PERIODONTAL CARE PLAN

ASSIGNMENT TEMPLATE

Use this template to write your periodontal care plans and submit through Blackboard.

Care Plan Part 1 submission will include Template items #1-8, using findings from initial patient
assessment appointment. Care Plan Part 2 submission will include entire PCP Template with all data
completed.

Patient Name: Age:

Date of initial exam: 9/6/2023 Date completed: 10/25/2023

1. Medical History: (systemic conditions, pre-medication, medical clearance, medications, etc.)

Explain steps to be taken to minimize or avoid occurrence. Discuss in detail the relationship and
effects of medical findings on patient periodontal diagnosis, progression, and treatment. You must
calculate and document the patient's BMI (Body Mass Index) for this section. Document if the BMI
indicates the patient is underweight, normal weight, overweight, or obese. Explain if the BMI could
be a risk factor for periodontal disease.

The patient is 25 years old; height is 5’10”, and weights 140Ibs. BMI is 20.1- indicates normal
weight.

According to his medical record, the patient has no medical conditions, is not taking any
medications, and does not have any allergies. He is a patient under the care of a primary care
physician, Dr. Trinh. However, he has not had a physical examination in 4 years indicating that it is
possible he has an undiagnosed disease.

The patient does not have a primary care dentist, he has only been to the dentist once, about four
years ago (2019), because he was experiencing pain due to decay, and he had the teeth extracted
and roots canal therapy. The patient is at a high risk of developing undiagnosed dental conditions,
for example: periodontal disease, caries, infections. I explained to him that routine dental visits are
necessary to maintain his oral health. Dental cleanings are necessary to remove plaque and calculus
that builds up on the teeth and can lead to a variety of dental problems in the future.

This patient has been smoking about 7 years and uses vape as well. He is at risk for bone loss and
periodontitis because of his smoking. Periodontal disease is associated with tobacco use in several
ways, including oral biofilms, host immunity, and bone resorption. Smoking can do a lot of damage
to the patient's gums by allowing bacteria to penetrate under the gum line as well as not brushing
nor flossing properly, resulting in layers of plaque that are built up and worsen the progression of
the disease.

The patient works night shifts full-time. Every two weeks he gets 2 days off on the weekends, but
the dentist’s office and family doctor’s office are only open on the weekdays, the patient indicated
 that he wanted to go see the dentist and family doctor about oral health and his health, but he is
too lazy to get up early since he is too tired from the night shift. The patient could end up
overworking himself, resulting in a weak immune system, lack of energy, insomnia, and a weak
immune system if the patient neglects his health.

I believe that this treatment will stop the progression of the patient's periodontal condition if he
complies with the treatment and learns to take good care of his teeth at home and develops good
hygiene habits.

2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief complaint,
present oral hygiene/ homecare habits, etc.) Discuss in detail the relationship and effects of
findings on patient periodontal diagnosis, progression, and treatment. Review patient’s homecare
and oral hygiene habits at each appointment and note improvements.

His chief complaint was for a cleaning. It is important to note that he has not been to the dentist for
4 years, which indicates low dental awareness and concern. Furthermore, he notes that he
experiences bleeding when brushing and flossing as well as sensitivity to cold foods, the sensitivity
in his teeth is a result from recession, attrition, and pocket depths. This indicates infection, which is
directly related to periodontitis.

When I asked the patient about the x-ray, he said that he doesn't remember, but he does know that
he might have taken his X-ray in the last 4 years, since he had a tooth extracted and root canal
therapy, putting him at a high risk of developing undiagnosed dental conditions.

The patient uses a manual toothbrush. He stated that he only brushes one time a day and that he
doesn't use mouthwash, as he feels the mouthwash has a strong smell, which he doesn't like, and
that he only flosses if he has food stuck between his teeth. When I check on his plaque score, it
shows that his plaque score is 3.8, which is a poor score, which indicates that he did not know how
to brush his teeth correctly. I asked how long he had to brush his teeth, and he replied that he
didn’t know how long he brushed his teeth. He brushes one time for each quadrant, and he only
brushes his tongue if the tongue has a brown color from the coffee. His poor oral hygiene, plaque
buildup, and calculus increase his risk of caries and progression of periodontitis. In order to keep his
teeth healthy, I recommend that he brush his teeth for two minutes and brush his tongue as well.
As I asked him to brush his teeth, he used a horizontal method and used a lot of force, which can
damage the gingival, so I showed him to brush gently at a 45-degree angle to avoid any further
damage to the tissue. In addition, I recommended that he purchase an electric toothbrush in order
to remove more plaque, prevent disease progression and keep track of the brushing time, since he
may lose track of it with a manual toothbrush.

The patient had teeth numbers 17, 18, 30, and 31 extracted. I explained to him that alveolar bone is
dependent on the presence of teeth, and once the teeth are extracted, the bone will resorb over
time, it is important to note that when a tooth becomes missing, the bone is at risk of degrading
and weakening. This deterioration can lead to healthy teeth becoming loose or even dislodged. In
addition, teeth number #30 and #31 are not in occlusion with other teeth. This can cause supra-
eruption of those teeth, which will further contribute to periodontitis progression.
 The combination of my encouragement and proper brushing and flossing combined with the
treatment will be a positive factor in the treatment of his periodontal disease. Additionally, there
are some other findings that can be attributed to the progress of the patient's periodontal disease,
such as the fact that he smokes and has some pocket depth. These factors can also contribute to his
progression of the disease.

3. Intraoral and Extraoral Examinations: (lesions noted, facial form, occlusion, habits and awareness,
consultation, etc.) Discuss in detail the relationship and effects of findings on patient periodontal
diagnosis, progression, and treatment.

