Date: 10/14/16
Student Name: Emily Hummel
Patient Name: Donella T
DOB: N/A
Medical History & Medications:
Patient is taking Simvastatin for high
cholesterol. Ranitidine for acid reflux.
Naproxen bid for arthiritis pain. Aspirin
every morning and a sleep aid when
needed.
Developmental Abnormalities & Defects: Restorative Problems:
Popping in left TMJ, bilateral mandibular
tori, attrition on # 27-22, wear faucets on 6
and 11
Risk Factors are as follows (be specific).
1. Systemic Health:
CVD:
Diabetes Mellitus:
Respiratory Disease:
DMACC
Dental Hygiene
Treatment Plan
ASA Physical Status Dental History: Occlusion:
Classification: Patient said she recently went to her Class I
Class I dentist 1 week ago and was told that she
needed a "deep cleaning" on all four
quadrants. The patients dentist told her
that she needs a root canal on her lower
molar #18. He suggested the deep
cleaning be completed before the root
canal. Due to the price of SRP treatment
in a dental office she decided to come
back to DMACC Dental Hygiene Clinic
to complete SRP. Patient has multiple
extracted teeth #1, 2, 3, 4, 5, 12, 13, 14,
16, 17, 19, 31, and 32. Patient also has
multiple restorations, #9 IDLF
composite, #11 DLF composite, #18,
21, and 28 O amalgam, #5 and 29 OD
amalgam, # 20 OD composite, and # 9
and 10 MIF composite.
Other: Radiographic Evidence:
#18 is in need of a root canal No
3. Caries High risk
No Sugar Intake: Intermediate
No Streptococcus Mutans Count: High
No Plaque-Removal Ability: Poor. Patient does not have
dexterity limitations and is able to
use a toothbrush and floss
normally. The patient does not
spend enough time removing
plaque from her teeth
1
 Osteoporosis: None Socioeconomic Status: Middle Class
Preterm Low Birth Weight: No Plaque Retentive Factors: Crown margins, decay
concavities, deep pockets,
missing teeth
Behavioral Status: Patient is interested in Fluoride History: Patient drinks flouridated water
returning for 3 month SPM regularly both as a child and
appointments to keep her currently. Patient uses flouride
remaining teeth intact. toothpaste daily.
Psychosocial Status: Normal Past & Present Caries Activity: Patient has Class V decay on
facials of 6 and 28. Class IV
decay on #10. Class II decay in
two areas on #18.Patient also has
multiple restorations, #9 IDLF
composite, #11 DLF composite,
#18, 21, and 28 O amalgam, #5
and 29 OD amalgam, # 20 OD
composite, and # 9 and 10 MIF
composite.
Medication Considerations: None Other: N/A
Other: None
4. Periodontal Disease: Generalized moderate
2. Oral & Pharyngeal Cancer: No (host environmental risk factors/indicators)
Tobacco Use: Cigarette Previous History of Disease: Patient has gone through SRP in
the past, and did not maintain
SPM appointments or proper oral
care.
Race: Caucasian Classification of Disease(s): Generalized moderate
periodontits
Alcohol Use Average Clinical Attachment Loss: Generalized slight/moderate
Sun Exposure: She takes smoke breaks Stress Factors
outside at work. After work
patient regularly takes a walk
around her neighborhood for
excercise.
Pathology: None PHP: 2 fair
Other: N/A PBI: 22% slight
Deposits Classification: Class V
Bacterial Pathogens: Decay causing pathogens are high

2
 in this patients oral cavity. Patient
scored a 8717 on the caries
suseptability test.
Tobacco Use: Cigarettes
Glycemic Control None
Inherited Risk None
Other: None

3
Date: 10/14/16
Student Name: Emily Hummel
Patient Name: Donella T
DOB: N/A

Diagnostic Decision Making

Eight Human Needs Related to Oral Health & Disease
Assessment (check signs and symptoms present)
1. Wholesome Facial Image 5. Freedom from Head and Neck Pain
Teeth Gingiva Facial Profile Extra-/intra-oral pain or sensitivity
Breath Other: Other:

2. Freedom from Anziety/Stress 6. Biologically Sound & Functional Dentition

Reports or Displays: Reports difficulty in chewing
Anxiety about proximity of clinician confidentiality or previous Presents with:
dental experience. Defective restorations Ill-fitting dentures, appliances
Oral Habits Substance Abuse Teeth with signs of disease Abrasion erosion
Missing teeth Rampant caries
Concern about: Other:
Infection control, fluoride therapy, fluoridation, mercury toxicity

3. Skin & Muccous Membrane Integrity of Head & Neck 7. Responsibility for Oral Health
Extra/intra-oral lesion Pockets greater than 4mm Plaque and calculus present
Swelling Attachment loss greater than 4mm Inadequate parental supervision of oral health care
Gingival inflammation Xerostomia No dental exam within the last 2 years
Bleeding on probing Other: Other:

