is 3 mm to the left. I noted an end to end bite on tooth
#s 14/19. He has a slight buccal crossbite on his left side # 3-15 and #18-20.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification: V
Periodontal Case Type: II
b. Gingival Description: Generalized slight periodontitis with slight bleeding on lingual of
maxillary anteriors, lingual of maxillary left posteriors, lingual of #18, 19, 24, 25, 28, 29 and
buccal of #28-31.
App't 1: 9-8-2016
Pts gingival architecture was generalized scalloped. The color was generalized red distributed
throughout the marginal and papillary. I did note along the lingual of #31 the tissues seemed
to be more red/diffuse and enlarged. The consistency was generalized soft, flaccid with #31
lingual area to have more of an edematous or spongy consistency. The margins were
generalized rolled. The papillae were bulbous and #31 had slight suppuration/bleeding upon
probing. The papillary and marginal surface texture for both maxillary and mandibular arch
was generalized smooth and shiny. The attached surface texture appeared smooth and shiny.
All his descriptions were associated with periodontal disease. He did have some slight
bleeding but again was masked by the vasoconstrictive effects of nicotine
App't 2:
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App't 3:
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App't 4:
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App't 5:
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App't 6:
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c. Plaque Index:

Appt 1: 0.33 (good) 2: _____ 3_____ 4_____ 5_____

d.Gingival Index: Initial:

1.21 (fair)

Final _____

e. Bleeding Index: Appt 1: 9.2% 2_____ 3_____ 4_____ 5_____

f. Evaluation of Indices:
1.Initial
On pts initial visit, he was classified as having mild periodontitis with slight horizontal bone
loss. The purpose of the plaque index is to assess and monitor the extent of dental plaque and
debris on a tooth and its surfaces. Pts plaque index score was 0.33 which is good. There is
always room for improvement and this can be done by proper brushing, flossing and regular
dental visits. Tooth # 19 had plaque on the M and L surfaces. I do feel as though my patient may
have brushed a bit more in depth than his normal homecare routine. The purpose of the Gingival
Index (GI) is to assess the severity of gingivitis based on color, consistency, and bleeding on
probing. Pts gingival index obtained was 1.21 which is fair. I do believe that his gingival color
and consistency is masked by his smoking. The lingual surfaces of #9, 25 and 28 had higher
scores on the gingival index. There were not any areas in the mouth other than #31 that would
have spontaneous bleeding but this tooth was not on the gingival index sheet. Again, I believe
this is masked by the patients habitual smoking habit. The bleeding score was 9.2%, indicating
that the patient does have lack of regular flossing habits and lack of frequent dental visits. All
but 6 of the bleeding points (28-31 facial) were on the lingual surfaces and they were mostly on
the anterior teeth. There were some bop areas along #13-15 lingual, 18-19 lingual, #28-29
lingual and #31 on all surfaces. Pts plaque, gingival and bleeding index indicate that the need
for regular flossing and good oral hygiene. These 3 factors are all directly correlated with
periodontal disease. If pt complies with all advised areas of brushing, flossing, tobacco cessation
and less alcohol consumption then these three indices will decrease and his overall oral health
will improve.

