Periodontal Care Plan Weebly

PERIODONTAL CARE PLAN
Patient Name__ __ Age__63__

Date of initial exam__October 12, 2017__ Date completed__November 20, 2017__
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.
Patient’s last physical was October 2016, she is currently seeing Dr. Jadoon. Patient has
excessive thirst and drinks lots of water. Patient has been tested for diabetes and all
results were normal. Patient’s blood pressure was pre-hypertensive and all other vitals
were within normal limits. The patient has severe sinus problems and takes Zyrtec and
Singular OTC as needed. Zyrtec and Singular both cause dry mouth. This could be the
cause of the excessive thirst. Although, the patient’s salivary flow was not notably
reduced, she could still be at risk for caries and periodontitis. When there is not enough
saliva there is an increase in plaque and when it is not adequately removed, it becomes
calculus which can harbor more bacteria. As the bacteria harbors it begins to destroy
periodontal tissues and move into the alveolar bone such in this patient’s case. The
patient has smoked three to four cigarettes a day for the past ten years and is currently
interested in quitting. Smoking can contribute to periodontal disease by reducing blood
flow and in turn causing a reduced healing rate.
2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q.,
chief complaint, present oral hygiene habits, effect on dental hygiene diagnosis and/or
care)
The patient has not been to the dentist in over 5 years. She is aware of her periodontitis
and states that she used to have her teeth cleaned every 3-4 months because she had,
“so much build up.” She also says that she can feel “grooves” in her teeth and pointed to
the abfractions on #28,#29, and #30. The patient had an FMX with vertical BWX on
October 12, 2017 in the clinic to assess bone levels and check for decay since the patient
could not recall her last x-rays. It has been several years since she has had any dental
care. Her chief complaint is she wants the calculus removed from the lower lingual of
her teeth because she wants the gap in her teeth back. The patient uses an electric
medium toothbrush twice per day and she states that she rarely changes out the heads.
She uses Mentodent toothpaste because she says the baking soda makes her gums feel
better when it bubbles. The patient uses scope mouth rinse twice per day. The alcohol
content can contribute to dry mouth and the patient’s excessive thirst. I recommended
trying a non-alcohol mouth rinse to see if symptoms improve. She has a positive outlook
on treatment when it was presented and explained to her. She states she is ready to get
back to a normal cleaning schedule. Her current oral hygiene habits need improvement.
If the patient cannot adequately remove plaque and prevent build up she will continue
to have periodontal disease.
3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
There was nothing notable during the head and neck and extra-oral exam and the
patient did not have any swollen lymph nodes. During the intra-oral exam, there was
slight mandibular tori on the right lingual side of the pre-molar. The etiology is
developmental. The patient says she has never clenched her teeth but due to high
stressed over the past five years of taking care of her mother before she passed away.
She was severely stressed and often woke during the night with sore teeth and an aching
jaw. The patient says it is not currently a problem and has not had symptoms in over a
year. Bruxism can cause recession and loss of bone because of an increase in pressure
during clenching. The patient should be educated on how this contributed to her
periodontal disease and how to cope with high stress situations to prevent a relapse in
jaw pain and discomfort. The patient put herself on hold to take care of her mother and
she is aware her oral hygiene habits have not been prestigious.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification __VI__ Periodontal Case Type__III__

b. Gingival Description:
App't 1: October 12, 2017

Architecture: Generalized scalloped; localized cleft
#30 and #31
Gingival color: Generalized redness
General Consistency: Generalized edematous/spongy
Gingival Margins: Generalized rolled
Papillae: Generalized bulbous especially mandibular arch
Supperation: None
Surface texture (papillary and marginal): Generalized smooth and shiny
Surface texture (attached): Generalized smooth and shiny

#30 and #31
Supperation: None

Max. Right:
Architecture: Generalized scalloped
Gingival color: Pink
General Consistency: Smooth
Gingival Margins: Localized rolled #2
Papillae: scalloped
Supperation: None
Surface texture (papillary and marginal): Smooth and stippled
Surface texture (attached): smooth and stippled in the anterior F/L; smooth and
shiny in posterior F/L
Max. Left:
Papillae: Generalized bulbous
Supperation: None
Mand. Right:
#30 and #31
Supperation: None
Mand Left:
Supperation: None
App't 4: November 2, 2017

