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 42 Date of initial exam 9/21/23 Date completed

11/26/23

1. Medical history-
The patient's comprehensive medical history highlights the presence of systemic conditions,
including arthritis, lupus, hyperthyroidism, and high blood pressure. These conditions may affect
the patient's immune response and overall health, potentially exacerbating periodontal disease due
to autoimmune-related inflammation, alterations in metabolism, and the possibility of gum
overgrowth caused by certain blood pressure medications. Furthermore, the medications they are
taking, such as hydroxychloroquine, metoprolol, and levothyroxine, present specific challenges,
including the potential for dry mouth, which can contribute to periodontal issues, the patient
should be recommended to drink plenty of fluid throughout the day to minimize dry mouth and
practice good oral hygiene. Decrease in saliva production can make it harder to halt the progression
of periodontitis and Decay. Their BMI of 29.28, classifying them as "Overweight," further
underscores a risk factor for periodontal disease, given the potential for increased inflammation
and compromised immune function. Recent studies have shown that people who are overweight
have twice the incidence of periodontal disease. Also, the patient has a past of 3 surgeries from
child birth, known as C section. To minimize the impact of these medical findings on periodontal
health, a comprehensive approach is essential including diet management in order to get the
patient to a “healthier” weight.

2. Dental History: chief complaint: pain near tooth #19, likely influenced by systemic conditions and
decay, underscores the need for a comprehensive approach. However, her current oral hygiene
habits, which include brushing twice a day, using mouthwash, but not flossing, sometimes grinding
teeth, and employing a horizontal/scrubbing brushing method, leave room for improvement.
Recommending a shift to a gentler brushing technique, incorporating flossing into her routine, and
introducing fluoride or other home hygiene aids can significantly enhance her oral hygiene
practices. Given her last dental visit in April 2023, regular monitoring and consistent adjustments to
her homecare regimen will be pivotal in ensuring optimal periodontal health amidst her complex
medical history.

3. Intraoral and Extraoral Examinations: The patient's intraoral and extraoral examinations provide
invaluable insights into her periodontal diagnosis, progression, and treatment, with several
 noteworthy factors at play. Firstly, her Class 1 occlusion, overbite of 4mm, and overjet of 4mm
indicate a relatively stable occlusal relationship, which is essential for proper masticatory function
and overall oral health. However, the presence of a 5 mm midline shift to the right is a significant
concern, as it can lead to occlusal discrepancies, potential temporomandibular joint (TMJ) issues,
and uneven wear on teeth, ultimately affecting her periodontal health. It's crucial to recognize the
impact of these occlusal findings and consider orthodontic evaluation and intervention to mitigate
potential complications. Furthermore, her systemic conditions, including arthritis, lupus,
hyperthyroidism, and high blood pressure, can exert profound effects on her oral health. These
conditions may influence her facial form, occlusal habits, and awareness, potentially exacerbating
periodontal disease due to autoimmune-related inflammation, alterations in metabolism, and
medication-related concerns. Collaboration with her healthcare providers, such as rheumatologists
and endocrinologists, is essential to ensure coordinated care, as these systemic conditions can
impact her immune response and inflammation, further underscoring the importance of a holistic
approach to her periodontal treatment.

4. Periodontal Examination: The patient's periodontal examination findings provide valuable insights
into her diagnosis, progression, and treatment. With localized deep pockets of 5, 6, and 4 mm on
posterior teeth and localized recession on mandibular anterior teeth, there is clear evidence of
periodontal disease. Additionally, the presence of less than 15% generalized bone loss suggests a
moderate level of periodontal involvement. Calculus visible on x-rays, carious lesions, and a stage 3
grade B periodontal condition underline the complexity of her oral health status. Notably, her
gingiva exhibits several notable characteristics, it appears spongy and edematous in texture, with
localized thickened margins observed on the anterior and blunted papillae in the right posterior
region. The gingival coloration presents as red, with particularly magenta hues in the anterior
maxillary area, signifying a degree of inflammation. These clinical findings are further corroborated
by a gingival index score of 1.5, categorized as "fair." This assessment underscores the necessity for
immediate periodontal intervention and the implementation of meticulous oral hygiene practices.
It's worth noting that the magenta hue observed on tooth #8-10 is attributed to the presence of a
PFM (Porcelain-Fused-to-Metal) bridge. This element of her dental anatomy contributes to the
localized gingival presentation.

a. Periodontitis Stage: 3

b. Periodontitis Grade: B

c. Extent & Distribution: generalized bone loss is around less than 15% of teeth in mouth.

d. In the case of this patient, who has been classified as a Stage 3 Grade B periodontal patient,
several factors and etiological considerations contribute to her periodontal condition. Her
stage 3 signifies a moderate periodontal disease state characterized by the presence of
pockets with depths of 5, 6, and 4 mm localized to posterior teeth, localized recession on
mandibular anterior teeth, and less than 15% generalized bone loss. The etiological factors
 behind this stage can be attributed to a combination of her systemic conditions and other
causes, including arthritis, lupus, hyperthyroidism, high blood pressure, and infrequent
dental checkups. Furthermore, her medications, such as hydroxychloroquine and
metoprolol, may contribute to dry mouth, exacerbating the periodontal condition. Given
her Fair gingival index of 1.5, it suggests that her gingival tissues exhibit some degree of
inflammation or irritation. Also, calculations were made to determine the grade of
periodontitis, by dividing bone loss and age, (15/42 = .3) her stage was grade B. This gingival
presentation aligns with her Stage 3 Grade B diagnosis.