4. Protection from Health Risks 8. Conceptualization & Understanding

BP outside of normal limits Need for prophylactic antibiotics Has questions about DH care and/or oral disease
Potential for injury Risk Factors Other:
Other: Tobacco Use

4
5
Date: 10/14/16
Student Name: Emily Hummel
Patient Name: Donella T
DOB: N/A

1. Initial Review Statement (chief concern, patient wants and expectations):

Patient is a 62 year old female seeking regular dental cleanings to maintain remaining teeth. She has not been into the DMACC Dental Clinic to get
her teeth cleaned in 3 years. She was last seen at the DMACC Dental Clinic in 2013. Patient has pain in lower left molar and her doctor at the Dental
Plaza recommended she have a root canal on that tooth. Her doctor recommended she got a "deep cleaning' before the root canal. She would also
like to get back on a regular cleaning schedule. My patient reports she smokes cigarettes but is somewhat interested in quitting. She reports that her
partner also smokes which makes it hard for her to quit. She would also like her teeth to be whiter and hoped that this cleaning plus whitening
toothpaste would help whiten her teeth. She brushes one to two times a day and trys to floss every day. The patient reports severe dental anxiety and
insists on nitrous for her scaling appointments. She also reports sensitivity under her gums and on her teeth.

2. Hypotheses (differential diagnosis):

Bleeding on probing
Periodontitis
Gingivitis
Sensitivity/gingival pain
Staining
Attrition
Halitosis
Calculus
Decay concavities causing plaque retention
Fair PHP due to: inadequate plaque removal
Limited finances

3. Inquiry Strategy:
Review health history
Review dental history
Extra-oral and intra-oral exams
Hard tissue charting and exam
CHX rinse before treatment
Full mouth periodontal assesment
PHP
PBI
Deposit classification
Caries risk assesment
Nutritional counseling
6
Intra-oral and extra-oral photos
4 quads SRP with anesthetic and nitrous
extensive patient education regarding gingivitis, periodontitis, and homecare.
demonstrate proper brushing and flossing technique.
Referral back to dentist for restorative dental treatment
6 week re-evaluation
3 month SPM
Prescription for CHX rinse

7
Date: 10/14/16
Student Name: Emily Hummel
Patient Name: Donella T.
DOB: N/A

4. Dental Hygiene Diagnosis (list the human need not met, then be specific about the etiology & signs & symptoms evidencing a defect):

Unmet Human Need Etiology Signs & Symptoms

1) Wholesome Facial Image
a) Teeth lack of routine dental care a) moderate plaque accumulation
lack of adequate home care heavy calculus
lack of dental knowledge missing teeth
b) Gingiva lack of adequate home care b) gingiva are are bolbous and bled easily during
lack of dental knowledge probing
c) Breath lack of brushing tongue c) halitosis
lack of tobacco knowledge
2) Freedom From Anxiety and Stress
a) Anxiety about proximity of clinician lack of past positive dental experiences a)patient does not want to be in any pain because
confidentiality or previous dental experience lack of previous dental care she had a bad experience in the past. She
lack of dental knowledge requested anestethetic and nitrous for all
treatment.
b) Oral habits lack of correct brushing form b) patient does not take enough time brushing and
lack of correct flossing technique does not use proper technique. Patient does not
floss often enough but when she does she does not
do it effectively.
3) Skin & Mucous Membrane Integrity of Head
and Neck
a) Gingival inflammation lack of adequate home care gingiva are erythematous and edematous, bleeding
lack of routine dental care on probing
inefficient interproximal home care and
toothbrushing technique
lack of dental knowledge
b) Bleeding on probing lack of adequate home care bleeding during and after probing
lack of routine dental care
inefficient interproximal home care and
toothbrushing technique
lack of dental knowledge
c) Pockets greater than 4mm lack of adequate home care pockets greater than 4 mm