Extraoral:

The patient had deviation to the left in the TMJ area because of his clenching and grinding.
Clenching occurs when the maxillary teeth are continually or intermittently forcefully closed against
the mandibular teeth, which may contribute to his current periodontal condition and progression
rate. The patient has lymphadenopathy, but there is no tender movement, possibly due to allergies,
weather change, or a past infection.

Intraoral:

The patient stated that he does not clench his teeth, but I observed linea alba on both cheeks,
which suggests that he may clench his teeth during sleep or at work and may be unaware of it,
which could lead to oral cancer. He also had scalloped bilateral borders on his tongue, which could
be the result of biting his lips or clenching at night or at work.

He has a white coating on his tongue, which is plaque, it could be a sign that he is not properly
removing bacteria from his mouth, putting him at risk for caries. He did not have tongue thrust. He
breathes with his mouth during his sleep and throughout the day at work, which would result in a
dry mouth. A dry mouth increases the risk of tooth decay or fungal infections in the mouth.

On an occlusion exam, he had an overbite of 2 mm and overjet of 3 mm, midline shift of 2 mm to

the left, open bites on 7 & 27 and 10 & 22, no crossbite, and occlusion class 1 on all sides.
Currently, the patient has a mesognathic class 1 occlusion, but there is a possibility that it will
change due to his absence of teeth 17, 18, 30 and 31.

According to the findings of the intraoral and extraoral examination, it appears that the relationship
between the minor TMJ dysfunction, scalloped tongue, and clenching may contribute to the
progression of periodontal disease, and it is recommended to use a night guard in order to prevent
the teeth from clenching.

4. Periodontal Examination: Discuss in detail the relationship and effects of findings on patient
periodontal diagnosis, progression, and treatment.

The gingival architecture presents as scalloped, the gingiva's color was generalized redness and
localized magenta, which is a result of inflammation caused by plaque accumulation in the gingiva.
The consistency of the gingiva was generalized edematous/spongy. The margins were generalized
rolled while the papilla was generalized bulbous. There was no suppuration. The surface texture of
 the papillary and marginal was smooth and shiny, the surface texture of the attached gingiva was
smooth and shiny. The shape of the papillae also shows how severe the recession.

It can be seen from the periodontal examination that the gingival tissues are severely inflamed as
well as rolled margins and bulbous papillae, as well as severe inflammation. With proper treatment
and patient education, the patient may be able to halt the progression of his disease and prevent
his gingival tissues from being further damaged.

a. Periodontitis Stage: II Periodontitis Grade: B Extent & Distribution: severe &

generalized.

• Describe determining factors/ etiology behind Stage AND Grade:

The periodontitis stage II was determined for this patient based on the measurement for
clinical attachment loss of 3mm and the probing depth of 4-5mm. The most severe
percentage of bone loss within the oral cavity was 15-33%. In addition, my patient smokes
approximately 1 packs cigarette per day and uses vape, which contributes to the progression
of his condition, as do infrequent dental visits and habits such as clenching and grinding the
teeth. Periodontitis grade B is determined by dividing the percentage of bone loss by the
patient's age. The patient has severe bone loss throughout his mouth, indicating that he has
generalized periodontitis.

b. Gingival Description: (color, contour, texture, consistency, etc.)

• Describe for each sextant or quadrant at each appointment:

Initial Assessment Appointment:

Appointment 1: The color of the gingiva was severely red and generalized. The architecture was
scalloped with generalized bulbous papilla and generalized rolled margins. The consistency is an
edematous/spongy generalized. The surface texture is smooth and shiny for papillary and marginal. The
surface texture is smooth and shiny for attached gingiva with bleeding.

Appointment 2: The color of the gingiva was severely red and generalized. The architecture was
scalloped with generalized bulbous papilla and generalized rolled margins. The consistency is an
edematous/ spongy generalized. The surface texture is smooth and shiny for papillary and marginal.
The surface texture is smooth and shiny for attached gingiva with bleeding. Furcation on #19M,
recession #23L #24L, and no mobility.

Appointment 3: The color of the gingiva was severely red and generalized. The architecture was
scalloped with generalized bulbous papilla and generalized rolled margins. The consistency is an
edematous/ spongy generalized. The surface texture is smooth and shiny for papillary and marginal.
The surface texture is smooth and shiny for attached gingiva with bleeding. No furcation, one
recession #25L and no mobility.

Appointment 4: The color of the gingiva was severely red and generalized. The architecture was
scalloped with generalized bulbous papilla and generalized rolled margins. The consistency is an
edematous/ spongy generalized. The surface texture is smooth and shiny for papillary and marginal.
The surface texture is smooth and shiny for attached gingiva with bleeding. No furcation, one
suppuration on #8L, six recessions on #3B&L, #6F&L, #8F&L, and class 1 mobility on #8.

Appointment 5: The color of the gingiva was severely red and generalized. The architecture was
scalloped with generalized bulbous papilla and generalized rolled margins. The consistency is an
edematous/ spongy generalized. The surface texture is smooth and shiny for papillary and marginal.
The surface texture is smooth and shiny for attached gingiva with bleeding. No furcation, one
recession on #9F and no mobility.