• Describe for each sextant or quadrant at each appointment:

Initial Assessment Appointment:

Appointment 1: Generalized redness with moderate bleeding

Appointment 2: Generalized redness with minimal bleeding

Appointment 3: (Mand. Left) 10/05/23 Generalized redness with minimal bleeding, lingual anterior area
was red, inflamed, and thickened with roll margins. The main cause for this was the buildup of plaque
pushing against the gums.

Appointment 4: : (Mand. Right) 10/18/23 localized redness with minimal bleeding, most severe
inflammation was on #31 and 32 since pocket depths were deeper and more irritated from scaling, since
the pocket depths were deeper it was harder for the patient to floss properly especially since it’s the last
molars back in the mouth.

Appointment 5: (post perio evaluation) moderate periodontitis with minimal gingivitis with minimal
bleeding

Post- Perio Reevaluation Appointment:

e. Plaque Index: Each appointment __2.15___, __.36___, ___.08__, __.02___, __.02___,

f. Gingival Index: Initial 1.5 Final .875 Gl

g. Bleeding Index: Each appointment ___.13___, __.05___, __.02___, __.05___, __.02___,

Note: Complete full mouth bleeding index at first and last appointments- can use indicator teeth for
other appointment scores.
 h. Evaluation of all index findings. During the initial assessment, The patient exhibited
generalized pocket depths of 3s and 2s, with some areas, particularly in posterior molars,
reaching 5s and 4s. The absence of furcation or mobility involvement, combined with her
infrequent flossing, indicated moderate periodontitis stage 3 grade B with a prophy class 4.
Suboptimal oral hygiene was evident from recorded plaque and bleeding scores. Teeth #31
and #32 showed pocket depths of 5, emphasizing localized concerns. At the final
appointment, after scaling procedures and consistent patient education, substantial
improvement was observed. Generalized pocket depths decreased from 3s and 2s to
primarily 2s, with a notable change in teeth #31 and #32. The gingival index score
decreased from 36 to 19, reflecting a significant reduction in gingival inflammation. The
decrease in plaque and bleeding scores highlighted the positive impact of the
comprehensive care plan. This progress at the final appointment indicates successful
periodontal management, emphasizing the effectiveness of the tailored treatment
approach and the patient's commitment to implementing oral hygiene practices.

1. Initial appointment (baseline):

The patient's periodontal examination findings offer valuable insights into her oral health
diagnosis and treatment plan. Notably, her periodontal condition, classified as Stage 3 Grade B, signifies
a moderate level of periodontal involvement. This classification is substantiated by various clinical
indicators, including localized deep pocket depths of 5, 6, and 4 mm on posterior teeth and localized
recession on mandibular anterior teeth. The presence of less than 15% generalized bone loss
underscores the complexity of her condition. Additional factors contributing to her periodontal diagnosis
include the presence of visible calculus on x-rays and carious lesions, such as calculus on #30 mesial and
#31 distal. Caries lesions on mesial #13, distal of #12, and clinical view of decay on #1,16,17, and 32.

2.Final appointment (Post- Perio Reevaluation): At the final appointment, the post-perio
reevaluation revealed notable improvements in the patient’s periodontal health following the
comprehensive care plan. The initial gingival index score of 36 witnessed a substantial decrease to 19,
indicating a commendable reduction in gingival inflammation. This positive shift was further reinforced
by improvements in both plaque and bleeding scores, emphasizing the success of the tailored treatment
approach and the patient’s commitment to sustaining improved oral hygiene practices. The post-perio
reevaluation serves as a testament to the efficacy of the care plan in enhancing periodontal health.

i. Prophylaxis Classification The presence of calculus on the anterior mandible lingual area
indicates a localized area of concern. This calculus may contribute to the localized recession
observed during the periodontal examination and could potentially exacerbate the
periodontal condition in this region. Additionally, the presence of some calculus on the
posterior molar area is noteworthy. This calculus can contribute to pocket formation and
may have played a role in the localized deep pockets observed during the periodontal
assessment, particularly on posterior teeth with pocket depths of 5, 6, and 4 mm. The
calculus in this area can also hinder effective oral hygiene practices, leading to further
progression of periodontal disease. To address the calculus-related issues, a comprehensive
periodontal therapy plan that includes full-mouth ultrasonic scaling and fine scaling is
essential. This treatment should focus on removing calculus from both the anterior
 mandible lingual area and posterior molar area. Moreover, ongoing periodontal
maintenance visits should be scheduled at appropriate intervals to monitor the patient's
progress and ensure calculus removal is maintained.

k. Periodontal Chart: During the initial assessment, several significant findings were noted,
including localized deep pocket depths of 5, 6, and 4 mm on posterior teeth and localized
recession on mandibular anterior teeth. Additionally, there was evidence of less than 15%
generalized bone loss, indicating a moderate level of periodontal involvement. Following
the removal of calculus, the patient’s periodontal chart findings were reevaluated by
quadrant. So far this has revealed a noticeable improvement in pocket depths and
reduction of inflammation due to calculus removal.