8

d) Attachment loss greater than 4mm
4) Protection from Health Risks
a)Other (Tobacco Use)
5) Freedom from Head and Neck Pain
a) Extra-/Intra- oral pain or sensitivity
6) Biologically Sound & Functional Dentition
a) Teeth with signs of disease
b) Rampant caries
c) Missing teeth
7) Responsibility for Oral Health
a) Plaque and Calculus Present
8) Conceptualization & Understanding
a) Has questions about gental hygiene care and
or oral disease
lack of dental knowledge
lack of regular dental care
lack of adequate home care attachment loss greater than 4 mm
lack of dental knowledge
lack of regular dental care
lack of knowledge about tobacco use patient smokes tobacco and wants to quit but feels
lack of dental knowledge as though it's too hard since her partner is a
smoker as well
lack of adequate home care pain in gingiva upon light probing
lack of routine dental care pain in gingiva upon light calculus detection
lack of dental knowledge
lack of adequate home care Patient has Class V decay on facials of 6 and 28.
lack of routine dental care Class IV decay on #10. Class II decay in two areas
lack of dental knowledge on #18. 6 mm probing depths.
lack of adequate home care 5 areas of decay charted.Patient has Class V decay
lack of routine dental care on facials of 6 and 28. Class IV decay on #10.
lack of dental knowledge Class II decay in two areas on #18
lack of dental insurance
lack of dental care missing # 1, 2, 3, 4, 5, 12, 13, 14, 16, 17, 19, 31,
lack of finances and 32.
lack of dental insurance
lack of dental knowledge
lack of adequate home care Class V calculus; PHP 2 Fair
lack our routine dental care
lack of dental knowledge
lack of knowledge of etiology of plaque and
calculus
lack of routine dental care Patient has question regarding her treatment needs
lack of dental education and prognosis
9
 Jointly Determined Treatment Plan
Date: 10/14/16
Student Name: Emily Hummel
Patient Name: Donella T
DOB: N/A
Patient Goals
Apt #: 1 1) patient will give consent for
Date: 6/23/16 treatment.
Time Req: 1 hours
2)
a) patient will show
understanding of how her health can
affect treatment and why having a
complete health history is important
b) patient will answer all
questions asked about and any issues
found in the health history.
c) patient will reveal all dental
history and dental concerns
3)
a) patient will consent to vitals
being taken
b) patient will show
understanding as to why her vital
signs need to be taken and the
equipment used to take them. consent
to having vital signs taken.
c) patient will show
understanding of what her vital sign
readings mean and explain if they are
normal for her.
4)
a) patient will show
understanding of instructions for the
use of chlorhexadine rinse.
b) patient will show
10
Educations and Treatment
(Target etiologies)
1) Obtain patient consent for
treatment and record in patient chart
2) Review health history
a) explain to patient the
importance of having a completed
health and dental history and how it
may affect treatment
b) clarify any questions about or
discrepancies in the history with the
patient.
c) discuss dental history with
patient and determine current dental
status. Record in patient chart/note
3) Vital signs
a) explain to patient why taking
vital signs is necessary and how they
will be taken.
b) take blood pressure, pulse, and
respirations and record in patient
chart.
c) report findings to patient and
discuss any abnormalities or
concerns with the patient. Have
patient clarify any findings.
4) Chlorhexidine Pre-Rinse
a) Give patient instructions on
how to rinse and how long they need
to rinse for.
b) explain to patient why it is
Evaluation
(goal met, partially met or unmet)
1) patient consented to treatment.
goal met
2)
a) patient showed understanding
of why a health history is important
and how it can affect treatment. goal
met
b) patient clarified all questions
about the health history. goal met
c) patient revealed all health
concerns and dental history. goal met
3)
a) patient showed understanding
of vital signs and why they are taken.
goal met
b) patient consented to taking
vital signs. goal met
c) patient showed understanding
of findings and clarified any
abnormal readings. goal met
4)
a) patient showed understanding
of how to use the chlorhexadinse
rinse. goal met
b) patient showed understanding
of what chlorhexadine is. goal met
understanding of why chlorhexadine
rinse is used
c) patient will consent to use of
chlorhexadine rinse and then use the
rinse
5)
a) patient will understand the
importance of an extraoral and
intraoral exam and how it will be
conducted.
b) patient will consent to having
an extraoral and intraoral exam
completed
c) patient will show