Post- Perio Reevaluation Appointment:

c. Plaque Index: Appointment 3.8 (poor), 4.2 (poor), 4 (poor), 3.6 (poor), 2.6 (fair), 1.2
(good), 0.8 (good), 0.4 (good), 0.2 (good)

d. Gingival Index: Initial 1.5 Final: 0.9

e. Bleeding Index: Each appointment 28%, 16%, 27%, 31.6%, 16.7 %, 16.7%, 12%, 12 %, 2.4%,
4%

Note: Complete full mouth bleeding index at first and last appointments- can use indicator teeth for
other appointment scores.

f. Evaluation of all index findings. Discuss in detail the relationship and effects of findings on
patient periodontal diagnosis, progression, and treatment. (Do this for initial and final appts
and compare progress at final appt).

1. Initial appointment (baseline): The patent has generalized

moderate periodontitis with moderate to severe bleeding. He has periodontal
disease at stage 2 grade B with 15%-33% horizontal bone loss throughout his
mouth. His pocket depths are 4-5mm, and they may be higher due to the
calculus buildup he has on his teeth. At only 25 years old, this is a serious issue
that urgently needs to be addressed so that he will be able to prevent bone loss
in the future. Patient had a fair gingival index of 1.5 and bleeding score of 28%
while probing. The patient had a poor plaque score of 3.8 which can be lower by
properly brushing method as mentioned and will assist with halting his
periodontal progression. Additionally, his bleeding score indicates active
periodontitis due to inflammation.

My goal is to decrease the plaque and bleeding scores with each appointment,
and to achieve a good gingival index by the final appointment. The findings
indicate that this patient's condition is deteriorating and will continue to
deteriorate unless he is treated and educated about proper oral
 hygiene/techniques. I will educate on plaque, brushing & flossing, bleeding, and
periodontist.

2. Final appointment (Post- Perio Reevaluation): After learning the proper

toothbrushing technique and flossing technique and participating in several
patient education sessions, the patient achieved their goal of decreasing his
plaque score by 0.5 at each appointment. His plaque score went from 3.8
(poor) to 0.2 (good). Furthermore, the patient has learned about the
importance of maintaining proper oral hygiene and removing plaque
effectively, which is one of the primary causes of periodontal disease. The
gingival index went from a 1.5 to a 0.95 which is considered good. With the
newly learned proper oral care techniques, such as flossing, the bleeding score
decreased from 28% to 4%. According to these indicators, the patient has
progressed during one treatment session. If the patient continues to maintain
good oral hygiene practices, periodontal disease can be halted. During the post
calculus, the patient developed calculus in a few areas since it had been three
weeks since his last appointment, and he explained to me that he would not
always complete his home care because of his busy schedule (work nightshift).
His gingiva, however, has improved throughout treatment, the redness and
shiny tissues have lessened in severity, and the papillae have become less
bulbous (intraoral camera).

g. Prophylaxis Classification (detection of calculus): Discuss the location and quantity of

calculus in relation to the patient’s periodontal diagnosis, progression, and treatment.

The patient has a class of 6, he has calculus almost everywhere, the most is on the on the
mandibular

h. Periodontal Chart: (pocket depths, recession, CAL, furcation, mobility, etc.). Discuss in
detail the relationship and effects of periodontal chart findings on patient periodontal
diagnosis, progression, and treatment. Compare progression of initial findings to findings by
quad after calculus removal, and then to findings at the final reevaluation appointment.

1. Initial appointment (periodontal chart findings at initial assessment

appointment, prior to calculus removal- record 4mm+ readings and recession):
As a result of heavy calculus, I was not able to obtain accurate probing depths in
the anterior portion and even in the posterior portion. The finding that I did get
was: he has pocket depth of 4-5mm and recession of 1mm on #29F, CAL of 2mm
on #3L, #19DF and #21 FM. The patient has no furcation involvement and no
mobility. The probing depths will be more accurate once scaling has been
completed.

Plaque accumulation is more likely to occur in deeper pockets since patients are
unable to properly clean them at home. Clinical attachment loss is a sign and
 effect of periodontitis. Through proper oral hygiene and patient education, a
patient may be able to reduce pocket depths. It is important for the patient to
understand that CAL and recession are irreversible, however they can be
stopped from progressing any further.

2. Baseline- Full Periodontal Charting by Quadrant (baseline findings recorded by

quad- after calculus removal at each scaling appointment):

Mandibular left: After moving the calculus with an ultrasonic, I was able to
record the pocket depth. As a result, I found that he had a generalized pocket
depth between 4&5mm on every teeth (mesial lingual/buccal, distal) - #15, 16,
17, 18, 19, 20, 21, 22, 23 24, one class 1 furcation on tooth #19 with pocket
depth on buccal of 8mm, two recessions on teeth #23L & #24L, and no
mobility.

Mandibular right: After moving the calculus with an ultrasonic, I was able to
record the pocket depth. As a result, I found that he had a generalized pocket
depth between 4&5mm on every tooth (mesial lingual/buccal, distal) – #25, 26,
27, 28, 29, 32, no furcation, one recession on teeth #26L, and no mobility.

Maxillary right: After moving the calculus with an ultrasonic, I was able to
record the pocket depth. As a result, I found that he had a generalized pocket
depth between 4&5mm on every tooth (mesial lingual/buccal, distal) - #1, 2, 3,
4, 5, 6, 7, 8, one suppuration on #8L, no furcation, six recessions on #3B&L,
#6F&L, #8F&L, and class 1 mobility on #7 & 8.

Maxillary left: After moving the calculus with an ultrasonic, I was able to record
the pocket depth. As a result, I found that he had a generalized pocket depth
between 4&5mm on every tooth (mesial lingual/buccal, distal) - #9, 10, 11, 12,
13, 14, 15, 16, no furcation, three recession on #9F, #15L, #16ML and no
mobility.