1. Initial appointment: The patient presents with generalized pocket depths of

3mm and 2mm, except for teeth #31 and #32, which have pocket depths of 5mm
with minimal to no attachment loss since the gumline aligns with the pocket
depth. There is no furcation or mobility involvement, and the patient has poor
flossing habits. To address this, the treatment plan will involve scaling to remove
both subgingival and supragingival calculus deposits, reducing the plaque
buildup. Failure to receive treatment could lead to the worsening of periodontitis
over time, emphasizing the importance of intervention to prevent disease
progression and minimize pocket depths for long-term periodontal health.

In the baseline full periodontal charting by quadrant, the patient's posterior

molars, both in the mandible and maxilla, exhibit localized pocket depths of 4s
and 5s on both lingual and facial aspects. Conversely, the remaining posterior
teeth generally show pocket depths of 3s and 2s. Moving to the anterior regions,
both maxillary and mandibular, pocket depths are predominantly 1s and 2s on
both lingual and facial surfaces. This comprehensive baseline assessment
provides a clear overview of the patient's periodontal health, highlighting
specific localized concerns in the posterior molars while generally noting
favorable pocket depths throughout the rest of the dentition.

2. Post Perio Reevaluation- Throughout the treatment, the pocket depths

significantly improved as the calculus that initially obstructed accurate readings
was removed at each scaling appointment. After the first maxillary quadrant
scaling, pocket depths that were initially generalized 3s and rarely 4s
transformed into generalized 3s and 2s within a week. Subsequently, with each
quadrant scaling, similar healing was observed, and post perio re-evaluation
after 2 weeks showcased considerable improvement. Many pockets, including
some that were 5s and 4s, transitioned to 3s and 4s, indicative of healing. It's
worth noting that specific pockets, like those at #31 and #32, showed more
limited change due to the natural positioning of the gumline, but without clinical
attachment loss. Additionally, generalized pocket depths, especially in the
 anterior mandibular region, decreased from 2s to 1s, reflecting the success of
the treatment in generally minimizing pocket depths and changing the
inflammation from generalized red gums to pink healthier gums. The
comprehensive care plan effectively addressed the periodontal condition,
resulting in improved periodontal health, healing of pockets, and healthier gums.

5. Dental Examination: Findings on dental charting had caries on #1,2,16,17,32 on all teeth occlusal
surfaces. Referral was made by the dentist to get a filling for tooth #15 and 20. Also the dentist
made a referral for Root canal therapy on #19 or extraction if RCT is not an option. Teeth #23-26
had attrition and dentist recommended getting bridge for tooth #3 since its missing and tooth
space could cause future complications. If her plaque score does not improve, then there will be
plaque retention that will cause her caries to develop further. If plaque retention continues in
demineralization, decayed areas, and around third molars then this could lead to decayed teeth
resulting in extraction to be needed as soon as possible. The sooner the progression of the disease
gets halted, and fillings done with root canal therapy, the better the outcome of her oral health will
be. The patient’s occlusal condition, characterized by a missing molar on the right side and a Class 1
occlusion on both right and left sides, plays a crucial role in her periodontal health. The midline
shift of 5 mm to the right presents a noteworthy occlusal challenge, potentially impacting the
distribution of forces during biting and chewing. This shift may result in uneven forces on certain
teeth, potentially contributing to periodontal pocket formation and bone loss, especially in areas
with pre-existing periodontal concerns.

6. Radiographic Findings: The presence of less than 15% generalized bone loss, as determined
through radiographic assessment using Vertical Bite-wing X-rays, confirms the extent of periodontal
involvement. The localized deep pocket depths of 5, 6, and 4 mm on posterior teeth, along with
localized recession on mandibular anterior teeth, are indicative of active periodontal disease.
Furthermore, visible calculus deposits on the radiographs, particularly in the distal aspect of #30
and mesial of 31, accentuate the complexity of her oral health status. The patient's missing tooth
#3, noted in both clinical and radiographic assessments, underscores the importance of considering
tooth replacement options to maintain occlusal function and prevent further periodontal
complications. Additionally, the presence of carious lesions, notably on the distal of 12 and mesial
of 13, necessitates restorative treatment.