understanding of anything that is
found and will explain if needed.
6)
a) patient will understand what a
hard tissue dental chart is and why it
necessary to have completed
b) patient will fully cooperate
during the recording of the hard
tissue chart
c) patient will show
understanding of and clarify any
findings.
7)
a) patient will show understanding
of the procedure of Oraqix
b) patient will understand benefits
of Oraqix
c) patient will discuss any
concerns she has about using Oraqix.
d) patient will consent to Oraqix
e) patient will follow all directions
during Oraqix and express any
11
important that she rinses with
chlorhexadine
c) administer chlorhexadine rinse
and record in patient chart.
5) Extra-Oral/ Intra-Oral Exam
a) explain to the patient what an
extraoral and intraoral exam consist
of and why it is important to her
treatment and health.
b) perform extraoral and intraoral
exam then record findings in the
patient chart.
c) report and explain any findings
with the patient.
6) Hard Tissue Charting
a) explain to patient what hard
tissue charting is and why it needs to
be performed.
b) perform hard tissue charting
and record in patient chart.
c) discuss and clarify any findings
with patient.
7)
a) explain to patient the Oraqix
procedure
b) explain to patient the benefits of benefits of Oraqix. goal met
Oraqix and express their
understanding
c) address and answer any
questions or concerns patient has
d) obtain consent for Oraqix
application and record it in the
patients chart
e) encourage the patient to keep
calm reassuring them throughout the
c) patient consented to using
chlorhexadine rinse. goal met
5)
a) patient showed understanding
of importance of extraoral and
intraoral exams and how it will be
done. goal met
b) patient consented to extraoral
and intraoral exam. goal met
c) patient clarified findings and
showed understanding of findings.
goal met
6)
a) patient showed understanding
of HTC and why it is done. goal met
b) patient followed all instruction.
goal met
c) patient clarified and showed
understanding of findings. goal met
7)
a) patient showed understanding of
Oraqix procedure. goal met
b) patient showed understanding of
c) patient asked questions and
concerns she had. goal met.
d) patient consented to treatment.
goal met.
e) patient followed all directions
and expressed discomfort when felt.
goal met
discomfort
8)
a) patient will show
understanding the procedure and
reasonding of periodontal probing
b) patient will follow directions
during the full mouth probing
c) patient will show
understanding of the findings
explained to her
d) patient will show
understanding of the etiology of
gingivitis and periodontal disease.
9)
a) patient wil show understanding
of PHP and how it will be measured.
b) patient will follow directions
during PHP.
c) patient will show
understanding of findings.
d) patient will show understanding
of the etiology of plaque and its
afffect on the teeth
10) patient will demonstrate brushing brushing and flossing technique.
and flossing technique.
11)
a) patient will show
understanding of the Bass brushing
technique.
12)
a) patient will understand how c-
wrap flossing is done.
appointment
8) Full Mouth Periodontal Probing
a) educate patient as to what
periodontal probing is, why it is
done, and how it will be done
b) perform full mouth periodontal
probing.
c) report and discuss findings with periodontal disease. goal met.
patient including PBI and periodontal
classifications.
d) discuss etiology of gingivitis
and periodontal disease.
9)PHP
a) explain to patient what PHP is
and how it will be assessed.
b) calculate PHP
c) report and discuss findings with of etiology of plaque. goal met.
patient and record in patient chart.
d) discuss etiology of plaque.
10) Have patient demonstrate current
11) Demonstrate Bass technique
a) discuss the reasoning behind
this technique and clarify any
questions the patient has.
12) Demonstrate c-wrap flossing
techinique
a) discuss the reasoning behind
using this technique and clarify any
questions the patient has.
12
8)
a) patient showed understanding
of periodontal probing. goal met
b) patient followed all directions.
goal met
c) patient showed understanding
of findings. goal met.
d) patient showed understanding
of the etiology of gingivitis and
9)
a) patient showed understanding
of PHP and how it will be measured.
goal met
b) patient followed all directions.
goal met
c) patient showed understanding
10) patient demonstrated brushing
and flossing technique. goal met
11) patient showed understanding of
the Bass technique. goal met.
12)
a) patient showed understanding
of c-wrap flossing. goal met.
13)
a) patient showed understanding
of etiology of calculus and why it