3. Post Perio Reevaluation- Full Mouth Periodontal Charting (final appt, after two-
weeks post scaling):

According to the periodontal charting, the highest pocket depth recorded for
this patient is 5mm, with a generalized loss of attachment of 2 to 3mm in the
posterior. One class 1 furcation is involved on #19 and one class 1 mobility is
present on #8 (root resorption). Following a full periodontal evaluation, four
areas were bleeding, which had the most gingival inflammation. There was a
placement of Arestin in two teeth #5D and #14D, which will hopefully reduce
the inflammation in those teeth. Throughout his treatment, he has been
instructed on ways to halt the progression of his disease, and to prevent
further bone loss by effectively brushing, flossing daily, and getting routine
cleanings. His gingiva has improved throughout the treatment, and after every
quadrant was cleaned, you could easily see an improvement in color and an
 adaptation of the gingiva to the tooth at the last appointment (intraoral
camera).

5. Dental Examination: (caries, attrition, midline position, mal-positioned teeth, occlusion,

abfractions, missing teeth, etc.) Discuss in detail the relationship and effects of findings on patient
periodontal diagnosis, progression, and treatment.

The patient has 28 teeth and 17, 18, 30 and 31 were extracted due to decay. There was a referral
for the patient to have #1, 16 and #32 extract due to suspicious areas on the teeth, according to the
dentist, it is better for him to extract that wisdom tooth since it is difficult for him to clean and has
a suspicious area, he would save money by extract the teeth rather than having it restored, he also
has referral to get restored of teeth #2 and #15 due to big decay, and several suspicious areas on
teeth #3 B&O, 5 O, 14 B, 20 O, 29 O, as well as external root extrusion on tooth 9. The patient has
root canal therapy on #13, the patient has attrition on #8,9. Having not received treatment to
replace or restore his missing teeth, this could cause the remaining teeth to shift, an increase in
caries, which is the fact that he has multiple suspicious areas #3, 5, 14, 20, 29 and progression of
periodontal disease, patient can experience occlusal changes, TMJ issues, nutritional deficiencies,
and negative systemic consequences that can cause progression in his periodontal disease.

6. Radiographic Findings: (bone loss, furcation, crown root ratio, root form, condition of interproximal
bony crests, thickened lamina dura, calculus, root resorption, missing teeth, etc.) Discuss in detail
the relationship and effects of findings on patient periodontal diagnosis, progression, and
treatment. An FMX and Vertical BWX are obtained and utilized for disease diagnosis.

Patient has generalized horizontal bone loss on 15-33% throughout the mouth. He has visible
calculus on all quadrants, which shows accumulation on bacteria from not brushing or flossing. He
has 4 missing teeth. The bone loss explains the deep pockets and CAL. The patient has root
anomalies on upper anterior #8 and caries on upper right and upper left. By practicing proper oral
hygiene care, however, it is possible to halt as well as control the progression of periodontitis.

7. Periodontal Disease Risk Factors: (include positive findings noted on the Periodontal Risk
Assessment) Discuss in detail the relationship and effects of risk factors on patient periodontal
diagnosis, progression, and treatment.

The biofilm retentiveness leads to calculus, pocket depths, and inflammation of the gums.
Therefore, periodontal disease will progress more rapidly. Patient education on proper brushing
and flossing techniques and topics related to plaque and calculus, are included in the treatment
process.

As a result of his infrequent dental exams, the patient is unaware that he has periodontitis. His
calculus has not been removed, and the disease continues to progress. Additionally, he does not
know how to properly brush and floss his teeth. Educate patients about the importance of dental
visits, as the patient has a root canal treatment and crown porcelain, so he should visit the dentist
every six months for a checkup and explain to the patient the risks associated with not visiting the
dentist frequently, as he did not realize he had so many suspicious areas and two large cavities.

The patient is referred by the dentist with 2 large cavities on teeth #2 and 15, as well as several
suspicious areas #3, 5, 14, 20, and 29. If left untreated, these cavities may cause pain and infection
 that may lead to difficulty eating and speaking, and since he is still a young 25-year-old, he may lose
all his teeth. Instruct the patient about carious lesions and have him make an appointment with the
dentist to have the teeth restored before the condition worsens.

This patient has a 15-33% boss of radiographic bone mass and clinical attachment loss, indicating a
stage 2 grade B periodontitis. Furthermore, he exhibits inflammation and bleeding on probing,
indicating a high bacterial count, which indicates an active disease process. The treatment includes
providing educational material about periodontal disease and how to stop further bone loss and
showing the patient their radiographs.

When a patient clenches their teeth, it puts them at risk for malocclusion, jaw pain, TMJ disorder,
and difficulty chewing. Treatment may include the recommendation of a night guard to minimize
these risks.

Smoking cigarettes has a direct link to periodontal disease. Smoking have an increased risk of
periodontitis. In additional, many other problems related to his health such as heart disease,
stroke, lung diseases, and chronic obstructive pulmonary disease (COPD). Tobacco smoke contains
chemical products and toxins that may delay healing by impairing the biological process of healing
and inhibiting the initiation of wound healing by the cells. Treatment consists of tobacco cessation
counseling, educating the patient about ways to quit smoking, putting myself in the patient's
position and understanding how difficult it may be to give up smoking, informing the patient that
there are numerous nicotine replacement therapies available over the counter that can help him in
quitting.

8. Dental Hygiene Diagnosis and Treatment Plan: (Include assessment of patient needs, appropriate
treatment, patient education plan- including individualized long and short-term goals).