Max. Right:
Gingival Margins: #2 no longer rolled
Papillae: scalloped
Supperation: None
Surface texture (attached): smooth and stippled
Max. Left:
Gingival Margins: WNL
Papillae: scalloped
Supperation: None
Surface texture (papillary and marginal): smooth and stippled
Mand. Right:
#30 and #31
Supperation: None
Mand Left:
Supperation: None
Max. Right:
Papillae: scalloped
Supperation: None
Max. Left:
Papillae: scalloped
Supperation: None
Mand. Right:
#30 and #31
Supperation: None
Mand Left:
Gingival color: Localized redness lingual anterior
General Consistency: Localized edematous/spongy lingual anterior but showing
improvement from previous week
Gingival Margins: Localized rolled #23 and #24 facial.
Papillae: Localized bulbous lingual anterior.
Supperation: None
Surface texture (papillary and marginal): localized smooth and shiny anterior
Surface texture (attached): localized smooth and shiny anterior
Max. Right:
Papillae: scalloped
Supperation: None
Max. Left:
Papillae: scalloped
Supperation: None
Mand. Right:
#30 and #31
Gingival color: Lingual anterior still slightly red due to plaque accumulation
Gingival Margins: Facial of #23 and #24 no longer rolled
Papillae: No longer bulbous
Supperation: None
Surface texture (papillary and marginal): smooth and shiny
Surface texture (attached): smooth and shiny
Mand Left:
Gingival color: Localized redness #30 lingual, #31 buccal and lingual, #25 F/L
General Consistency: Localized edematous/spongy #30 and #31
Gingival Margins: Localized rolled #31 buccal
Papillae: Localized bulbous #31 buccal, #25 F/L
Supperation: None
Surface texture (papillary and marginal): localized smooth and shiny #30 and #31
Surface texture (attached): localized smooth and shiny #30 and #31
c.Plaque Index:
Appointment
1. 4.0 Poor
2. 4.0 Poor
3. 2.1 Fair
4. 1.8 Fair
5. 1.6 Good
6. 1.0 Good
d. Gingival Index:
Initial: 1.29 Fair
Final: 0.5 Good
e. Bleeding Index:
Appointment
1. 29%
2. 33%
3. 19%
4. 16%
5. 16%
6. 13%
f. Evaluation of Indices:
1. Initial:
The patient’s plaque index was 4.0-Poor with a positive reading on 24 out of 24
surfaces.
The patient’s gingival index was 1.29-Fair. The patient’s mandibular arch had score
of 2-3 on 12 out of 12 surfaces. The maxillary arch had score of 2 on the mesial and
distal of tooth #3 and the distal of #9, a score of 1 on the facial and lingual of #3,
and a score of 0 for the rest of the designated surfaces. The patient’s bleeding
index was 29% with 42 bleeding points out of a possible 144. The patient’s poor
plaque control is contributing to the inflammation and redness of her gums and
causing an increase in her gingival index and bleeding score. This could be causing
her periodontal disease because periodontal disease is defined as destruction of
the periodontal tissues and alveolar bone from bacteria-induced inflammation.
Final:
The patient’s plaque index was 1.0-Good with a positive reading on 6 out of 24
surfaces.
The patient’s gingival index was 0.5-Good. The patient’s mandibular arch had score
of 0 on 5 out of 12 surfaces and a score of 2 on #25. The maxillary arch had score
of 0-1 on 12 out of 12 surfaces. The patient’s bleeding index was 13% with 5
bleeding points out of a possible 36. The patient has implemented her plaque
control and it has shown in her improvement throughout the course of her
treatment. This could halt her periodontal disease because periodontal disease is
defined as destruction of the periodontal tissues and alveolar bone from bacteria-
induced inflammation. By lowering her plaque and bleeding score the patient is
helping herself by halting the progression of her disease with these improvements.
g.Periodontal Chart: (Record Baseline and First Re-evaluation data)