13)
a) patient will show
understandings of etiology of
calculus and why it needs to be
removed.
b) patient will tolerate calculus
detection well.
c) patient will understand findings
and the significance
14)
a) pt will understand the reasoning
for radiographs
b) pt will contact Dental Plaza and
have current X-rays sent to DMACC
Clinic.
c) pt will understand the findings
or diagnosis of her radiographs
15)
a) pt will show understanding of
why a complete dental exam is
necessary.
b) patient will agree to complete
exam.
c) patient will show
understanding of exam findings and
ask any questions she has.
16)
a) pt will show understanding of
the reason for taking photos.
b) patient will follow directions
while taking photos.
c) patient will show
understanding of findings.
13
should be removed. goal met
13) Deposit Recognition b) patient tolerated procedure
a) discuss etiology of calculus and well. goal met
purpose of performing deposit c) patient showed understanding
recognition. of findings.
b) perform deposit recognition.
c) report findings to patient and 14)
record in patient chart. a) patient showed understanding of
why radiographs are important and
14) X-rays necessary. goal met
a) explaining to the patient why b) pt has not contacted Dental
radiographs are important and Plaza to have current x-rays sent to
necessary DMACC Clinic. goal unmet
b) explained to the patient the c) X-rays not present yet. goal
importance of having current X-rays unmet
on file.
c) explained the findins and
diagnosis of her radiographs 15)
a) patient showed understanding
of why a complete exam is needed.
15) Full Mouth Examination goal met
a) explain why an exam by the b) patient agreed to complete
dentist is necessary and what the exam.
dentist will do during the exam. c) patient showed understanding
b) have the dentist perform exam. of exam findings. goal met
c) discuss and clarify any findings
from radiographic exam and oral
exam done by the dentist with the 16)
patient. a) patient showed understanding
d) determine need for prescription of the need for photos. goal met
toothpaste and/or CHX rinse b) patient followed directions. goal
met
16) Intra-Oral/Extra-Oral Photos c) patient showed understanding of
a) explain to patient the reason for findings. goal met
taking photos.
b) take photos. 17)
c) show photos and discuss any a) patient showed understanding
findings with the patient. of recommended treatment,
evaluation, and 3 month recall. goal