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g.Periodontal Chart: (Record Baseline and First Re-evaluation data)
1.Baseline
There were a total of 162 areas of the 27 teeth examined for periodontal involvement. Thirty of
the possible 162 areas had 4-5 mm pockets. A total of 19 out of the 27 teeth examined had 1 mm
of recession. There were 17 out of the 162 spots that bled upon probing, totaling a bleeding score
of 9.2% The maxillary right quadrant contained 2 bleeding spots upon probing on #7 & #8, 6
teeth with 1mm of recession on #2-4 facial, 6-8 facial, and 6 areas of 4 mm pocket depths on
#2DL, 3DL, 4DL, 5ML and 6DL. The maxillary left quadrant contained 6 spots that bled upon
probing on #9-11 lingual, #12-15 lingual, 5 teeth with 1mm of recessionon #9-11 facial,12-13
lingual, 14 facial/lingual and #15 facial , and 4 areas of 4 mm pocket depths on #12DB, 13MB,
#14DL, and #15ML. The mandibular left quadrant contained 3 areas of bleeding spots on
probing on #18, #19 and #24, 4 teeth with 1mm of recession on #21-24 facial, and 8 areas that
had 4 mm pocket depths on #18ML, #18MB, #18DB, #19DL, #19ML, #19DB, #21DL, and
#22DB. The mandibular right quadrant contained 8 bleeding spots upon probing on #25L,
28B/L, #29B/L, #30B, #31 B/L, 4 teeth with 1mm of recession on #25-26 lingual, #28
facial/lingual, #29 facial/lingual and 12 areas of 4-5 mm pocket depths on #26DB (4mm),
#27MB/DB (4mm), #28MB (4mm), #29DL (4mm), #30ML (5mm) and #30 DL (4mm),
#31ML,L, MB (5mm) and 331 DL/DB (4mm).
2.Firstevaluation__________________________________________________________________
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5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions)
Pts dental exam presented incisal attrition on #7-10 and #23-26 due to grinding/bruxism. There was
no active caries noted but there were 3 areas of hypomineralization on #29-31 on the gingival third
buccal area. The Dentist said we can put a watch on these 3 areas but at this time no treatment is
needed. #1 and #16 are impacted and not believed to ever come down or cause patient any issue. Pt is
missing #17, #20 and #32. There are silver alloy fillings on #2DOL, #3O/MO, #15O, #18DOL,
#31MOL. This patient has a malocclusion of Class I on Molar regions Class II right Canine region
and Class I on left Canine. There was a midline shift of 3 mm to the left and overbite of 4 mm and
overjet of 3 mm. There is a slight crossbite on left side #3-15 and #18-20 and an end to end bite on
#14/19.

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

App't 1: 9-8-2016
I went over my patients medical and dental history and took his vitals. I had him sign
appointment practice, statement of release, and HIPPA forms. I had him pre-rinse with the
antiseptic ACT mouthrinse. I took pt to the xray room and took a FMX using phosphor plates
including vertical bitewings. I decided to do this given his tobacco/alcohol history and length of
time since previous dental cleaning. I was VERY hopeful he was going to be my Perio Patient
. Next, I began intra/extra oral examination, periodontal assessment, dental charted using
xrays, oral health risk assessment and took plaque/bleeding scores. I had patient sign his
informed consent so he is aware of all our findings. I then got his Gingival Index and did some
patient education at the chair on correct angulation of toothbrush while brushing to get bristles
into sulcus. I also educated patient on importance of flossing, tobacco cessation and need for
frequent dental visits.
App't 2:
Since my patient is a class V and periodontal case II, I plan on using the ultrasonic scaler due
to the amount of calculus buildup and heavy staining. I do plan on having patient anesthetized as
most of his buildup is subgingival and this can be uncomfortable.
Update MDX
-Pre-rinse
-Retake any Xrays needed
-Gingival Index
-Bleeding score
-Plaque score
-Patient Education session I
-Ultrasonic scale Maxillary right
-Full perio chart Maxillary right
-Fine scale Maxillary right

Pt Ed Session 1
1. Discuss goals for session, modify if necessary.
LTG 1: Reduce plaque score by .1 each visit
STG: Goal is .10 by last visit
STG: Define plaque
STG: Modify patients brushing technique as needed
2. Teach Lesson 1: Plaque and Brushing

 Question pt for knowledge of plaque

-Can you tell me what plaque is?
-soft, sticky, white or yellow substance that forms over teeth
-Plaque if not brushed off teeth properly will harden into calculus (show on xray)
-Tell me what plaque can cause
Teach your Topic (Plaque)
-Use FLIP BOOK , patients paperwork and x-rays as visual aids.
Teach your Skill (Brushing)
-Explain to Patient why you are teaching them this technique
- Brush teeth 2xday
-Demonstrate on typodont
-Let Patient try technique on typodont-modify if needed
Teach your Skill (Brushing) at the sink
-PPE
-Allow Patient to brush while looking in the mirror
-Modify their technique as they brush
-Disclose and allow patient to evaluate how well they brushed
-Point out areas they missed and assist in removing plaque
-Teach importance of tongue brushing
3.