7. Periodontal Disease Risk Factors: Firstly, she presents with decreased salivary flow, likely
exacerbated by the dry mouth symptoms associated with her medications, including
hydroxychloroquine and metoprolol. This decreased salivary flow can contribute to plaque
retention and bacterial proliferation, making her more susceptible to periodontal disease.
Additionally, her plaque score of 1.5 and bleeding score of 0.3% indicate poor plaque control,
further highlighting the risk of periodontal issues. The presence of radiographic bone loss and
clinical attachment loss, as confirmed through radiographic assessments and periodontal probing,
underscores the active periodontal disease process. The patient's gingival inflammation and/or
bleeding on probing further emphasize the severity of her periodontal condition. Her systemic
conditions, lupus and hyperthyroidism, may exacerbate inflammation, making it crucial to manage
 her periodontal health effectively. Furthermore, her oral habits, including possible dietary choices
and adherence to oral hygiene practices, may contribute to her periodontal risk. Lastly, the
presence of missing teeth, notably tooth #3, can lead to occlusal issues and potential periodontal
complications in the surrounding dentition.

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

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: Inadequate Plaque Control and Poor Oral Hygiene Habits

The patient exhibits suboptimal plaque control and struggles with poor oral hygiene habits, as
indicated by a plaque score of 2 and limited compliance with recommended practices such as
flossing. This problem will be addressed during the first patient education session.

Diagnostic Statement #2: Lack of Understanding and Awareness Regarding Caries

The patient lacks a comprehensive understanding of caries development, prevention, and the
importance of timely dental treatment. This knowledge gap poses a risk to their oral health. This
issue will be addressed during the second patient education session.

Diagnostic Statement #3: Unaddressed Dental Treatment Needs

The patient has an outstanding filling that requires attention on tooth #15O. Delaying this dental
treatment may result in the progression of caries and further complications. This issue will be
addressed during the third patient education session, emphasizing the urgency of addressing the
dental filling to maintain oral health.

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

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

For STG 1, which aims to achieve optimal periodontal health by reducing the plaque score to 0 by the post-Perio
appointment on 11/19/23, I will begin the session by emphasizing the importance of plaque control in
maintaining healthy gums. I will explain what plaque is, its role in gum disease, and the potential consequences
of inadequate plaque control. To achieve this goal, I will educate the patient on proper brushing techniques,
including the bass method, highlighting the need for 10 strokes on every 2-3 teeth and angulating the brush
towards the gumline. We will also discuss the importance of regular dental check-ups and cleanings. For STG 2,
which focuses on decreasing the plaque score incrementally (0.4 reduction each visit), I will emphasize the need
for consistent improvement. During each appointment, I will review the patient's plaque score and provide
feedback on their progress. I will reinforce the importance of daily oral hygiene practices and guide the patient
on areas where they can make specific improvements. By setting specific targets for each visit, we will work
collaboratively to reduce the plaque score systematically. For STG 3, which aims to demonstrate proper brushing
technique by the next appointment on 10/12/23, I will provide a hands-on demonstration of the bass method. I
will use models and visual aids to illustrate the correct angulation and brushing strokes. Additionally, I will
encourage the patient to practice the technique under my supervision during the session. To measure progress,
I will ask the patient to replicate the technique at the end of the education session, ensuring they are confident
in their ability to maintain proper brushing habits at home. Throughout the education session, I will encourage
the patient to ask questions and seek clarification on any concerns they may have. This interactive approach will
empower the patient to take an active role in their oral health and work collaboratively with me to achieve
these important goals.

LTG: STG 1: Achieve optimal periodontal health by reducing plaque score and maintaining it to 0 by post-Perio
appointment on 11/19/23. We will reach this goal by educating the patient on plaque and correct brushing
method.

STG 2: Decrease plaque score by 0.4 each visit. Her current plaque score is 2 which is fair. We need to set the
goal to 1 by 10/12, .8 by 10/19, and .5 by 10/26 and hopefully by recall appointment on 11/9 it should be 0

STG 3: Demonstrate proper brushing technique by next appointment on 10/12/23. Explain the bass method.
How there should be 1o strokes on every 2-3 teeth and how the brush should be angulated towards the
gumline.

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

Get medical and dental history signed after patient has been seated

Record plaque and bleeding score

Review old and new plaque and bleeding score

Gingival description
Patient Ed about plaque and brushing

Demonstrate on typodont and allow patient to practice on their own teeth

Encourage patient to brush twice a day

Local anesthesia (if needed)

Ultrasonic maxillary left quadrant

Perio chart quadrant

Get US check and perio probing checked by instructor before fine scaling

Final scale the same quadrant

Appointment 2- Education Plan: (include key problem/ diagnosis statement #2). Develop goals and discuss how
you will present the patient education session.