17)
a)patient will show understanding
of recommended treatment,
evaluation, and 3 month recall.
18) patient will understand the
prognosis of her oral condition
with/without treatment.
19)
a) patient will show
understanding of tobacco use and its
effects on the oral cavity.
b) patient will understand the
benefits of smoking cessation and
access quitline
c) patient will agree to discuss
more in the future
20)
a) patient will show
understanding of the cost of
treatment.
21) patient will agree to attend all the
required appointments and show
understanding of how many and how
long her appointments will be.
22)
a) patient will show
understanding of the importance of
regular dental care and examinations
by her dentist.
b)pt will schedule an appointment
with her dentist.
14
17) Determine treatment plan. met
a) discuss with patient that
periodontal scaling and root planing
with local anesthetic will be needed
and that we will be able to complete 18) patient showed understanding of
1 quadrant at the next two her prognosis with/without treatment.
appointments and the whole upper goal met
arch at the third appointment. Each
will be one hour appointments.
Discuss that a six week evaluation
following treatment is recommended
and that we recommend a 3 month 19)
recall. a)patient showed understanding of
tobacco use and its effects on the oral
18) Prognosis cavity
a) discuss prognosis of patient's b) patient understood the benefits
oral condition following treatment/no of smoking cessation and agreed to
treatment. access quitline
c) patient agreed to discuss more
19) in the future
a) discuss with patient tobacco use
and its effects on the oral cavity 20) patient showed understanding of
b) discuss with patient benefits of the cost of treatment. goal met
smoking cessation and accessing
quitline
c) discussed with patient future 21) patient showed understanding of
discussion about tobacco cessation how many appointments would be
needed and how long each
20) Cost appointment would be. goal met.
a) discuss estimated cost of
treatment with patient. 22)
a) patient showed understanding
21) Discuss number of appointments of the need for regular dental visits
and length of appointments and agreed to set an appointment
with her dentist. goal met.
22) Referrals b) patient will schedule an
a) give and discuss referral to appointment with her dentist once
patients general dentist for regularly her appointments at the DMACC
intervalled examinations and Clinic are completed. Goal unmet

Apt #: 2 1) Patient will discuss any changes in
Date: 6/30/16 her health history since her last visit.
Time Req: 1 hour 2) Patient will consent to todays
treatment
3) Patient will allow vitals to be
taken and understand why while
following directions correctly
4) Patient will agree to use
chlorhexadine rinse and understand
the reason for it.
5) Patient will understand the need
for and extraoral and intraoral exam
and follow directions during
6) Patient will understand the need to
update the hard tissue charting and
cooperate during.
7)Patient will understand the
reasoning for finding a PHP and
understand the findings
8) Patient will understand the
benefits and risks of Nitrous Oxide
and will discuss any concerns she
has.
9)Patient will understand the benefits
and risk of local anesethic and will
discuss any concerns she has about
using topical and local anesthetic and
be open to using both types of
anesthetic.
10) Patient will follow all directions
15
restorative care
b)encourage patient to schedule
an appointment with her dentist.
1) Update health history
2) Patient consents to treatment
3) Vital Signs
4) Chlorhexadine rinse
5)Extraoral and Intraoral Exam
6)Hard tissue charting for changes
since last appointment
7) PHP
8) Perform nitrous sedation on
patient.
9) Evaluate the need for local
anesthetic and explain the benefits
and risk associated with LA
10) Perform scaling and root planing
on the LL quad using a cavitron and
hand instruments.
11) Patient Education, Have patient
demonstrate the Bass brushing
technique and c-shape flossing.
1) Patient revealed changes in her
health history. goal met
2) Patient consented to todays
treatment. goal met
3) Patient allowed vitals to be taken.
goal met
4) Patient consented to chlorhexadine
rinse. goal met
5) Assesment completed . goal met.
6) Changes in hard tissue charting
completed. goal met
7) Completed patients PHP and
patient understood findings. goal
met.
8) Patient understood the benefits
and risks of Nitrous and asked any
questions she had. goal met
9)Patient understands the risk and
benefits of LA. goal met
10)Patient followed all directions
during scaling and root planing and
expressed pain. goal met
11)patient demonstrated the Bass
technique and c-shape flossing. goal
 during the scaling and root planing
and will express any pain or
senstivity
11) Patient will demonstrate the Bass
brushing technique and c-shape
flossing correctly.
a) Patient wil understand the
benefits of brushing for 2 minutes
and also the benefits of an electric
toothbrush
b)Patient will understand the
importance of a good homecare
routine
c) Patient will understand the
benefits of flossing and the different
products that may be used instead of
regular string floss
12) Patient will have scheduled an
appointment with her dentist.
13) Patient will follow and
understand all post-op instructions
given to her
Apt #: 3 1) Patient will discuss any changes in 1) Update health history
Date: 7/7/16 her health history since her last visit.
Time Req: 1 hour
2) Patient will consent to todays
treatment
3) Patient will allow vitals to be
taken and understand why while
following directions correctly
4) Patient will agree to use
chlorhexadine rinse and understand
the reason for it.
16
a) discuss increasing brushing
time to 2 minutes. Discuss options of
an electric toothbrush
b) evaluate patients current
homecare routine to see if positive
changes are being made.
c) discuss different flossing
options inclusing waterpik and
airflosser.
12) follow up on appointments made
to the patient's general dentist.
13) Give post-op instructions
2) Patient consents to treatment
3) Vital Signs
4) Chlorhexadine rinse
met.
a)Patient showed understanding
of the benefits of brushing for 2min.
goal met
b)Patient understands the
importance of a good homecare
routine. goal met
c)Patient understand the benefits of
flossing and the different products
available.goal met
12) Patient has not made follow up
appointments with his dentist. goal
unmet.
13) Patient followed and understood
all post-op instructions. goal met
1) Patient revealed any changes in
her health history. goal met
2) Patient consented to treatment.
goal met
3) Patient allowed vitals to be taken.
goal met
4) Patient consented to chlorhexadine
rinse. goal met
5) Assesment completed on patient

