Periodontal Care Plan

Patient Name:
Date of Initial Exam: 8-20-2015

Student: Tara King

Age: 50

1. Medical History:
My patient has a medical history of hypertension, nerve
damage in her arm, anxiety, and tachycardia. Patient does
not require any pre medication or a medical clearance. A
systemic condition that could alter my treatment that my
patient has been diagnosed with is hypertension. However,
the patient has it controlled with medication. To ensure it is
controlled, I need to make sure patient has taken her
medication. I will need to check vital signs at every
appointment and monitor any signs of dizziness, headache,
or nosebleeds. I also should limit the stress my patient has
in my dental chair because stress can increase blood
pressure. Periodontitis has been researched and has been
found to be associated with a higher risk of hypertension. I
feel this makes it very important to halt the progression of
the periodontitis and could possibly help with her
hypertension. Other medical conditions that my patient has
a history of are nerve damage in her arm. I need to make
sure and be aware of which arm to avoid and care not to
bump into so I can avoid hurting my patient. I also need to
recommend using an electric toothbrush to ensure proper
oral hygiene since she has difficulty using her arm. When
assessing my patient, I noticed she was having trouble
using the arm and proper brushing was hard to achieve.
This could contribute to my patients periodontitis, because
it leads to leaving plaque on the teeth increases her risk of
periodontitis. My patient also suffers from anxiety. In order
to reduce the risk of my patient having an anxiety attack in
my chair I should first make sure patient is taking
medication. I should then be cautious about how I explain
and go about my treatment to be able to reduce any
anxiety. Also my patient has controlled high heart rate. I
should ensure she is taking her medication and also should
take vitals at every appointment. My patient is currently on
multiple medications. Hydrocodone, Savella, Meloxicam,
Gabapentin, Clonazepam, Metoprolol, Cyproheptadine,
Dymista, and Spironolactone are all medications which
have xerostomia as a possible side effect. Adequate saliva
in the mouth is necessary to maintain healthy tissues in
the mouth. Xerostomia can cause caries and gingival

inflammation, which contribute to periodontitis. Meloxicam,

Clonazepam, and Metoprolol can cause slow wound healing
which I should consider during treatment. My patient also
drinks alcohol socially which can also contribute to
periodontitis. Alcohol can cause overgrowth of bacteria in
the mouth, which can lead to inflammation of the gums
and periodontitis.

2. Dental History
My patients reason for her visit is that her gums bleed
when brushing. Her last dental visit was in January of 2014
to replace a broken tooth. Her last cleaning was in 1999,
which was sixteen years ago. This has a big impact on her
periodontitis. Calculus remaining on her teeth for so many
years causes inflammation, redness, and bleeding of the
gums, forcing them to recede trying to get away from the
bacteria in that calculus. She stated that her gums bleed
while brushing and flossing on all teeth. This is a symptom
of periodontal disease. My patient has a habit of clenching
and grinding, which we recommended starting to use a
night guard. On the occasions she does go to the dentist
she is prone to having a few caries each time. She states
that she suffers from dry mouth, which also has a big
impact on the health of the mouth. Saliva helps with
cleaning and getting rid of bacteria, and without it, it can
cause increase of plaque build up and bacteria on the teeth
causing periodontal disease. I feel my patients dental IQ is
fair. She does know some basic information but has a lot to
learn. She has learned so much by being in my dental
chair, including proper brushing techniques. My patient
does not have any past dental diseases she is aware of.
When going to the dentist to get a tooth fixed or caries
restored she was never told she had any kind of gum
disease. I feel this contributes to her periodontitis because
if she would have been educated early on she could have
reversed her gingivitis and it would not have become
periodontitis. She has an awesome attitude about learning
things to better her oral health. She is very excited about
being able to halt her disease and learning ways to
maintain it.
3. Oral Examination:

On my patients oral exam her TMJ pops and deviates to the

left. She had a very small tori in the back and center of the
hard palate which was slightly red. Also had slight
mandibular exotosis. My patient grinds and clenches out of
habit, this can contribute to her periodontitis. The forces of
grinding and clenching can cause alveolar resorption. She
is going to start using a night guard at night. My patient
also breathes out of her mouth while sleeping, which is
another thing that can contribute to her periodontitis
because it can cause drying of the gums and teeth in the
front of the mouth. All occlusions were class 1. Her overbite
was 2mm and over jet 3mm.
4. Periodontal Examination:
a. Case classification: V
b. Gingival Description:

Periodontal Case Type: III

Appt 1: 8/20/15
Architecture was generalized scalloped. The color of the
gingiva was red generalized. Consistency was generalized
edematous and spongy. Has generalized thickened margins.
Generalized bulbous papillae. Surface texture papillary and
marginal is generalized smooth and shiny. Surface texture of
attached gingiva is stippled. All of these are symptoms of
periodontitis. I did not get as far as getting a plaque score,
bleeding score, or gingival index at this first appointment.
Appt 2: 9/1/15
At this appointment the architecture was generalized
scalloped. Color of gingiva was red generalized. Consistency was
edematous and spongy generalized. Generalized thickened
margins and bulbous papillae. Surface texture of papillary and
marginal was smooth and shiny generalized. Surface texture of
the attached gingiva was stippled. She had a plaque score of 1.7
(good). A bleeding score of 60%. Her initial gingival index was a
2.1 (poor).
Appt 3: 9/8/15
Today my patients architecture was generalized scalloped.
Color of the gingiva was red generalized but on mandibular right,
where we have scaled you could see the color getting slightly
more pink. Consistency was edematous and spongy generalized.
Margins remained thickened and papillae remains bulbous.
Generalized smooth and shiny surface texture of papillary and
marginal. Surface texture of attached gingiva was stippled

generalized. She had a plaque score of 0.6 (good) which was a

great improvement from last appointment! A bleeding score of
51% which has also went down since last appointment!
Appt 4: 9/22/15
The architecture was generalized scalloped. Color of the
gingiva was red generalized on the maxillary. On the mandibular right
the gingiva was a very slight red, almost pink. The Mandibular left you
could see a slight change in the red to a more soft red. The consistency
on the maxillary was generalized edematous and spongy. The
mandibular right and left consistency was showing improvement.
Maxillary left the margins remained thickened and papilla bulbous. The
mandibular right and left quadrants were showing improvements in
this as well. Surface texture was still slightly smooth and shiny on
mandibular and generalized on maxillary. Surface texture of attached
gingiva was generalized stippled. She had a lot less bleeding
generalized with a bleeding score of only 11%. A plaque score of 0.6
(good) which remained the same as her last appointment.
Appt 5: 9/29/15
At this appointment the architecture remained generalized
scalloped. The color of the gingiva was soft red on maxillary left and
remained red on the maxillary right quadrant. The gingiva was slightly
red almost pink on mandibular quadrants. The consistency and the
surface texture were showing improvements in all quadrants I have
scaled so far along with the margins and papilla. Her bleeding score
was 13% and plaque score a 0.3 (good) which went down from her
previous appointments.
Appt 6: 10/6/15
At this appointment architecture is generalized scalloped.
The color of the gingiva on the mandibular was slightly red almost
pink. The color of the maxillary left was also slightly red almost pink
and the maxillary right was becoming a softer red. The mandibular and
maxillary left consistency was within normal limits. The maxillary
rights consistency showed improvements. The surface texture was still
slightly smooth and shiny but was showing great improvements from
first seen. The mandibular quadrants and maxillary left quadrant
showed margins and papilla within normal limits. Bleeding score was
11% at this appointment and plaque score was a .5 (good).
Appt 7: 10/28/15
Her last appointment her gingival tissue was generalized
scalloped. The color of the gingiva was slightly red on linguals but pink
or normal generalized on the anteriors. Consistency was slightly

edematous and spongy on linguals but showed great improvements.

Consistency was within normal limits on anteriors. Surface texture of
papillary and margins were slightly smooth and shiny but greatly
improved on linguals and smooth on facials. Surface texture for
attatched was generalized stippled. Margins and papillae were
generalized within normal limits. Bleeding score was 10% at this
appointment and plaque score was .5 (good).

C. Plaque Index:
Appt: 1. None
Appt: 2. 1.7 (Good)
Appt: 3. 0.6 (Good)
Appt: 4. 0.6 (Good)
Appt: 5. 0.3 (Good)
Appt: 6. 0.5 (Good)
Appt: 7. 0.5 (Good)
D. Gingival Index:
Initial: 9/1/12: 2.08 (Poor)
Final: 10/28/14: 1.04 (Fair)
E. Bleeding Index:
Appt: 1. None
Appt: 2. 60%
Appt: 3. 51%
Appt: 4. 11%
Appt: 5. 13%
Appt: 6 11%
Appt: 7 10%
F. Evaluation of Indices:
Initial: Bleeding was moderate and generalized
throughout the mouth. Bleeding is associated with active
infection of my patients periodontitis. Plaque score was a 1.7
(Good). Very close to being fair but learned a new brushing tech
so hoping will be lowered by next appointment. Gingival Index is
2.08 which is poor. Patient had generalized moderate
inflammation, bleeding, and redness. With the proper home care
I will be teaching and after cleaning I am confident to see great
changes by final appointment.
Final: At her final appointment bleeding was very
slight and localized. Her first bleeding score was 60% and by her