To address the first goal, which is achieving optimal periodontal health by reducing plaque score to 0 by the
post-Perio appointment on 11/19/23, I will commence the session by highlighting the importance of
maintaining a low plaque score for overall gum health. I will educate the patient on what plaque is, how it
forms, and its direct contribution to periodontal issues. A critical component of this goal will involve providing a
comprehensive demonstration of the recommended brushing technique, with a particular focus on the bass
method, emphasizing the significance of angling the brush toward the gumline. Furthermore, I will stress the
critical role of daily flossing and introduce the patient to two different flossing methods, explaining the
advantages of each. The criteria for success in this stage will involve assessing the patient's initial plaque score
to establish a baseline, ensuring the patient understands the principles of plaque control and proper brushing
and flossing techniques, and encouraging them to replicate the demonstrated methods. Ultimately, I will set the
expectation that the patient will commence daily flossing as part of their routine to achieve optimal periodontal
health. For the second goal, which focuses on the patient understanding what periodontitis is, its causes, and
providing a definition by the next appointment on 10/19/23, the education session will start by introducing the
term "periodontitis" and its relevance to gum health. I will then delve into a discussion about the causes of
periodontitis, elucidating the role of plaque, bacteria, and inflammation. To ensure clarity, I will offer a concise
and straightforward definition of periodontitis, potentially utilizing visual aids or diagrams for enhanced
comprehension. Throughout this phase, I will actively encourage questions and engagement to ensure the
patient grasps the concept. The success criteria here will involve gauging the patient's existing knowledge of
periodontitis, confirming their ability to articulate the causes and definition of the condition, and creating an
environment conducive to dialogue and inquiry. The session will conclude with a summary of the key points and
a reiteration of the importance of understanding periodontitis for effective oral care. Lastly, the third goal
centers on the patient's ability to demonstrate proper flossing technique and commence daily flossing by the
next appointment on 10/19. To achieve this, I will emphasize the crucial role of flossing in eliminating plaque
from interdental spaces that are inaccessible to toothbrushes. Both flossing techniques - wrapping the longest
side around one middle finger and tying two ends - will be presented, with a clear explanation of their
respective benefits. To empower the patient in making an informed choice, I will encourage them to try both
 methods and determine which one they find more comfortable and motivating. The session will conclude with a
confirmation of the patient's commitment to incorporating daily flossing into their oral hygiene routine.

LTG: STG 1: Achieve optimal periodontal health by reducing bleeding score and gingival index maintaining it to 0
by post-Perio appointment on 11/19/23. We will reach this goal by educating the patient on plaque and correct
brushing method (bass method) and start flossing once a day.

STG 2: Understand what periodontitis is, what causes it, and be able to define it by the next appointment on
10/19/23.

STG 3: Demonstrate proper flossing technique and start flossing once a day by the next appointment on 10/19.
Suggest both methods of flossing, the first being wrapped the longest side on one middle finger and the other
method of tying two ends, In order to see which would be more comfortable and more encouraging to the
patient.

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

Get medical and dental history signed

Record plaque and bleeding score

Gingival description

Patient Ed about periodontitis and flossing

Demonstrate on typodont and allow a patient to practice on their own teeth

Encourage patient to floss daily

Review brushing and plaque from last appointment

Local anesthesia (if needed)

Ultrasonic maxillary right quadrant

Pero chart quadrant

Get US check and perio probing check by instructor before fine scaling.

Fine scale the same quadrant

Appointment 3- Education Plan: (include key problem/ diagnosis statement #3). Develop goals and discuss how you will present
the patient education session.

The first goal, which entails completing the filling on tooth #15O by the 3-month recall appointment next semester, will be
addressed by emphasizing the significance of addressing caries promptly. I will explain that caries, also known as dental cavities or
decay, is caused by the interaction between bacteria in the mouth and sugars from foods or drinks. A detailed discussion on the
development of caries will follow, highlighting the importance of regular dental check-ups and prompt treatment to prevent
further progression. This information will create the context for the urgency of addressing the filling on tooth #15O. The criteria
for success here will involve ensuring the patient recognizes the importance of timely dental treatment and their commitment to
scheduling and attending the recall appointment. For the second goal, which focuses on educating the patient about caries and
ensuring they can define the term by 10/26/23, the education session will commence with a clear explanation of what caries are
and how they develop. I will use visual aids to illustrate the process of caries formation. I will delve into the role of plaque and
bacteria in this process, emphasizing the role of acids produced by bacteria in damaging tooth enamel. Throughout this phase, I
will encourage active participation and questions to ensure the patient comprehends the material. Success criteria for this stage
will involve assessing the patient's ability to articulate the concept of caries and their understanding of the key factors
contributing to their development. Lastly, for the third goal of initiating the daily use of fluoride mouth rinse and explaining its
preventive benefits by 10/26/23, I will begin by providing an overview of fluoride. I will explain that fluoride is a natural mineral
found in various sources, including drinking water and certain foods. I will emphasize its role in strengthening tooth enamel and
making teeth more resistant to acid attacks from bacteria. Additionally, I will elaborate on how fluoride mouth rinse can be a
valuable tool in preventing caries by enhancing the remineralization process. Practical guidance on the proper use of fluoride
mouth rinse will be offered, and I will encourage the patient to incorporate this into their daily oral hygiene routine. Success
criteria in this phase will involve confirming the patient's understanding of fluoride's benefits and its source, as well as their
commitment to daily use.