5) Patient will understand the need
for and extraoral and intraoral exam
and follow directions during
6) Patient will understand the need to
update the hard tissue charting and
cooperate during.
7)Patient will understand the
reasoning for finding a PHP and
understand the findings
8) Patients will understand the
benefits and risks of Nitrous and
discuss any concerns she has
9)Patient will understand the benefits
and risk of local anesethic and will
discuss any concerns she has about
using topical and local anesthetic and
be open to using both types of
anesthetic.
10) Patient will follow all directions
during the scaling and root planing
and will express any pain or
senstivity
11) Patient will demonstrate the Bass
brushing technique
a) Patient will understand the
benefits of an electric toothbrush
b)Patient will understand the
importance of a good homecare
routine
c) Patient will understand the
benefits of flossing
17
5)Extraoral and Intraoral Exam
6)Hard tissue charting for changes
since last appointment
7) PHP
8) Nitrous sedation on patient
9) Evaluate the need for local
anesthetic and explain the benefits
and risk associated with LA
10) Perform scaling and root planing
on the UR quad using a cavitron and
hand instruments.
11) Patient Education, Have patient
demonstrate the Bass brushing
technique
a) Discuss options of an electric
toothbrush
b) Evaluate patients current
homecare routine to see if positive
changes are being made.
c) discuss the importance of
flossing
12) follow up on appointments made
to the patient's general dentist for
restorative care.
13) Give post-op instructions
and directions were followed during.
goal met.
6) Hard tissue charting changes were
updated and patient cooperated
during. goal met
7) Patient understood reason for
finding PHP and understood the
findings. goal met.
8) Patient understood the benefits
and risks of Nitrous and asked any
questions she had. goal met
9)Patient understood the benefits and
risk of local anethetic and discussed
any concerns about topiacl and local
anesthetic and was open to using
both types of anethetic. goal met
10)Patient followed all directions
during scaling and root planing. goal
met
11)Patient demonstrated the Bass
brushing technique. goal met.
a)Patient showed understanding
of the benefits of an electric
toothbrush. goal met
b)Patient understands the
importance of a good homecare
routine. goal met
c)Patient understands the benefits of
flossing. goal met
12) Patient has not made follow up
appointments with his dentist. goal
unmet.
 12) Patient will have scheduled an
appointment with her dentist for
restorative care
13) Patient will follow and
understand all post-op instructions
given to her
Apt #: 4 1) Patient will discuss any changes in 1) Update health history
Date: 7/14/16 her health history since his last visit.
Time Req: 1 hour
2) Patient will consent to todays
treatment
3) Patient will allow vitals to be
taken and understand why while
following directions correctly
4) Patient will agree to use
chlorhexadine rinse and understand
the reason for it.
5) Patient will understand the need
for and extraoral and intraoral exam
and follow directions during
6) Patient will understand the need to
update the hard tissue charting and
cooperate during.
7)Patient will understand the
reasoning for finding a PHP and
understand the findings
8) Patient will understand the
benefits and risks of Nitrous and
discuss any concerns she has
18
2) Patient consents to treatment
3) Vital Signs
4) Chlorhexadine rinse
5)Extraoral and Intraoral Exam
6)Hard tissue charting for changes
since last appointment
7) PHP
8) Nitrous sedation on patient
9) Evaluate the need for local
anesthetic and explain the benefits
and risk associated with LA
13) Patient followed and understood
all post op instructions given to him.
goal met
1) Patient revealed any changes in
her health history. goal met
2) Patient consented to treatment.
goal met
3) Patient allowed vital to be taken
and understood why. goal met
4) Patient consented to chlorhexadine
rinse and understood the reason for
it.goal met
5) Patient understood the need for
extra and intra oral exam and
followed directions during. goal met.
6) Hard tissue charting changes were
made and patient cooperated during.
goal met
7) Patient understood the reasoning
for finding a PHP and understood the
findings. goal met.
8) Patient understood the benefots
and risks of Nitrous and asked any
questions she had. goal met
9)Patient understood the benefits and
risks of local anethetic and discussed
 9)Patient will understand the benefits
and risk of local anesethic and will
discuss any concerns he has about
using topical and local anesthetic and
be open to using both types of
anesthetic.
10) Patient will follow all directions
during the scaling and root planing
and will express any pain or
senstivity
11) Patient will understand the need
for good oral homecare
a) Patient will understand the
benefits of a good homecare routine
and understand why she needs to
brush and floss correctly
b)Patient will understand the
benefits of using chlorhexadine rinse
at home
12) Patient will have scheduled an
appointment with her dentist for
restorative care
13) Patient will follow and
understand all post-op instructions
given to her
Apt #: 5 1)Patient will discuss any changes to
Date: 8/25/16 her health history since his last visit
Time Req: 1 hour
2)Patient will give consent to
treament
3) Patient will allow vital signs to be
taken and understand why.
4) Patient will agree to use CHX
rinse.
19
10) Perform scaling and root planing
on the UL & UR quad using a
cavitron and hand instruments.
11) Patient Education
a) evaluate patients current homecare
routine to see if positive changes are
being made. Reinforce brushing and
flossing
b)discuss the benefits of using
Chlorhexadine rinse at home.
12) follow up on appointments made
to the patient's general dentist.
13) Give post-op instructions
1) Update patient health history
2) Obtain patient consent for
treatment
3) Vital signs
4) Chlorhexadine rinse
concerns. goal met
10)Patient followed all directoins
during scaling and root planing of the
UL & UR quadrants and expressed
sensitivity. goal met
11)Patient showed understanding of
a good oral homecare routine. goal
met
a)Patient showed understanding of
the benefits of a good oral homecare
routine. goal met
b)Patient understands the benefits
of using a chlorhexadine rinse at
home. goal met
12) Patient has not made follow up
appointments with his dentist. goal
unmet.
13) Patient followed and understood
all post-op instructions given to her.
goal met
1) Patient revealed changes in her
health history. goal met
2) Patient consented to treatment.
goal met
3) Patient allowed vitals to be taken
and understood the need. goal met
4) Patient concented to
chlorhexadine rinse. goal met