Complete session- return to table

Ask Patient questions to check for learning
- Tell me what you remember about plaque
- Why did I teach you about brushing technique?
- Do you remember what plaque can cause?
Encourage, Encourage, Encourage
Give Patient a brief idea about their next session
Establish with your patient that you are partners improving their oral health. You
are committed to teaching them and cleaning their teeth, but they need to do their
homecare- WE ARE A TEAM!!
Always THANK Patient for their efforts and time

App't 3:

Update MDX
-Pre-rinse
-Gingival Index
-Bleeding score
-Plaque score
-Patient Education session II
-Ultrasonic scale Maxillary left
-Full perio chart Maxillary left
-Fine scale Maxillary left

Pt Ed Session II
1. Discuss goal attainment from last session
2. Discuss new goals for session, modify if necessary
LTG 2: Halt Periodontitis by end of treatment
STG: Define Periodontitis (receding gums, bone loss, irreversible, loss of attachement)
STG: Teach importance of flossing technique
STG: Reduce bleeding score by .2 each visit
3. Teach Lesson 2- Periodontal disease and Flossing
Question for knowledge- ask questions first to see what patient already knows so you
know where to start teaching.
- Can you tell me what Periodontal Disease is?
- Did you know you have Periodontitis, a form of Periodontal disease?
(attachment loss, irreversible)
- Do you know the difference between Gingivitis and Periodontitis?
Teach Topic (Periodontitis)
- Use Flip Chart, Patients paperwork, and xrays as a visual aid
Teach Skill (Flossing)
- Explain why flossing is so important
- Demonstrate on Typodont
- Let Patient try technique on typodont. Modify technique as needed
Teach your skill at the sink
- Always have PPE
- Allow patient to floss while looking in the mirror
- Modify their technique as they floss
- Disclose patient to evaluate how they flossed
- Point out areas they missed and assist them in removing plaque

1. Complete session- return to table

Ask questions to check for learning
- Tell me what you remember about Periodontitis
- Why is flossing so important?
Encourage, Encourage, Encourage!!
Give Patient a brief idea about next session
Establish with your patient that you are PARTNERS in improving their oral health. You are
committed to teaching them and cleaning their teeth, but they need to do their homecarewe are a TEAM!!
Thank Patient for their time and effort

App't 4:
Update MDX
-Pre-rinse
-Gingival Index
-Bleeding score
-Plaque score
-Patient Education session III
-Ultrasonic scale Mandibular right
-Full perio chart Mandibular right
-Fine scale Mandibular right
Patient Ed Session III
1. Discuss goal attainment from last two sessions
2. Discuss new goals for this session, modify if necessary
LTG: Patient will quit smoking completely by recall date in Spring 2017
STG: Teach importance of overall health and effects of tobacco on oral health
STG: Find support system (wife), call 1800 227-2345 seek patches, nicotine gum
STG: Change lifestyle patterns to avoid smoking or cessation failure
3. Teach Lesson 3. Patient will quit smoking by Spring 2017 (recall date)
Question for knowledge ask questions first to see what patient already knows so
you know where to start teaching
Teach topic
- What can tobacco cause?
Stained teeth
Dulled sense of taste

Slow healing after tooth extraction or cleaning

Oral Cancer
- Present Smoking Cessation Resource Guide with info to patient

You said you would like to quit. Lets set a realistic date you plan on quitting by
- March 1, 2017 (allow patient to pick date)
- Hold them accountable, tell them you will be calling to check up on them
- Ask them if they have any questions

4. Tell Patient that you are partners in improving their oral health and that you are
committed to teaching and helping them improve their oral health. Remind them that they
need to continue their regular homecare of flossing and brushing and tobacco cessation.
Thank your Patient for their time and effort
App't 5:
Update MDX
-Pre-rinse
-Gingival Index
-Bleeding score
-Plaque score
-Ultrasonic scale Mandibular left
-Full perio chart Mandibular left
-Fine scale Mandibular left
App't 6:
UPDATE MDX
-Pre-rinse
-Gingival Index
-Bleeding score
-Plaque score
-Patient Education at chair
-Evaluate all 4 quadrants
-Check for calculus that may have been missed
-Plaque free
-Fluoride (Varnish, Pt Ed)
Set Recall Appointment
Ask patient about concerns
THANK PATIENT!!

7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony
crests, thickened lamina dura, calculus, and root resorption)
Upon review of pts xrays noted some horizontal bone loss on #28M and #30-31 which is
consistent with suppuration noted. Also, #31D has a widened PDL and #14 has widened PDL
on D of mesial root. There was calculus seen on xrays of #5, 6, 9, 10, 22-26. Also, #1 and
#16 3rd molars are impacted. Calculus is a risk factor for periodontitis because it contains
bacteria. The bone loss is the cause of his immune response and trying to maintain a healthy
sulcus. Once the bone is lost in periodontitits, it irreversible and will not come back but we
can stop the progression of this disease.