1.Baseline:
The patient had generalized 4-6mm pockets throughout the maxillary and
mandibular arch. The patient had generalized recession on the mandibular
buccal/facial and abfractions on tooth #28, #29, and #30. The CAL for these ranges
from 3-5mm. The patient also has 1mm recession on tooth #3 and tooth #6. The
probing depths and recession for mandibular anterior lingual were unreadable due
to calculus build-up. There are possible signs of recession in this area but it will be
unclear until the calculus is properly removed. The patient has a Class I furcation
on tooth #30. The patient is classified with generalized moderate chronic
periodontitis because of her pocket depths in conjunction with radiographic
findings. The patient should be educated about furcation involvement and without
halting the progression of the disease it could cause mobility of the tooth and
eventual extraction could be needed.
2.First Evaluation
The patient had generalized 3-4mm pockets throughout the maxillary and
mandibular arch. The patient has generalized 5-7mm pockets on #29, #30, and
#31. There is generalized recession throughout the mandibular arch. The facial and
lingual anterior teeth have 1-3mm of recession throughout. The patient also has 2
mm recession on tooth #3, #7, and #6. The patient has abfractions on tooth #28,
#29, and #30. The CAL for these ranges from 3-5mm on the maxillary arch and
mandibular right. The CAL for the lower left ranges from 3-7 and localized 9mm
CAL on mesial of #31. The patient has a Class I furcation on tooth #30. The patient
is classified with generalized moderate chronic periodontitis because of her pocket
depths in conjunction with radiographic findings. The patient has shown
improvements in her home care and reduced her pocket depths in most areas. The
patient should especially focus on the lower left by flossing and brushing this area
more often when she noticed the plaque is starting to accumulate. At this point the
patient has not completely halted her disease, but has made vast improvements
over the course of a month.
5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of

teeth, occlusion, abfractions)
Midline position: 2mm to the lef
Occlusion:
Right molar: Class I
Right canine: Class I
Lef molar: Class III
Lef canine: Class I
Missing: #1, #5, #12, #16, #17, #18, #28, #32
Amalgam restorations: #3- O #14- O #19- O #30- O #31- O
Abfraction: #28, #29, #30
Malocclusion could contribute to her periodontal disease because the teeth are putting
uneven force on one another. This can cause a widened PDL and result in rapid bone
loss and pocket formation in teeth that already have a damaged periodontium.
Missing teeth could contribute to her periodontal disease because remaining teeth can
drift into the open space. This can cause new hard to reach places created by the
shifted teeth. It is also common for bone to recede once a tooth is missing because it
is no longer needed. This can cause bone loss around adjacent teeth and possible
loss of these teeth as well.
Abfractions could contribute to her periodontal disease by trapping more bacteria and
plaque. If this plaque is not adequately removed it could cause gingival inflammation
and aid in periodontium destruction.
6. Treatment Plan: (Include assessment of patient needs and education plan)

Medical/Dental History
Statement of Release
Pre-rinse
Head and Neck Exam
Periodontal Assessment
Plaque Score: 4.0 Poor
Bleeding Score: 29%
Dental Charting with x-rays
Informed consent
Risk Assessment
FMX- Assess bone levels, check for caries, patient had not had x-rays in several years
Gingival Index: 1.29 Fair
Patient Education: Will teach brushing and flossing techniques in patient education
sessions. Discussed topics today.
Learning Level: Interested
No referrals
Generalized moderate periodontitis with generalized moderate BOP.
App't 2: October 16th, 2017

Medical/ Dental History
Pre-rinse
Take intra-oral pictures
Retake x-rays if needed
Plaque score on indicator teeth
Bleeding score on indicator teeth
Detailed gingival description UR
Ultrasonic scale UR
Full periodontal charting on UR
Fine scale UR
Patient education: Session One

Plaque and brushing
LTG-She will reduce the bacteria in her mouth and reach a plaque score of 0 by her recall
appointment in February.
STG- She will define plaque and use a disclosing solution to detect plaque in her mouth.
STG- She will correctly demonstrate sulcular brushing in her mouth.
STG- She will lower her plaque score at each appointment by .5 until she reaches 0.
Patient education session will start with an explanation of topics that will be discussed.
Then the short-term goals and long term goals will be discussed and agreed upon.
Session One
Topic: Plaque
Ask patient questions to assess their knowledge. “Can you tell me what plaque is, and
what it can cause?” Define plaque: soft, sticky, colorless film of harmful bacteria that
constantly forms on teeth. Explain that plaque develops when food is left on teeth then
turns into calculus (tartar) when not removed. Using flip book and intraoral pictures to
show patient tartar that develops when plaque is not removed, talk about plaque score
and how we plan to improve it. Explain how plaque contributes to periodontal disease.
Skill: Brushing
Use a typodont to show patient sulcular brushing first, and then let the patient
demonstrate on typodont. Instruct patient to make sure to brush morning and night for
at least two minutes.
While at sink: Use PPE, patient looking in the mirror, modify technique, disclose, point
out missed areas, and teach tongue brushing.
End of Session: Recap