5)Patient will understand the need
for an extraoral and intraoral exam
and will follow directions during
6)Patient will reveal any dental work
since last appointment and will
follow directions during
7)Patient will understand the need to
probe the whole mouth and will
understand why and the findings.
8)Patient will understand the
reasoning for a PHP and understand
the findings and following directions
during
9) Patient will understand the
benefits and risk of Nitrous and
discuss any concerns she has
10)Patient will understand her PBI
and gingivitis classifications.
11)Patient will understand the
findings during deposit recognition
and follow directions during
12) Patient will show understanding
of the results of the pictures
13)Patient will show understanding
of patient education given
a) patient will show
understanding of the progression of
his treatment and healing process.
20
5) Extraoral and Intraoral exam
6) HTC
7) Full mouth periodontal probe,
periodontal classification, discuss
findings with patient
8)PHP, discuss findings with patient
9) Nitrous sedation on patient
10)PBI, gingivitis classification,
discuss findings with patient
11)deposit classification, discuss
findings with patient
12) Extra-oral/Intra-oral pictures
a) discuss any improvements/lack
there of with patient.
13) Patient Education
a) discuss with patient how
treatment and healing is progressing.
14)Discuss the need for a 3 month
SPM.
b) discuss any areas that may
need further attention or treatment.
c) reinforce proper brushing and
5)Patient understood the need for
extra and intra oral exam and
followed directions during. goal met
6) Patient revealed dental work done
since last appointment. goal met
7)Patient understood the need to
probe the whole mouth and
understood the findings. goal met
8)Patient does not yet understand the
reasoning for a PHP or the findings.
goal met
9) Patient understood the benefits
and risk of nitrous and discussed any
concerns she had. goal met
10)Patient undersatnds her PBI or
gingivitis classification. goal met
11)Patient understands the findings
during deposit recognition and
followed directions during. goal met
12)patient showed understanding of
the results of the pictures. goal met
13)
a) patient showed understanding of
the progression of her treatment and
healing. goal met.
14) Patient has not yet shown
understanding of the need for 3
14)patient will show understanding
of the need for a 3 month SPM and
commit to keeping these
appointments.
b) patient will show
understanding of the reason for
further treatment if necessary.
c) patient will reveal that she has
been brushing twice a day with
correct form and flossing once a day
with correct form
15)Patient will follow all directions
during full mouth coronal
debridement
16)Patient will follow all directions
during the polishing, flossing and
fluoride varnish
a)Patient will understand post-op
instructions for fluoride varnish
17) Patient will be prescribed CHX
a) Patient will understand benefits
of CHX and proper use
b) Patient will understand side
effects of longterm CHX rinse
18)
a) patient will show
understanding of tobacco use and its
effects on the oral cavity.
b) patient will understand how
smoking cessation will help keep her
mouth healthier
c) patient will agree to discuss
more in the future
21
flossing techniques and frequencies.
15) perform full mouth coronal
debridement
16) coronal polish, floss and fluoride
varnish
a) give post-op instructions for
fluoride varnish
17) DDS signs prescription for CHX
a) Discussed with patient benefits
and proper usage of CHX.
b) discussed with patient side
effects of CHX rinse
18)
a) discussed with patient tobacco
use and its effects on the oral cavity
b) explained to patient how
smoking cessation will help keep her
mouth healthier
c) discuss with patient discussing
more in the future
month SPM or commited to keeping
the appointments. goal met
b) patient understands the need
for further treatment. goal met
c) patient has made changes in her
homecare routine. goal met
15) Patient followed all directions
during coronal debridement. goal
met
16)Patient followed all direction
during polish, floss and flouride. goal
met
a)Patient understands post op
instructions for fluoride varnish. goal
met
17) DDS signed prescription. goal
met
a) Patient understood proper usage
and benefits of CHX. goal met.
b) Patient understood side effects
of CHX rinse. goal met
17)
a) patient showed understanding of
tobacco use and its effects on the oral
cavity. goal met.
b)patient showed understanding of
how smoking cessation will help
keep her mouth healthier. goal me.
c) patient agreed to discuss more
in the future. goal met.
Apt #: 1) Patient will discuss any changes in 1) Update health history
6 her health history since her last visit.
Date: 11/23/16 2) Patient will consent to todays
Time Req: 1:00 treatment
3) Patient will allow vitals to be
taken and understand why while
following directions correctly
4) Patient will agree to use
chlorhexadine rinse and understand
the reason for it.
5) Patient will understand the need
for and extraoral and intraoral exam
and follow directions during
6) Patient will understand the need to
update the hard tissue charting and
cooperate during.
7)Patient will understand the
reasoning for finding a PHP and
understand the findings
8) Patient will understand the
benefits and risks of Nitrous Oxide
and will discuss any concerns she
has.
9) Patient will follow all directions
during the full mouth debridement
and will express any pain or
senstivity
10) Patient will demonstrate the Bass
brushing technique and c-shape
22
health history. goal unmet
2) Patient consents to treatment
3) Vital Signs
4) Chlorhexadine rinse
5)Extraoral and Intraoral Exam
6)Hard tissue charting for changes
since last appointment
7) PHP
8) Perform nitrous sedation on
patient.
9) Perform full mouth debridement
with hand instruments.
10) Patient Education, Have patient
demonstrate the Bass brushing
technique and c-shape flossing.
a) discuss increasing brushing
time to 2 minutes. Discuss options of
an electric toothbrush
b) evaluate patients current
homecare routine to see if positive
changes are being made.
c) discuss different flossing
options inclusing waterpik and
1) Patient revealed changes in her
2) Patient consented to todays
treatment. goal unmet
3) Patient allowed vitals to be taken.
goal unmet
4) Patient consented to chlorhexadine
rinse. goal unmet
5) Assesment completed . goal
unmet.
6) Changes in hard tissue charting
completed. goal unmet
7) Completed patients PHP and
patient understood findings. goal
unmet.
8) Patient understood the benefits
and risks of Nitrous and asked any
questions she had. goal unmet
19)Patient followed all directions
during full mouth debridement and
expressed pain. goal unmet
10)patient demonstrated the Bass
technique and c-shape flossing. goal
unmet.
a)Patient showed understanding
of the benefits of brushing for 2min.
goal unmet
b)Patient understands the
 flossing correctly.
a) Patient wil understand the
benefits of brushing for 2 minutes
and also the benefits of an electric
toothbrush
b)Patient will understand the
importance of a good homecare
routine
c) Patient will understand the
benefits of flossing and the different
products that may be used instead of
regular string floss
11) Patient will have scheduled an
appointment with her dentist.
12)Patient will follow all directions
during the polishing, flossing and
fluoride varnish
a)Patient will understand post-op
instructions for fluoride varnish
13)
a) patient will show
understanding of tobacco use and its
effects on the oral cavity.
b) patient will understand how
smoking cessation will help keep her
mouth healthier
c) patient will agree to discuss
more in the future
Apt #:
Date:
Time Req:
Apt #:
Date:
Time Req:
23
airflosser.
11) Follow up on appointment made
at patients general dentist.
12) coronal polish, floss and fluoride
varnish
a) give post-op instructions for
fluoride varnish
13)
a) discussed with patient tobacco
use and its effects on the oral cavity
b) explained to patient how
smoking cessation will help keep her
mouth healthier
c) discuss with patient discussing
more in the future
importance of a good homecare
routine. goal unmet
c)Patient understand the benefits of
flossing and the different products
available.goal unmet
11) Patient has not made follow up
appointments with his dentist. goal
unmet.
16)Patient followed all direction
during polish, floss and flouride. goal
met
a)Patient understands post op
instructions for fluoride varnish. goal
met
17)
a) patient showed understanding of
tobacco use and its effects on the oral
cavity. goal unmet.
b)patient showed understanding of
how smoking cessation will help
keep her mouth healthier. goal
unmet.
c) patient agreed to discuss more
in the future. goal unmet.
24