8. Journal Notes: (Record in detail the treatment provided, oral hygiene education, patient response,
complications, improvements, diet recommendations, learning level, progress towards short and long
term goals, expectations, etc.) The progress notes should be written by appointment date.
9-8-2016
Pt was seated in the dental chair and we filled out his paperwork and medical/dental history. His vitals
were good except he is Stage 1 Prehype (130/90) so we discussed his history with blood pressure. He
has anxiety when he goes to any sort of medical appointment. He smokes a pack or more of cigarettes
per day and drinks at least 30 beers per week. Patient states that he has not had a dental cleaning in
over 25 years and no xrays either. The only medicine pt takes is Zyrtec 10mg for allergies. At this
time I advised patient that we should take a FMX to aid in cavity detection, periodontal disease status
and any other pathological issues that may be going on. Next, we performed a head and neck exam
and intraoral exam. Only noted one area under patients right eye where he had a raised lesion. The
lesion has not changed in years and explained to patient the importance of monitoring for any
changes. The patient does have bilateral lymphadenopathy along his submandiubualr glands and this
is consistent with sinus drainage he states he has had for the past week or so. His orophayrnx and
tonsil area was red bilaterally with etiology also being sinus drainage. Patient states that every time he
has quit smoking his sinus drainage and allergies go away. I used this as a perfect time to discuss the
importance of quitting smoking. I told him that there are so many resources now to aid in smoking
cessation. Pts wife was at the appointment and she used to smoke so she will be his biggest support.
Pt also has bilateral linea alba on his cheeks from biting and I discussed a NG though he does not
seem interested at this time. We went on to the periodontal assessment and noted scalloped and red
gingival tissue. The marginal gingival was rolled and bulbous. There was suppuration and bleeding
upon probing #31 lingual area. The surface texture for papillary and marginal tissue was smooth and
shiny and attached texture was stippled. I then pulled up the xrays we took and began the
radiographic findings. There was horizontal bones loss noted and I explained to patient that at this
time he has periodontitis with bone loss. I explained to him that if this disease progresses without any
sort of change (flossing, brusing, tobacco cessation, etc) that he will continue to lose bone and
eventually his teeth will be mobile. He was very understanding and equally concerned about this. He
states that the reason he is here is to prevent that. There was calculus detected on his xrays along
lower anteriors and #5, #6, 9-10. I explained that this is the hard tartar that he is unable to remove at
home. He understands. After the perio assessment, I charted the patients existing restorations. He has
5 teeth with alloy restorations. The dental exam noted attrition on incisal edge of anterior teeth due to

grinding and we discussed again the idea of a night guard. There were a few areas of hypcalcification
on gingival third of #29-31. The patient had several bleeding spots mostly along the lingual surfaces.
He does have some 4-5 mm pockets and explained the difficulty in cleaning these pockets. Pt also
have several areas with minor 1mm of recession. After dental charting a plaque, gingival and bleeding
index were taken. Pts plaque index was good at 0.33, his bleeding index was 9.2% and his gingival
index was fair at 1.21. I explained to patient that a lot of oral health conditions are masked when the
patient smokes. With regular flossing, brushing, frequent dental visits, tobacco cessation and alcohol
consumption reduction these factors may be significantly reduced. We went over the Oral Health Risk
Assessment and determined due to smoking, drinking, personal history of periodontal disease,
infrequent dental care, radiographic loss of crestal bone, clinical recession, BOP, hypocalcification
areas, infrequent dental exams, exposed root surfaces and missing teeth that this patient is at high
risk. He is at high risk for multiple disease factors including but not limited to periodontal disease,
caries, oral cancer/pathology and a multitude of other factors. Once I had completed collecting all of
my findings, I explained to pt what periodontal disease is and how high his risk is. I explained that
along with smoking, drinking and infrequent dental visits to maintain plaque and calculus control his
overall oral health is in need of a big change. I explained that I would love for him to be my
Periodontal patient and that involved several visits. I explained that I would ultrasonic/scale each of
his quadrants at separate visits to assure the utmost level of cleaning and healing time possible. The
patient was very compliant and excited and signed the informed consent.
9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth
morphology, periodontal examination, recare availability)

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

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11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing
depths)

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12. Patient Attitudes and Cooperation:
So, I have been so nervous and anxious to find my periodontal patient. I can honestly say this
patient could not be more compliant, tolerable, motivated and accountable. He is very interested
in tobacco cessation and excited to get his oral health care under control. He looks forward to the
patient ed sessions and seems very interested.

13. Personal Evaluation/Reaction to Experience:

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