The patient has stage II grade B periodontitis generalized with bleeding. It is necessary for this
patient to receive comprehensive education on what plaque biofilm is, what causes it, how to
remove it effectively, and what will happen if the plaque is not removed. To improve not only his
oral health, but also his systemic health, he needs to be informed of the importance of dental visits
and home care. In order to prevent further bone loss and manage periodontitis, I will educate him
about what periodontitis is, what causes it, that it cannot be cured but can be managed, ways to
manage it, and the importance of flossing and proper brushing techniques to prevent further bone
loss from occurring. The patient has 2 big decay and several suspicious areas. I will provide a
comprehensive explanation of caries, how they are formed, and how to prevent them, including
diet, acid attack, flossing and proper brushing techniques, as well as have him set up an
appointment with the dentist to get the caries restored. The patient is a smoker, I will educate the
patient about the dangers associated with smoking and provide evidence-based cessation
treatment that involves counseling and regular monitoring of the patient's smoking status to
reduce the risks associated with tobacco use. It is recommended that the patient be educated
concerning his dental health, ultrasonic scaling, fine scaling, polishing, and fluoride treatment.

a. Develop a Dental Hygiene Diagnosis: Identify and prioritize three key problems based on
the patient’s assessment data. Write a diagnostic statement for each key problem. You will
 use this information to plan appropriate goals, education, interventions, and outcomes for
each.

• Diagnostic statement #1: (the problem to be addressed at Patient Ed #1): (Explain plaque
and demonstrate brushing method.

• Diagnostic statement #2: (the problem to be addressed at Patient Ed #2): Explain

periodontitis and demonstrate flossing technique.

• Diagnostic statement #3: (the problem to be addressed at Patient Ed #3): Tobacco cessation.

b. Develop an Appointment Plan for the Nonsurgical Periodontal Therapy Phase & Post
Periodontal Reevaluation (this will include both the education plan and the treatment plan
for each appointment)

Initial Appointment - Completed Patient Assessment and Data Collection

 8/30/2023:

Medical/dental history and vital signs

Vertical BWX/ plates

Intraoral picture

Periodontal Assessment

Dental Charting with x-rays (need check)

Head/Neck Intraoral examination (need check)

Initial Plaque score

Initial Bleeding score

 9/1/2023:

Head/neck intraoral examination

 9/6/2023:

Dental charting with Xray

Risk Assessment

Informed Consent

Initial Gingival Index

Appointment 1 -Education Plan: (include key problem/ diagnosis statement #1). Develop goals and discuss how
you will present the patient education session.

Firstly, I will go over all the patient's goals with him and ensure that they are acceptable to him. I will use open
and closed questions to determine what the patient knows about plaque and calculus, and then I will use the
PowerPoint to define about plaque, calculus, and how it forms to help him have a clear understanding and using
the photos as a visual aid, I will instruct him on how to properly remove plaque using the Bass Method and
demonstrate the proper brushing technique using a video, I also demonstrate the brushing technique on the
typodont as well. I will then let him demonstrate the brushing method on the typodont to show his
understanding of proper brushing technique and have him show me as well. We will then move to the sink
where he will brush his own teeth and I will make any adjustments to his brushing, show the patient where the
improvement is needed by disclosing solution. I will view plaque score with the patient and see if it has
improved or not. Toward the end I will ask the patient to make sure he remembers about the information was
given during the session. Lastly, I will summarize the session and notify him that our next appointment we will
discuss periodontitis and flossing.

Goals- address the problem by developing measurable goals.

• Each goal will relate to the specific DH diagnosis being addressed.

• Each goal will include an intervention (what is recommended to accomplish the goal)

• Each goal will include a criteria/ outcome to measure the goal progress.

LTG: Decrease and maintain plaque score of 0.5 or less by end of treatment on 10/20/2023.

STG 1: Decrease plaque score by 0.5 or more at each visit.

STG 2: Patient will have an understanding of what plaque is and be able to define plaque at this
appointment 9/15/2023.
STG 3: Demonstrate proper brushing technique and utilizing method on 09/15/2023

Appointment 1-Treatment Plan: (include all assessments and treatment you plan to perform at this appt, in
sequence)

 Medical/dental history
 Pre-rinse
 Plaque and bleeding score
 Patient Ed session #1
 Ultrasonic mandibular right quadrant
 Periodontal charting mandibular right
 Fine-scale right mandibular right quadrand
Appointment 2- Education Plan: (include key problem/ diagnosis statement #2). Develop goals and discuss how
you will present the patient education session.

In order to prevent or slow the progression of periodontal disease by reducing bleeding scores, I will review
previous topics regarding plaque and newly learned tooth brushing techniques to ensure that the patient has a
good understanding to move onto the next topic. I will use the PowerPoint to define gingivitis and periodontist
to help him have a clear understanding and using photos as a visual aid, I also use the patient's x-rays to visually
illustrate the bone loss, explain the process of periodontal disease, use probe charts to visualize pocket depths
and bleeding points, emphasize the importance of flossing at least once a day, introduce the proper flossing
technique and supplementary aids, and demonstrate flossing techniques using a typodont. Ask the patient to
demonstrate the newly learned flossing technique on the typodont and have him to practices on the sink, I will
also make any adjustments to his flossing, show the patient where the improvement is needed by disclosing
solution and explain about the recall date for periodontal disease. Recommend a 3-month recall, emphasizing
that recalls are common for periodontal disease. Finally, I will preview the next/last session, which will be about
tobacco cessation.

Goals- address the problem by developing measurable goals

• Each goal will relate to the specific DH diagnosis being addressed

• Each goal will include an intervention (what is recommended to accomplish the goal)

• Each goal will include a criteria/ outcome to measure the goal progress

LTG: Halt or slow the progression of periodontal disease by reducing the bleeding score to 0% by reevaluation
appointment 10/20/2023.

