TREATMENT PLAN MODIFICATIONS

Due to heavily tenacious calculus, this patient was

completed in a total of eight hygiene therapy appointments,
with one re-evaluation appointment.
Juan was also appointed for completion of restorative
work due to decay:
Tooth number 4 retained root tip was extracted
Teeth numbers 15 & 16 were extracted due to decay
Tooth number 2 MO composite restoration completed
Tooth number 14 MO composite restoration completed
 PATIENT MOTIVATIONS

At the beginning of his appointments, Juans main focus was on relieving pain
that he was experiencing in his teeth. He also realized that he needed
professional hygiene therapy.
However, Juan was not aware of periodontal disease, and the importance of
arresting the progression of periodontal disease, and movement toward oral
health.
After these and other risk factors were explained, Juan was very receptive to
change, and making behavioral changes toward maintaining oral health.
 ORAL HYGIENE INSTRUCTION

First Appointment:
Instructed patient to start brushing at night as well as in
the morning, and for 2-minute intervals
Reinforced the Bass method of brushing
Recommended an electric toothbrush and Waterpik
Demonstrated Perio-Aid and Interproximal Brushes
Talked about periodontal disease and decay prevention
 ORAL HYGIENE INSTRUCTION

Subsequent Appointments and Continuing care appointment:

Patient began doing a great job with his home care! At following
appointments, the Bass method and interproximal aids were again
reinforced.
The LCSC clinic was also able to provide an electric toothbrush to
Juan, which improved his homecare even more
The patient has not gotten a Waterpik, but has utilized interproximal
aids.
The importance of regular professional maintenance appointments
was also discussed
 CONTINUING CARE/RE-EVALUATION
APPOINTMENT (5/31/17)

New Treatment Plan:

Reevaluation, 4 bitewing radiographs to check for
residual calculus (D0274), OHI (D1330), Fluoride Varnish
(D1208), Intra-Oral Photos
 RE-EVALUATION
PERIODONTAL CHARTING
(5/31/17)

Significant Reduction in
Periodontal Probing
depths, and bleeding
points
74 readings 4 mm and
above
44 bleeding points
 TISSUE DESCRIPTION

Color: Generalized slight hyperemia, with localized moderate

hyperemia on the lingual of mandibular anteriors
Contour: Generalized slight enlarged, with localized moderate
enlargement lingual of mandibular anteriors
Consistency: Generalized slight edematous, localized moderate
edematous lingual of mandibular anteriors
Bleeding: Generalized spontaneous upon probing
Clinical Assessment Markers: Furcations Involvement, Recession,
Mobility
Statement of inflammation: Generalized slight marginal and papillary
inflammation with localized moderate inflammation on the lingual of
the mandibular anteriors
Deposit evaluation: 1.5/1.5
Microscope Evaluation: Risk Factor B; some spinning rods/spirochetes,
moderately mobile
POST TREATMENT INTRA-ORAL PHOTOS
 REFLECTIONS

I believe that we provided the best care possible for this patient. By the end of
his hygiene therapy, we were able to see significant improvement in Juans oral
health, and a move towards periodontal stability.
The recommended recall interval is 3-4 months, as Juan builds calculus quickly,
and a professional maintenance appointment can assess how well he is doing
with home care.
Based on Juans move toward periodontal stability, I do not think he needs to
be referred to a periodontist, however for further restorative work, he needs a
consultation from an oral surgeon, or orthodontist.
 Non-Surgical Periodontal Therapy was
initiated January 27, 2017; and Therapy was
completed May 4, 2017; with a re-evaluation
appointment on May 31, 2017.