LTG: STG 1: Get filling done on #15O by the 3 month recall appointment next semester

STG 2:Teach patient about caries and how they develop, be able to define caries by 10/26/23

STG 3: Start using fluoride mouth rinse daily and explain the benefits on how fluoride can prevent caries, explain how fluoride
comes from a mineral and where it can be found. Be able to remember this information by 10/26/23

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

Get medical and dental history signed

Record plaque and bleeding score

Gingival description

Patient Ed about caries and additional use of fluoride

Encourage patient to use mouthwash daily

Review brushing and flossing

Ask questions about previous patient ed sessions

Local anesthesia (if needed)

Ultrasonic mandibular left quadrant

Perio Chart quadrant

Get US check and perio probing checked by instructor before fine scaling

Fine scale the same quadrant

Appointment 4- Chairside Education Plan:

Patient Ed on recall appointment. Since this patient has several decay areas of caries and a filling needing to be
done, explain the importance of getting the filling done and visiting dental checkups regularly in order to halt
the progression of periodontal disease

Appointment 4- Chairside Education Plan:

Get medical and dental history signed

Record plaque and bleeding score

Review old and new plaque and bleeding score

Gingival description

Patient Ed about recall appointments

Encourage patient to use mouthwash daily

Review information from previous appointments such as brushing, flossing, plaque, periodontitis, caries, and
mouthwash.

Local anesthesia (if needed)

Ultrasonic mandibular right quadrant

Perio Chart quadrant

Get US check and perio probing checked by instructor before fine scaling

Fine scale the same quadrant

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

Chairside Education Plan: Pain from tooth #19 will be alleviated after vising dental office for Root canal
therapy or extraction, Patient will know the importance of getting this done along with her caries controlled
and halted. Also patient will know the importance of having her wisdom teeth extracted because of the
decay on it.

Post-Perio Treatment Plan:

Get medical and dental history signed

Record plaque and bleeding score

Review old and new plaque and bleeding score

 Calculus detection and remove any found

New gingival index

Full mouth probe

Gingival description of all 4 quads

Review information from previous appointments

Polishing (plaque free)

Use Arestin in pockets designated by instructor

Flouride

Schedule perio maintenance in 3 months

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.

During the initial appointment on 9/21/23, the Patient pre-rinsed and then we started on a
thorough patient assessment to lay the foundation for the comprehensive care plan. This included
conducting a head and neck exam, an intraoral exam to assess the oral cavity's condition, a
thorough periodontal assessment to evaluate the patient's periodontal health, dental charting
accompanied by X-rays to gather important data, gingival index, and obtaining informed consent.
The patient did not need new X-rays since X-rays were taken last semester. Additionally, I also
gathered the patient's medical and dental history to review their medications which were
Hydroxychloroquine, metoprolol, and levothyroxine to assess any potential risk factors. The patient
was guided through completing important forms, such as the Statement of Release, HIPAA form,
and Patient Appointment Practice Form, ensuring the process was started off correctly. For the
Informed Consent, the dentist wrote referrals for #20 which needed a filling, Caries on #12 distally
and on the occlusal surfaces, #15 also needed a filling on the distal surface and #19 needed to be
extracted due to RC Torert. The patient was notified when signing the informed consent knowing
that she needed the treatment for the referrals. Chairside patient education was done during this
appointment in order to give the patient a brief overview of what caries is and what the referrals
were, later on in the treatment the caries process was explained more in detail. The learning level
for this patient was awareness since now the patient is aware of the findings that were put on the
informed consent. The patient paid 25$ with debit before the appointment began.

on 9/27/23, our focus shifted to the initiation of treatment. We began by addressing the
maxillary right quadrant, commencing with scaling to remove calculus deposits and recording
pocket depths to gauge periodontal health. The patient was seated, and medical and dental history
documents were reviewed and signed. I then recorded plaque and bleeding scores to assess the
 oral hygiene status. By comparing old and new scores, I was able to track progress. Detailed gingival
descriptions were noted as well. On this day the patient had the maxillary right scaled, followed by
ultrasonic scaling and chairside patient education until the next appointment, and was only seen
for 2 hours. Quad was also probed in order to re-evaluate pocket depths that were inaccurate due
to calculus build-up.