STG 1: Reduce bleeding score by 5% at each visit.

STG 2: Have an understanding of what periodontitis is and the cause of periodontitis by 9/22/2023.

STG 3: Demonstrate proper flossing technique and introduce flossing aids and start flossing once a day by
10//20/2023

Appointment 2- Treatment Plan: (include all assessments and treatment you plan to perform at this appt, in
sequence)

 Medical/dental history
 Pre-rinse
 Plaque and bleeding score
 Patient Ed session #2
 Ultrasonic mandibular left quadrant
 Periodontal charting mandibular left
 Fine-scale right mandibular left quadrant
Appointment 3- Education Plan: (include key problem/ diagnosis statement #3). Develop goals and discuss how
you will present the patient education session.

The session will begin by reviewing the previous session's topics to ensure that the patient understands and is
applying the new techniques correctly. As part of the treatment, I will educate the patient about tobacco use
can contribute to the development of periodontitis at an accelerated rate, it also effect his health, talk about the
risk of tobacco: cancer, heart disease, stroke, lung diseases, and chronic obstructive pulmonary disease (COPD),
I will use the 5 major steps to intervention (ask, advise, assess, assist and arrange), I will discuss how to quit
smoking and how to obtain assistance, I will discuss nicotine replacement therapy in order to help him control
his cravings and to help him quit smoking (nicotine patches, gum, and lozenges).I will show the patient his x-rays
and explain that tooth loss, decay, and suspicious areas are a possibility if he continues to smoke. I will also
show him the intraoral picture and explain about tooth staining, changes of his him gum, architecture, color,
margins, consistency, papillary, marginal and halitosis. Then I will refer him to the support offered Quitline (US
department of Health and Human Services). We will review plaque and bleeding scores from previous
appointments and brush and floss, as well as disclose if no improvement has been achieved. Then I will discuss
the patient's long-term and short-term goals for this appointment, as well as what they have learned from the
last two patient education sessions. Finally, I will discuss the recall appointment and thank the patient for his
time and effort.

Goals- address the problem by developing measurable goals.

• Each goal will relate to the specific DH diagnosis being addressed.

• Each goal will include an intervention (what is recommended to accomplish the goal)

• Each goal will include a criteria/ outcome to measure the goal progress.

LTG: The patient will reduce smoking one pack of cigarettes a day to half a pack and quit using vape.

STG 1: The patient will reduce smoking 1 cigarettes by each visit.

STG 2: The patient will understand tobacco cessation and join the Quitline.

STG 3: The patient will quit smoking by 10/9/2023.

Appointment 3- Treatment Plan: (include all assessments and treatment you plan to perform at this appt, in
sequence)

 Medical/dental history
 Pre-rinse
 Plaque and bleeding score
 Patient Ed session #3
 Ultrasonic maxillary left quadrant
  Periodontal charting maxillary left.
 Fine-scale right maxillary left quadrant

Appointment 4- Chairside Education Plan: I will discuss with the patient about his missing molars #18, #30, and
#31, and have the patient plan to make an appointment with a DDS to have a teeth implant, I will explain to him
about the bone loss due to his missing teeth and how bone grafting and an implant would help prevent future
bone loss, I will also have him make an appointment with the dentist to restore the big 2 decay on #2 and #15
and several suspicious areas on #3, 14, 20, 29 restored. I will also review what we discussed in our previous
session about quitting tobacco, as well as what we talked about plaque, calculus, gingivitis, and periodontist and
ask open-ended questions. Additionally, I will check on his smoking status, inquire about whether he has
purchased the nicotine replacement therapy (patch, gum, and lozenge) and called Quitline yet, and ask him
whether he has been able to quit smoking using the nicotine replacement therapy. Explain the importance of
fluoride and the best application for the patient.

Appointment 4 Treatment Plan:

 Medical/dental history
 Pre-rinse
 Plaque and bleeding score
 Ultrasonic maxillary right quadrant
 Periodontal charting maxillary right
 Fine-scale right mandibular maxillary right

Post Perio Reevaluation Appointment (2 weeks after final quad of scaling)

Chairside Education Plan: I will discuss with the patient any questions or concerns he might have, as well as
discuss his current plaque scores and bleeding score. I will also check on his smoking status and I will explain to
him how important it is to schedule regular and proper dental appointments.

Post-Perio Treatment Plan:

 Medical/dental history
 Plaque and bleeding score
 Polishing
 Fluoride
 Intraoral picture to compare before and after treatment.
 Final gingival index
 Post calculus
 Full mouth perio chart
  Arestin if pockets exceed 5mm.
 Ending gingival statement and patient learning level

9. Journal Notes: (Record in detail the treatment provided at each appointment, oral hygiene
education, patient response, complications, improvements, recommendations, learning level,
progress towards short and long-term goals, expectations, etc.) The notes should be written by
appointment date.