Ask the patient if she has any questions. Then ask the patient questions: “Tell me what I
taught you about plaque.” “Do you remember what plaque can cause?” conclude with
noting the topic for the next session (periodontitis and flossing). Remind the patient that
we are a team and encourage patient to implement new skills at home.
App't 3: October 23rd, 2017

Pre-rinse
Detailed gingival description UL
Ultrasonic scale UL
Full periodontal charting on UL
Fine scale UL
Patient education: Session Two

Periodontitis and flossing
LTG 2: She will halt the progression of her periodontal disease by using techniques being
taught. She will reduce her bleeding score to 0% by her recall appointment in February.
STG: She will define periodontal disease.
STG: She will show an improvement in pocket depths and reduce bleeding score by 5%
at each appointment.
STG: She will correctly demonstrate how to floss.
Then the short-term goals and long term goals will be discussed and agreed upon. The
patient will be asked if she has any questions about session one and we will recap on
those areas.
Session Two
Topic: Periodontitis
Ask patient questions to assess their knowledge. “Can you tell me what periodontal
disease is?” “Are you aware you have periodontitis?” Define periodontal disease, starts
as gingivitis and leads to periodontitis, bone level migrates apically, and teeth can
become loose, and eventually be lost. Explain to patient what host response is. Explain
how bacteria and host response play a factor in periodontal disease.Use flipbook,
pictures and patient’s radiographs to show patient bone loss. Allow patient to practice
on typodont.
Skill: Flossing
Use a typodont to demonstrate good flossing techniques using “c” shape to patient.
While at sink: Use PPE, patient looking in the mirror, modify technique, disclose, point
out missed areas, and assist patient with removal.
End of Session: Recap

Ask the patient if she has any questions. Then ask the patient questions: “Tell me what
you remember about periodontitis.” “Why is flossing so important?”. Conclude with
noting the topic for the next session (tobacco cessation). Remind the patient that we are
a team and encourage patient to implement new skills at home.
App't 4: November 2nd, 2017

Pre-rinse
Detailed gingival description LL
Ultrasonic scale LL
Full periodontal charting on LL
Fine scale LL
Patient education: Session Three

Tobacco Cessation
Then the short-term goals and long term goals will be discussed and agreed upon. The
patient will be asked if she has any questions about session one and session two and we
will recap on those areas.
LTG 2: She will stop smoking by her recall appointment in February.

STG: She will reduce cigarette use by one per week.
STG: She will use nicotine aids to help her stop smoking.
STG: She will use the money she normally spends on cigarettes and put them in a jar to
save for a vacation.
Topic: Tobacco Cessation

Ask patient why she is interested in quitting. Explain that this should be the patient’s
idea, cannot be forced or the cessation is more likely to fail. Explain to the patient her
high risk of oral cancer and other causes smoking has on oral tissues. Explain smoking
suppressed the immune system and causes delayed healing. Smoking has a negative
impact on regeneration after periodontal therapy. Smoking increases rate and severity of
periodontal destruction, increases bone loss, attachment loss, and pocket depths.
Smoking can increase rate of periodontal disease and tooth loss. Discuss reasons for
quitting and how to quit with patient. Explain to patient things not to do when quitting
such as replacing a cigarette with peppermints because they contain sugar and cause
caries. Encourage good replacement therapies such as running, rewarding herself for
small successes, and starting a savings with the money she would use on cigarettes.
End of session: Ask the patient if she has any questions. Take patients recommendations
into consideration and come up with a plan for cessation together. Remind the patient
that we are a team and encourage patient to implement new skills at home.
App't 5: November 6th, 2017

Pre-rinse
Detailed gingival description UR
Ultrasonic scale UR
Full periodontal charting on UR
Fine scale UR
Plaque Free
5% fluoride varnish to help with any sensitive areas
Patient Education: Explain to patient about changes in her gingival status. Explain since
calculus was removed, there might be some root exposures which can cause sensitivity.
Introduce Arestin to the patient and explain the benefits. Arestin is an antimicrobial
agent that works with your body to increase healing rate. Explain to patient she will
need to come back in two weeks for a final appointment. At this appointment, she will
be able to see how well she has healed. Also, ask patient about how well she is
implamenting new techniques taught in patient education. Answer any questions she
may have and help patient if she needs to be shown a skill again or modify a skill.
App't 6: November 20th, 2017