On 10/05/23 the patient was educated about plaque control, what plaque is, and proper
brushing techniques. The patient was educated on how plaque could form between 4 – 12 hours
after eating and all the surfaces of the teeth it can form on, she also learned that plaque needs
three components to become plaque such as bacteria, food, and saliva. Using a typodont, the
patient was shown the correct brushing method, which was brushing at a 45-degree angle, and
encouraged to practice on their own teeth. Then they brushed off the disclosing solution when I
placed it in their teeth for them to observe. We emphasized the importance of brushing twice a day
for optimal oral health and the correct brushing technique which was the bass brushing technique,
as well as long-term and short-term goals were presented to the patient to accomplish. Local
anesthesia was not administered since the patient did not feel discomfort and did not want the
anesthesia. Afterward, ultrasonic scaling of the maxillary left quadrant was performed, as well as
fine scaling, followed by perio charting. The ultrasonic scaling and perio probing were checked by
the instructor before proceeding with fine scaling to ensure precise treatment. Throughout the
appointment, the patient exhibited keen interest in the topics discussed and demonstrated a strong
determination to transform her oral habits into positive ones, her learning level changed into action
as a result since she retained the information from the patient education session. Patient was also
seen for partial appointment, not full 4 hours.

During the appointment on 10/18/23, we initiated the session with a thorough assessment of the
patient's medical and dental history, including vital signs. Following this, I had the patient swish with a
pre-rinse solution and recorded her plaque score, which was impressively low at .08, indicating good
plaque control, and her bleeding score was minimal at 0.02%. We revisited her previous plaque and
bleeding scores, noting that they remained consistent, a testament to her commitment to meeting short-
term goals, particularly in keeping her plaque score below .8 During this appointment, we reviewed her
brushing technique and observed that she continued to use the bass method. In the patient education
room, we dived into the topics of periodontitis and the proper method of flossing, expanding on our
previous discussions. We highlighted the key distinctions between gingivitis and periodontitis,
emphasizing that gingivitis is reversible with clinical signs like redness and sponginess, while
periodontitis is irreversible, and lost bone cannot be restored. Using radiographs, we pinpointed areas
showing evidence of bone loss and explained her classification as a Stage III, Grade B periodontal patient.
We also clarified the meaning of staging and grading, underscoring how these parameters could progress
without change. Focusing on flossing, we discussed the C-shape technique that allows the floss to
conform to the tooth's contours and reach subgingival areas. Stressing the importance of daily flossing, I
demonstrated the technique using a typodont and guided her through the process. We practiced flossing
together at the sink, with special attention to interproximal areas. Disclosing solution was applied to help
identify missed areas, and she practiced until she felt confident in her technique. In terms of the learning
level framework, her response can be described as “action,” as she actively engaged with the education
and didn't give up, particularly in learning to floss effectively. As the session concluded, I posed questions
to assess her retention of the information presented and reviewed content from previous educational
sessions to gauge her memory. We also revisited our long- and short-term goals, with her short-term
objectives including a further reduction in her plaque score to at least half by 10/25, a deeper
understanding of plaque, and the ability to define it by 10/25, and successful demonstration of proper
brushing and flossing techniques. After patient education, I then started treatment on the right of the
mandibular section with the ultrasonic and fine scaling after the instructor checked the ultrasonic
section of the treatment of course. Local anesthesia was not needed as the patient felt comfortable and
did not want it.

On 10/25/23, we started the appointment by updating the patient's medical and dental history and
recording her vital signs. She was directed to use a pre-rinse before I proceeded to check her pocket
depths and perform ultrasonic scaling on the mandibular right quadrant. This procedure was overseen
and approved by an instructor to ensure its accuracy and effectiveness. Following the ultrasonic scaling,
we proceeded with fine scaling in the same quadrant. Subsequently, her plaque score was measured at a
commendable .02, indicating effective plaque control, and her bleeding score was 0.05%. A comparison
with her previous scores showed notable improvement, with the plaque score decreasing by .28 and the
bleeding score decreasing by.03% During this appointment, we conducted patient education session #3,
focusing on caries and fluoride. We revisited topics such as plaque, brushing, flossing, and periodontitis.
Our discussion covered the transmissibility and formation of caries, and we highlighted the need for her
to have #20 and #15 occlusal fillings, pointing out the specific locations in her mouth on a typodont.
Additionally, we explored the benefits of fluoride, its sources, and its practical applications. I also
recommended the incorporation of a daily mouth rinse into her oral hygiene routine, a suggestion she
actively embraced. In terms of her learning level, her engagement and inquisitive nature marked a clear
“action” phase, as she sought information regarding fluoride content in her toothpaste and inquired
about suitable fluoride-containing mouth rinses. She ultimately made proactive choices by selecting
ADA-approved fluoride products designed for periodontitis management. Since the patient had caries on
some surfaces of the teeth, I took images with the intraoral camera and showed the patient the findings
from the pictures which helped her understand and perform action on using fluoride products. After the
patient education session, we then progressed to ultrasonic of the mandibular left quadrant followed by
fine scaling and probing in order to check the progress of the healed pocket depths which was then
checked by a instructor.