August 30, 2023:

 Medical and dental history

 Pre-rinse
 BWX/ plates
 Intraoral picture
 Head neck and intraoral exam (stated)
 Dental charting (stared)
 Periodontal assessment
 Plaque score: 3.8 poor
 Bleeding score: 28%
 Pt ed chairside: bass brushing method, and brush at least 2 minutes
 TTM: action
 Risk assessment
 Informed consent

September 1, 2023:

 Medical and dental history

 Vitals
 Pre-rinse
 Head neck and intraoral exam
 Dental charting (started)
 Pt ed chairside: Use the flossing method and encourage him not to rush when brushing his
teeth for at least two minutes.
 TTM: action
 Plaque score: 4.2 poor
 Bleeding score: 17 %

September 6, 2023:

 Medical and dental history

 Vitals
 Pre-rinse
 Dental charting (finished)
 Pt ed chairside: recommend electric toothbrush, electric toothbrush include built in timer
that lets him know him is brushed for 2 minutes.
  TTM: action
 Plaque score: 4 poor
 Bleeding score: 27 %

September 15, 2023:

 Medical and dental history

 Vitals
 Pre-rinse
 Retake 1 BWX
 Plaque score:3.6 poor
 Bleeding score: 31.5%
 Gingival description mandibular left
 Pt ed 1: Defining the patient's short and long-term goals, explaining plaque theory and
how to reduce plaque buildup, stating you cannot completely remove plaque, but you
can reduce its amount, showing the correct brushing and tongue brushing technique on
typodont, explaining it to the patient and having him disclose and try it on himself, and
discussing any questions the patient may have. Benefit of local anesthesia. Risk and
benefit of dental radiograph
 Oraqix
 Ultrasonic mandibular left
 Periodontal charting mandibular left
 Hand scale mandibular left (started)
 TTM: action

September 22, 2023:

 Medical and dental history

 Vitals
 Pre-rinse
 Plaque score: 2.6 good
 Bleeding score: 16.7%
 Gingival description mandibular right
 Pt ed 2: I reviewed the patient's short-term and long-term goals, reviewed previous
topics and brushing techniques to see what was remembered and learned, explained
periodontal disease, explained periodontitis and how to halt its progression,
demonstrated a new flossing technique on the typodont and had the patient
demonstrate the new technique on himself or herself. Benefit of local anesthesia
 Oraqix
 Hand scale mandibular left (finished)
 Ultrasonic mandibular right
 Periodontal charting mandibular right
 Hand scale mandibular right (started)
 TTM: action

September 29, 2023:

 Medical and dental history
 Vitals
 Pre-rinse
 Plaque score: 1.2 good
 Bleeding score: 12%
 Gingival description maxillary right
 Pt ed 3: I reviewed the patient's short- and long-term goals, reviewed previous topics
such as gingivitists, periodontists, flossing techniques to determine what the patient
remembered and had learned, explained that tobacco can cause perio disease to
progress, provided information about different products that assist in tobacco cessation.
Having him disclose and having him brush and floss his teeth on the sink in order to
obtain an understanding of what he remembered and had learned, discussing any
questions the patient may have. Benefit of local anesthesia.
 Oraqix
 Hand scale mandibular (finished)
 Ultrasonic maxillary right
 Periodontal charting maxillary right
 Hand scale maxillary right (started)
 TTM: action

October 6, 2023:

 Medical and dental history

 Vitals
 Pre-rinse
 Plaque score: 0.8 good
 Bleeding score: 8%
 Gingival description maxillary left
 Pt chair side: : : I reviewed the patient's short and long term goals, reviewed previous
topics such as plaque, calculus, gingivitists, periodontists, brushing, flossing techniques
to determine what the patient remembered and had learned, discussed with the patient
about his missing molars #18, #30, and #31, and have the patient plan to make an
appointment with a DDS to have a teeth implant, I also explained to him about the bone
loss due to his missing teeth and how bone grafting and an implant would help prevent
future bone loss, and have him make an appointment with the dentist to restore the big
2 decay on #2 and #15 and several suspicious areas on #3, 14, 20, 29 restored. Benefit of
local anesthesia
 Oraqix
 Hand scale maxillary right (finished)
 Ultrasonic maxillary left
 Periodontal charting maxillary right
 Hand scale maxillary left (started)
 TTM: action

October 23, 2023:

 Medical and dental history
 Vitals
 Pre-rinse
 Plaque score: 0.4 good
 Bleeding score: 2.4%
 Gingival description of all quadrants
 Final gingival index
 Plaque free
 Post calculus
 Post periodontal (started)
 Hand scale maxillary left (finished- It was permitted to recheck some spots left on the
post-calculus day)
 Fluoride topical NAF 2%
 Pt ed chair side: I reinforced previous patient education topics on brushing, flossing,
stopping periodontal disease, I asked the patient if he had any additional questions,
reviewed his plaque and bleeding score from his first appointment to his last
appointment, gave positive feedback. In addition, I checked his smoking status, I
congratulated him on quitting smoking, explained to him the benefits of quitting
smoking, and explained to him that if he begins to smoke again, this condition will
continue to progress because tobacco plays a big role in the progression of periodontist,
discussed fluoride and its benefits, recommended a fluoride mouth rinse be used daily,
and explained the importance of scheduling regular dental appointments.
 Intraoral picture
 Customer survey
 TTM: action

October 25, 2023:

 Medical and dental history

 Vitals
 Pre-rinse
 Plaque score: 0.2 good
 Bleeding score: 0%
 Post periodontal (finished)
 Arestin #5D and #14D
 Pt ed chair side: I reinforced previous patient education topics on brushing, flossing,
stopping periodontal disease, I asked the patient if he had any additional questions,
reviewed his plaque and bleeding score from his first appointment to his last
appointment, gave positive feedback, tobacco cession was discussed with the patient
again, explaining to him the benefits of quitting smoking and explaining that if he began
to smoke again, his periodontal condition would continue to progress, discussed Arestin
and its benefit, I also gave Arestin instructions to take home
 TTM: action
10. Prognosis: (Based on attitude, age, number of teeth, systemic/ social background, malocclusion,
tooth morphology, periodontal examination, recall availability)

My patient is a 25-year-old male with 28 teeth. I am unsure of the prognosis due to a systemic or
social background and a lack of dental awareness on the part of the patient. My hope is that each
session reinforces the importance of dental visits, and he will continue to seek dental care as a
result. I hope he will take advantage of receiving this information now before his periodontitis
becomes worse, and he will quit smoking with the help of tobacco cessation counseling.