Pre-rinse
Plaque score
Bleeding score
Gingival description
Check for any reformed or residual calculus and remove
Final Gingival index
Periodontal Charting
Place Arestin where needed
Establish recall
Patient Education: Answer any questions patient has about treatment she received.
Stress the importance of implementing and maintaining the skills taught in patient
education sessions. Remind patient we are a team and the goal is to halt the progression
of her disease. Stress the importance of maintaining regular dental checkups and how
they promote oral and overall health. Give post-op instructions for Arestin. Patient
cannot brush the area for 24 hours and cannot floss the areas Arestin was placed for 10
days and show patient in the mirror the exact sites. Let the patient know she will be seen
in the spring for a recall and to assess healing and gingival tissues.
App't 7: February 2017

Medical/Dental History
Statement of Release
Pre-rinse
Head and Neck Exam
Intra/Extra Oral Exam
Periodontal Assessment
Plaque Score
Bleeding Score
Gingival description
Patient Education: Answer any questions patient has about treatment she received.
Stress the importance of implementing and maintaining the skills taught in patient
education sessions. Remind patient we are a team and the goal is to halt the progression
of her disease. Stress the importance of maintaining regular dental checkups and how
they promote oral and overall health
7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony
crests, thickened lamina dura, calculus, and root resorption)
Generalized moderate horizontal bone loss UR, UL, LL, LA, LR quadrants. Generalized
moderate calculus in all quadrants. If the progression of her periodontal disease is not
halted at the moderate stage the patient could experience severe bone loss and
eventual tooth loss. Furcation involvement noted intraorally, cannot be seen
radiographically. Furcation involvement can contribute to periodontal disease by
harboring bacteria and causing destruction to the periodontium. Calculus left
undisturbed will attribute to her periodontal disease. I will teach patient about
periodontal disease and how to halt progression.
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.
Appt 1: October 12th, 2017

Patient appointment practice, HIPAA, and statement of release were all signed.
Medical/dental history, pre-rinse, head and neck exam, periodontal assessment with full
periodontal charting including dental charting with x-rays were completed. Plaque score
and bleeding score were also taken. Patient was classed as a prophy class VI and perio
case III. Her gingival index was 1.29-Fair. I explained to my patient what the periodontal
case study was and that if she agreed to be a part of it she will need to come in once a
week and only one quadrant can be cleaned at a time, patient agreed. We discussed
what periodontitis is and the goal is to halt progression. While brushing at the sink, I
observed my patient and explained to her what sulcular brushing was and I would teach
her in further detail during patient education sessions. Learning level: Interested.
Appt 2: October 16th, 2017

Medical/dental history, pre-rinse, and intra oral pictures were taken of patient. Plaque
score was 4.0-Poor and bleeding score was 33%. Ultrasonic, full periodontal charting,
and fine scale on maxillary right was completed. The first patient education session over
plaque and brushing was completed. We discussed the long term and short term goals.
LTG-She will reduce the bacteria in her mouth and reach a plaque score of 0 by her recall
appointment in February. STG- She will define plaque and use a disclosing solution to
detect plaque in her mouth. STG- She will correctly demonstrate sulcular brushing in her
mouth. STG- She will lower her plaque score at each appointment by .5 until she reaches
0. Asked the patient questions to assess their knowledge. “Can you tell me what plaque
is, and what it can cause?” Talked about plaque score and how we plan to improve it.
Showed patient intraoral pictures and explained what calculus is and how it builds up on
the teeth. Explain that plaque develops when food is left on teeth then turns into
calculus (tartar) when not removed. The patient was using a medium brush head for her
electric toothbrush. I explained how this can contribute to the calculus build up, the
recession, and the abfractions she already has. I also explained that the medium brush
head can inhibit plaque removal because the bristles cannot contour to the tooth like a
soft bristle brush does. I explained that the patient must brush twice a day for two
minutes, angling the toothbrush toward gum-line, because plaque forms in the mouth
daily and must be adequately removed to prevent build up and transforming into
calculus. I told patient to use pea size amount of toothpaste. I also explained to her the
Mentadent toothpaste she is currently using could be harmful to her gums because of
the peroxide it contains. I explained is could cause inflammation and contribute to her
periodontal disease. Showed the patient pictures of plaque in the patient education flip
book. I asked the patient to show me how she brushed using the typodont, I then
modified the technique on the typodont and let the patient practice. I then disclosed the
patient at the sink and showed her the places she was missing with previous brushing
and taught sulcular brushing in the mirror with a soft electric toothbrush. The patient
had some trouble at first angling the brush but quickly got the hang of it when I aided
her with my hand on hers on how to turn the brush and use circular motions.
The patients learning level is self-interest. The patient was very optimistic about learning
a modified brushing technique and to implement them into her routine. She admitted it
would be a learning curve but she was more than willing to try. She stated she could tell
a difference using the soft brush at the sink and would purchase these heads to use daily
at home. Explain how plaque contributes to periodontal disease.
We discussed that the next session we would discuss periodontal disease and flossing,
and our last session would cover tobacco cessation. The patient felt that the goals
established today were attainable and looked forward to seeing her progression at her
next appointment. Reminded the patient that we are a team and encourage patient to
implement new skills at home.
Appt 3: October 23rd, 2017