On 11/10/23, I initiated the appointment by having the patient use a pre-rinse. Thereafter, I
conducted periodontal probing in all four quadrants, meticulously comparing the probing depths
quadrant by quadrant for a comprehensive evaluation. During this process, any remaining calculus was
identified and removed through plaque-free procedures. Furthermore, I administered fluoride varnish at
a concentration of 5%. The patient education segment of this appointment centered on emphasizing the
advantages of fluoride varnish and providing detailed instructions to maximize its effectiveness. The
patient's adept responses to questions posed in our previous three patient education sessions indicated
a proactive action learning level. Her plaque score was commendable at .02, with only a minor plaque
spot, and I gently reminded her to continue brushing 2-3 teeth at a time to maintain optimal oral
hygiene. While her bleeding score was recorded at .02%, not reaching our goal of 0%, it marked a
notable improvement compared to her initial bleeding score. I reinforced the importance of daily
flossing, acknowledging the initial challenges she faced as a newcomer to this practice, and emphasized
that increased flossing would gradually reduce bleeding. In the concluding gingival statement, I
described her condition as "generalized moderate periodontitis with minimal bleeding" and displayed a
visual comparison of her current dental state against the starting point. It's worth noting that I
completed her gingival index with a .875 GI, a highly favorable result post-treatment. Despite explaining
the benefits of arrestin, the patient declined the treatment, indicating her preference not to proceed
with it.

Prognosis: (Based on attitude, age, number of teeth, systemic/ social background, malocclusion,
tooth morphology, periodontal examination, recall availability)

The patient consistently exhibited a positive attitude throughout her appointments and
demonstrated an impressive ability to retain and apply the information discussed during our
sessions. She proactively purchased floss picks and fluoride mouth rinse, indicating her genuine
commitment to improving her oral health, which is commendable given her age. Given the number
of teeth she has, the primary concern currently lies with her wisdom teeth, some of which have
occlusal caries and need to be taken out. The dentist has referred her for removal, but its
completion will depend on her follow-through during her upcoming recall availability. She hails
from a foreign background, where regular six-month cleanings were not a common practice during
her upbringing. Furthermore, she explained that she was never taught how to floss, resulting in
infrequent use, except for occasional floss pick usage to dislodge food particles. During her initial
periodontal examination, notable generalized inflammation and bleeding on probing were
observed, which have since shown significant improvement following her post-perio appointment.
Our discussions have prompted her to schedule a recall appointment next semester, reflecting her
commitment to maintaining her oral health. At the next appointment, I anticipate downgrading her
to a lower Prophy class, and I look forward to witnessing significant positive changes, given her
dedicated practice of the information provided during our patient education sessions and
enthusiasm.

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

My patient was prophy class 4 and is stage 3 grade B, her recall appointment is written down for
6/10/23

The referrals written for her are #20 O filling, #12 DO filling and extraction of #19
 11. 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)

Periodontal grade could possibly change to stage 2 grade A since she has shown sigicant
improvement to her oral hygiene habits and lowered her bleeding score every appointment,
although the goal to 0% wasn’t accomplished she could reach that goal by her next recall
appointment if she continues to improve her oral hygiene habits that she has learned from our
education sessions. Probing depths also changed by 1 mm generally in the whole mouth which
could potentially set her on the right path to changing her staging and changed her grading from B
to A.

12. Patient Attitudes and Cooperation:

The patient consistently maintained a positive attitude throughout our whole care plan. Notably,
she displayed heightened attentiveness during discussions centered around periodontitis and
flossing. She had previously shared that she had never been taught how to floss and only did so
sporadically when she remembered. However, following the patient education session that
specifically addressed flossing, a marked reduction in inflammation became apparent. After the
third patient education session, which covered fluoride, she went out of her way to acquire a
fluoride mouth rinse specifically designed for periodontitis, an ADA-approved choice. Her
cooperation and understanding of the necessity for multiple appointments were notable, and she
consistently attended to all her appointments punctually, eliminating the need for any
rescheduling. From speaking the language of the patient, I noticed she learned more and had a
better understanding of the general idea of the topics we were discussing, such as caries and
periodontitis. Her positive enthusiasm was consistent throughout the entire project, and I was
delighted to have her as a patient.

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

My experience with the periodontal care plan has been exceptionally positive and informative.
Throughout this journey, I not only facilitated my patient's progress but also expanded my knowledge
and skills in the realm of oral health. The process of researching and exploring various educational
methods to convey topics like fluoride, flossing, caries, periodontitis, plaque, and gingivitis was
enlightening. It revealed the importance of effective communication in dentistry and the significance of
tailoring information to individual needs. One significant realization that emerged from this experience
was the realization that oral health awareness can vary widely among individuals, especially across
different countries and cultural backgrounds. It highlighted the essential role of oral health education, as
many may not have access to comprehensive oral hygiene resources or knowledge. This entire care plan
project has ignited a deep sense of inspiration within me regarding my choice of profession. It reaffirmed
my belief that dentistry is the right path for me because it provides a unique opportunity to positively
impact people's lives not only through clinical procedures but also through education. The ability to
empower individuals with the knowledge and tools to take control of their oral health is a gratifying
aspect of this profession. I have learned that helping others in this holistic manner can be profoundly
fulfilling, and I am enthusiastic about continuing to make a positive difference in people's lives through
oral health education and dental care.