According to my opinion, the patient has a good prognosis based on factors such as attitude, age,
number of teeth, systemic/social background, malocclusions, tooth morphology, periodontal
examination, and recall availability. From the beginning, he seemed eager to learn how to
maintain his oral health. He had not been to the dentist for over 4 years, and he had not been
aware of the proper technique of brushing and flossing until he learned from each visit. After the
initial appointment, he was eager to learn how to maintain his oral health.

He had been smoking one pack of cigarettes a day for the past seven years. Smoking contributes
greatly to the progression of his periodontal disease. At the 3 appointments, I provided him with
information on tobacco cessation, explained how tobacco can lead to periodontal disease, and
explained the various products that can assist with smoking cessation. I had set a date for him to
stop smoking, and he agreed (10/9/2023). When the patient returned for post-cal and post-perio,
I inquired about his quitting status. He stated that he had quit as of the date I set for him.
Additionally, he also stated that it was difficult, but that he was using the nicotine patches that I
suggested, which helped him greatly.

Furthermore, he has been referred for the restoration of teeth #2 and #15 due to large decay,
several suspicious areas on teeth #3 B&O, 5 O, 14 B, 20 O, 29 O, as well as external root extrusion
on #9. As part of the four appointments, I educated him about decay and made an appointment
with a dentist for restoration and also implanting or fixing bridges on #18, #30 #31, and he
seemed very interested in getting them restored, he had already scheduled an appointment with
a dentist next month (11/20/2023).

The patient plans on returning for his three-month recall appointment (01/2024) and mentioned
that he has decided to continue to attend recall appointments. He is 26 years old, expects to
attend recall appointments, has shown good results, and has taken steps to improve his oral
health.

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

Referral: extract #1, 16, 32; restore #2, 3, 5, 14, 15, 20, 29

Recall date: 01/2024 (3 months)

The patient was advised to emphasize our partnership at the reevaluation and to maintain good
oral hygiene at home. This will reduce the amount of inflammation, plaque buildup, and bleeding
in the mouth. I also mentioned that smoking can play a significant role in his periodontal health
 and will continue to worsen if he starts smoking again. Taking good care of his oral health can be
a significant factor for improving his oral health. However, if he starts smoking again, it does not
matter how well he brushes or flosses, his epithelial cells will be irritated, and inflammation will
not go away.

In response to the referral, the patient had already scheduled an appointment with the dentist to
have decayed teeth restored, extract 3rd molars, and to replace missing teeth with implants or fix
bridges.

I explained to the patient the importance of a recall appointment every three months, and he
agreed to return in January 2023 for the next recall appointment.

12. Assessment of Changes: (note “Periodontal Grade” at the end of treatment, compare changes in
periodontitis classification, changes in plaque control, bleeding tendency, gingival health, probing
depths, effect on future periodontal disease management)

A patient put each patient education session into practice in order to improve his oral health. As
a result of brushing effectively, the plaque score went down from 3.8 (poor) to 0.2 (good), which
shows how significant the reduction in plaque score was due to good brushing practices. Even
though his bleeding score decreased from 28% to 4% at his last appointment, there was still 15-
33% bone loss that cannot be reversed, which remained the same in his periodontal staging and
grading. After removing all the calculus from the gingiva, the color returned to a healthier state.
Before, the gingiva was magenta and inflamed. As expected, the depth of the probes decreased.
This has an adverse effect on the periodontium since bacteria are no longer able to accumulate in
a deep pocket, causing further bone damage.

13. Patient Attitudes and Cooperation:

Throughout his patient education sessions, he was enthusiastic about learning about and
improving his oral health. At each session, he would ask many questions and expressed that he
did not understand how to brush and floss properly. He knew how long it took to brush and floss
every day since he used to brush quickly and only spend seconds. He never missed an
appointment, and he always arrived early to every meeting he attended. When scaling or probing
the patient would change his attitude. He would get a little irritated at some points, when I asked
him to use local anesthesia to make him feel comfortable because he is very sensitive, but he
rejected the local anesthesia because he has been afraid of needles since he was a child. In order
to minimize discomfort, I used Oraqix instead. I explained to him the advantages of local
anesthesia as well as the fact that Oraqix only numbs his gums, not his teeth, and when I used an
ultrasonic scaler, he complained that the pain was intense. In spite of the patient constantly
complaining, he cooperated in every aspect and tried to retain as much information as possible.
He was particularly attentive during patient education. Overall, he was thankful for the
opportunity and glad he was able to attend.

14. Personal evaluation/ self-assessment of personal progression with this experience:

I was somewhat nervous when I first asked him if he would be able to attend many appointments
per week because he works night shifts from 7 p.m. to 6 a.m. I was worried that he would not be
able to or would not show up to an appointment, which would have resulted in not completing
the periodontal patient. Nevertheless, I found him to be very pleasant from the very beginning,
which gave me confidence that he would keep his appointment. I scheduled him every Friday
morning. He was always early and never complained that he did not get enough sleep. Taking off
his calculus was a very difficult process for me because it was very tenacious. I have to spend
more time on him, but I learned a lot in the process. In addition to improving my instrument skills
and removing calculus from a high-class patient whose pocket depth was deep, this was also a
wonderful opportunity for me to provide insightful educational sessions that assisted me with
providing proper advice and helping me to become a better clinician in general.