Medical/dental history, pre-rinse, and calculus detection for difficult calculus evaluation.
Plaque score was 2.1-Fair and bleeding score was 19%. Ultrasonic (except #15), full
periodontal charting, and fine scale on maxillary left (except #15) was completed. The
patient’s learning level was involvement. The patient received praise for lowering her
plaque score and is making progress on using the sulcular brushing technique. I
reiterated why it is important to learn and maintain brushing this way and how it aids in
plaque removal and can help the patient heal once all the calculus removed. This
technique is also very important to prevent the calculus from building up with adequate
plaque removal. The patient stated she is now using sensodyne toothpaste instead of
the mentident. She also states that her gingival tissues feel better now that she has
switched products.
Appt 4: November 2nd, 2017

Medical/dental history, pre-rinse, and difficult calculus evaluation. Plaque score was 1.8-
Fair and bleeding score was 16%. Ultrasonic, full periodontal charting, and fine scale on
mandibular left and #15 was completed. I showed patient pieces of calculus as they
were being removed on lower anterior teeth. I reiterated the importance of proper
brushing and the need to floss daily. Patient doing very well with plaque control. The
patient also stated she is flossing three times per week now compared to once. The
patient’s learning level was involvement.
Appt 5: November 6th, 2017

Medical/dental history, pre-rinse, and difficult calculus evaluation. 1.7ml 2% Lidocaine
w/ epinephrine 1: 100,000 local anesthesia used on lower right. Plaque score was 1.6-
Good and bleeding score was 13%. Ultrasonic, full periodontal charting, and fine scale
on mandibular right was completed. The second patient education session over
periodontal disease and flossing was completed. We discussed the long term and short
term goals. LTG 2: She will halt the progression of her periodontal disease by using
techniques being taught. She will reduce her bleeding score to 0% by her recall
appointment in February. STG: She will define periodontal disease. STG: She will show an
improvement in pocket depths and reduce bleeding score by 5% at each
appointment. STG: She will correctly demonstrate how to floss. Asked the patient if she
has any questions about session one and how she was doing. She stated she was doing
well and I praised her for reducing plaque score from 4.0-Poor to 1.8-Fair. The patient is
meeting her short-term goals and is on track to meet her long-term goal in February.
Asked patient questions to assess their knowledge. “Can you tell me what periodontal
disease is?” “Are you aware you have periodontitis?” Defined periodontal disease, starts
as gingivitis and leads to periodontitis, bone level migrates apically, and teeth can
become loose, and eventually be lost. Explain to patient what host response is. Explain
how bacteria and host response play a factor in periodontal disease. I used the patient’s
radiographs and pictures from my flipbook to show patient bone loss. The patient did
not know what periodontal disease was and stated no one ever sat down and explained
it to her. The patient stated when she had a cleaning regularly she had to go every 3-4
months because of plaque the tartar that built up so fast. The patient seemed a little
upset no one had ever told her about periodontal disease and that it did not just effect
the gums but also her bone level. I explained that periodontal disease is irreversible but
it can be halted. Explained that if it is not halted it could lead to tooth loss. The patient
jumped at this opportunity and stated she would do whatever she could to keep her
teeth. She became very eager to learn how to floss properly and stated the quadrants
that were already cleaned felt very clean and her gums felt a lot better. She would like to
maintain this. I asked the patient to show me how she flossed using the typodont, I then
modified the technique on the typodont and let the patient practice. The patient stated
when she was practicing with regular floss that she generally used only a floss-aid. I
explained why a floss aid is good some of the time but it is better to use regular floss
because it can go below the gums and increase plaque removal. I then disclosed the
patient at the sink and showed her the places she was missing with previous flossing.
The patient had a hard time wrapping the floss around her finger and making a “c”
shape. Worked with patient to find a more natural way to floss. The patient was using to
long of a piece to work with the floss. Showed her how to use just a small piece to wrap
around the teeth and go all the way below the gums. She then began to improve on her
flossing technique and stated she would implement this into her daily routine. Asked the
patient if she had any questions. Then ask the patient questions: “Tell me what you
remember about periodontitis.” “Why is flossing so important?”. Conclude with noting
the topic for the next session (tobacco cessation). Remind the patient that we are a
team and encourage patient to implement new skills at home.
Appt 6: November 20th, 2017

Medical/dental history, pre-rinse, and difficult calculus evaluation. Plaque score was 1-
Good and bleeding score was 13%. Final gingival index was 0.5-Good. Post calculus
evaluation and full post periodontal charting was completed. The patient had a few
areas of residual calculus and soft reformed calculus on the lingual anteriors. placed
Arestin #31- MB #31- ML #30-ML. Gave post-op instructions for Arestin. Patient cannot
brush the area for 24 hours and cannot floss the areas Arestin was placed for 10 days
and showed the patient in the mirror the exact sites. Let the patient know she will be
seen in February for a recall and to assess healing and gingival tissues. The third patient
education session over tobacco cessation was completed. We discussed the long term
and short term goals. LTG 2: She will stop smoking by her recall appointment in February.
STG: She will reduce cigarette use by one per week. STG: She will use nicotine aids to
help her stop smoking. STG: She will use the money she normally spends on cigarettes
and put them in a jar to save for a vacation. Asked the patient if she has any questions
about session one and session two and we recapped on those areas. Disclosed the
patient in the mirror and asked her to show me how she has been brushing. Modified
how she used electric toothbrush. Patient doing very well angling bristles. Showed
patient how to use circular motions. Explained to her she must work the toothbrush
can’t rely just on it working itself. Also, showed patient how to exaggerate “c” shape in
lower anteriors now that calculus is removed and she has recession. Asked patient why
she is interested in quitting. Explain that this should be the patient’s idea, cannot be
forced or the cessation is more likely to fail. Explain to the patient her high risk of oral
cancer and other causes smoking has on oral tissues. Explain smoking suppressed the
immune system and causes delayed healing. Smoking has a negative impact on
regeneration after periodontal therapy. Smoking increases rate and severity of
periodontal destruction, increases bone loss, attachment loss, and pocket depths.
Smoking can increase rate of periodontal disease and tooth loss. Discuss reasons for
quitting and how to quit with patient. Explain to patient things not to do when quitting
such as replacing a cigarette with peppermints because they contain sugar and cause
caries. Encourage good replacement therapies such as running, rewarding herself for
small successes, and starting a savings with the money she would use on cigarettes. Ask
the patient if she has any questions. Take patients recommendations into consideration
and come up with a plan for cessation together. Reminded the patient that we are a
team and encourage patient to implement new skills at home. The patient’s learning
level is involvement. Answered any questions patient had about treatment she received.
Stressed the importance of implementing and maintaining the skills taught in patient
education sessions. The patient stated she does not have near as much bleeding as she
did when we first started treatment. Explained to her this was a sign of improvement her
oral health. Remind patient we are a team and the goal is to halt the progression of her
disease. Stress the importance of maintaining regular dental checkups and how they
promote oral and overall health.
9. Prognosis: (Based on attitude, age, number of teeth, systemic background,

malocclusion, tooth morphology, periodontal examination, recare availability)
My patient has a superb attitude and has an overall good prognosis. She does not take
any medications besides occasional over the counter medications for allergies or sinus
problems. She is 63 and has 24 teeth. The teeth she is missing were extracted as a child
before she had braces according to my patient. She is also missing her wisdom teeth
which she got extracted as a teenager. She has a few fillings, none of which are very
large. All of them cover the occlusal surface and she has never had any problems with
these areas. The patient’s malocclusion could play some factor into her periodontal
disease but it is not a high possibility. Her teeth are still straight from having braces as a
child. There is some overlap but nothing that is too substantial it would hinder the
patient from cleaning an area insufficiently. Overall her periodontal assessment
improved throughout the course of treatment. Her gingival tissues responded well after
the calculus was removed and the patient did a good job on cleaning during the week
before returning for each appointment. She is eager to continue good oral hygiene and is
very willing to come back in February for a recall appointment.
10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and
recall schedule. (Note: Include date of recall appointment below.)
Suggestions offered to the patient regarding re-evaluation were to continue to
implement good brushing and flossing until they become natural and part of her
everyday routine. I pointed out the patient should focus on the lower left because this
area was still inflamed at her post calculus appointment. All though there was still some
bleeding in this area it has improved greatly and went from moderate to slight. I
explained to the patient how important it was to come back in February for a recall for
me to assess her gingival tissues and continue to monitor her oral health. I also
explained how it important it is to continue to stick to a cleaning schedule and get any
calculus removed.
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival

health, probing depths)
The patient improved greatly on her plaque control. In one month, she lowered her
plaque score from 4.0-Poor to 1-Good. She also showed improvement on pocket
depths. The patient had generalized 4-6mm pockets throughout the maxillary and
mandibular arch. The patient had generalized 3-4mm pockets throughout the
maxillary and mandibular arch except for the lower left that had generalized 5-7mm
pockets on #29, #30, and #31. The patient also improved her bleeding score from
33% to 13% in her month of treatment. Her gingival index started at 1.29-Fair and
was reduced to 0.5-Good. Overall her gingival health improved greatly. At her first
appointment, the patient had generalized redness, rolled, bulbous, and smooth and
shiny. By her final appointment her gums were pink, normal, and smooth and
stippled. The only problem area was the lower left posteriors. These were aided in
healing by placing Arestin in these sites. These sites will be evaluated at her recall
appointment in February.
12. Patient Attitudes and Cooperation:

My patient had a positive attitude throughout her entire treatment. She was more than
happy to come for six appointments when I explained the periodontal case study to her
and how this cleaning and evaluation would improve her health and make her feel
better about her mouth. She has been down on herself for the past couple of years
because she put herself off when she had to take care of her mother before she passed
away. She stated she was ashamed she let it get this bad and, “wanted her gaps back in
her bottom teeth.” She knew she could use a deep cleaning and when shown her
intraoral pictures she was shocked. She did not realize how bad it had gotten and was
very eager for me to clean her teeth. Each appointment she showed a lot of interest in
what was being taught or what area of her mouth was being clean. She asked several
questions at each appointment and asked for help with brushing and flossing when
needed. Overall her attitude and cooperation were nothing short of perfect. She has
done everything asked of her and is implementing her new taught skills very well.
13. Personal Evaluation/Reaction to Experience:

As a hygienist, we have an important role to help patients improve their oral health and
therefore improve their overall health. During the treatment period, I could physically
see the impact removing calculus can make on gingival tissue healings. I could show my
patient what healthy gingival tissues compared to unhealthy gingival tissues. I feel I did a
good job on her overall cleaning. The patient was very happy and stated on multiple
occasions how much better her gums and mouth feel. That is an amazing feeling and
makes me feel like I am implementing what I have learned in previous semesters and
now apply them fully to my patients. This overall experience makes me look forward to
private practice and to work with patients daily to improve their oral health.

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PERIODONTAL CARE PLAN

Patient Name__ __ Age__63__

1. Medical History: (systemic conditions altering treatment, pre-medication, medical

4. Periodontal Examination: (color, contour, texture, consistency, etc.)

a. Case Classification __VI__ Periodontal Case Type__III__

App't 1: October 12, 2017

App't 2: October 16, 2017

App't 3: October 23, 2017

App't 4: November 2, 2017

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

5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of

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

App't 2: October 16th, 2017

Patient education: Session One

End of Session: Recap

App't 3: October 23rd, 2017

Patient education: Session Two

End of Session: Recap

App't 4: November 2nd, 2017

Patient education: Session Three

LTG 2: She will stop smoking by her recall appointment in February.

Topic: Tobacco Cessation

App't 5: November 6th, 2017

App't 6: November 20th, 2017

App't 7: February 2017

Appt 1: October 12th, 2017

Appt 2: October 16th, 2017

Appt 3: October 23rd, 2017

Appt 4: November 2nd, 2017

Appt 5: November 6th, 2017

Appt 6: November 20th, 2017

9. Prognosis: (Based on attitude, age, number of teeth, systemic background,

11. Assessment of Changes: (including plaque control, bleeding tendency, gingival

12. Patient Attitudes and Cooperation:

13. Personal Evaluation/Reaction to Experience:

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Patient Name Age63

a. Case Classification VI Periodontal Case TypeIII