final bleeding score it dropped to 10%. Bleeding is a sign of

active infection and her bleeding levels went down tremendously
from her first appointment. With phenomenal homecare and a
cleaning has showed great improvements on my patients
periodontitis. My patients final plaque score was 0.5 which went
down tremendously from her first plaque score. Getting the
plaque off of her teeth is keeping the bacteria out of her mouth
giving great improvements of my patients periodontitis. My
patients final gingival index was 1.04 which dropped 50% from
her first appointment.
G: Periodontal Chart:
1. Baseline: The highest periodontal pocket my
patient had was a five on the distal of tooth #10.
Had generalized 1-4 pocket depths throughout the
mouth. Was unable to chart linguals of # 22-24
due to calculus build up. The highest CAL is a four
on lingual surface of tooth #25. A CAL of one and
twos are generalized throughout the mouth, only
a couple of threes. All the posterior teeth have the
least amount of CAL throughout the mouth.
Generalized one through threes in tissue height
throughout the mouth. Recession on lingual
surface of tooth number 26 of a one. Recession
also on lingual surface of number 25 of a three
lingual and two mesial, also a 2 on the facial
surface. Mobility of a 1 was found on tooth
numbers 26 and 25. No furcation involvement,
sensitivity
to
percussion,
suppuration,
or
inadequate zone of attatchement was found.
2. Final: The highest periodontal pocket she had was
a five on the distal of tooth #10. She had
generalized 1-3 pocket depths and a few 4 pocket
depths. A CAL of 0-2 and generalized throughout
the mouth with a few 3 and 4s. Her highest CAL
was a 5 on the lingual of number 24. Tissue height
had generalized 1 and 2 with very few 3s. I have
recession on lingual of number 4 of a one and we
have recession on #26 lingual of a 1, #25 lingual
of a 3 and 2 and facial of a 2, #24 lingual of a 3
and facial of a 1, and #23 lingual of a 1. Mobility
of a one was found on numbers 26 through 23. No
furcation involvement, sensitivity to percussion,
suppuration, or inadequate zone of attatchement
was found.

5. Dental Examination:
Patient has all four 3rd molars removed. Also has tooth #15
removed due to a large cavity. Patient has a cavity on distal
of tooth #14 in the interproximal surface. Also has cavities
on the occlusal surface of teeth #s 29 and 28. Cavities
contribute to her periodontitis because the increase plaque
biofilm retention. Leaving these cavities untreated can give
plaque a area to grow and change into a gram negative
anaerobic environment. Patient has attrition on teeth #s
23-26 due to grinding which is a contribution to
periodontitis because the pressure put on tooth can cause
root resorption.
6. Treatment Plan:
Appt 1:
1.
2.
3.
4.
5.
6.
Appt 2:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Health history/ Vitals

Vertical BWX
Head and neck / Intra Oral exam
Periodontal Assessment
Dental Charting with X-rays
Began full periodontal charting
Health history/ Vitals
Take one retake
Complete full perio charting besides lingual of 22-27
Plaque Score
Bleeding Score
Gingival Index
Risk assessment
Informed Consent
1st Patient Ed session
Went over all long term goals and short term goals I
have set for us to accomplish.
Discuss what plaque is, how it hardens into calculus,
how to prevent it, what plaque build up can cause.
Teach how to do circular motions and bass technique.
Also how to put toothbrush at 12 and 6 Oclock
position to get lingual of anterior teeth.
Patient practice on a typodont and then on herself in
the mirror.

Discuss that we are a team and I am dedicated to

educating her as well as cleaning but she must do
her oral hygiene at home!
10. Began ultra sonic on mandibular right
Appt 3:
1.
2.
3.
4.
5.

Health history/ Vitals

Take Intra Oral pictures
Plaque Score
Bleeding Score
Patient ed session 2
Go over all long term and short term goals.
Teach that she has periodontitis, what periodontitis
is, signs of periodontitis, causes of periodontitis, and
prevention of periodontitis.
Teach how to properly floss, taught to use the C
shape.
Recommend floss with handles to use because of
difficulty she has with using her arm.
Practice the skill on typodont and then also on
herself.
Discuss that we are a team and I am dedicated to
educating her as well as cleaning but she must do
her oral hygiene at home!

6. Finish ultrasonic on mandibular right

7. Complete full perio charting on that quadrant
8. Scale mandibular right
Appt 4:
1.
2.
3.
4.

Health history/ Vitals

Plaque Score
Bleeding Score
Patient ed session 3
Go over all long term and short term goals.
Teach what a cavity is, what the process is, what a
cavity can cause, and ways to prevent them.
Will discuss trying to avoid fermentable carbs and
why.
We will review over her brushing and flossing
techniques.

Discuss that we are a team and I am dedicated to

educating her as well as cleaning but she must do
her oral hygiene at home!
5. Ultrasonic Mandibular left
6. Finish full perio charting on that quadrant
7. Scale mandibular left
Appt 5:
1.
2.
3.
4.

Health history/ Vitals

Plaque Score
Bleeding score
Chair side patient Ed
Will discuss what xerostomia is, what it can cause,
and how to prevent it.
Will talk about what fluoride is and how it can help.
Will teach what biotene is and how it can help.
5. Ultrasonic maxillary left
6. Scale maxillary left

Appt 6:
1.
2.
3.
4.

Health history/ Vitals

Plaque Score
Bleeding score
Chair side patient ed
Will discuss what all grinding can cause and why it is
important to stop.
Will explain the importance of getting a night guard
and wearing it at night to prevent further attrition.
5. Ultra Sonic Maxillary Right
6. Scale Maxillary Right

Appt 7: Final Appointment

1.
2.
3.
4.
5.
6.
7.
8.
9.

Health History/ Vitals

Plaque Score
Bleeding Score
Perio Charting
Gingival Index
Reinforce patient education
Polish
Fluoride treatment
Chemical Irrigation

10. Referral for cavaties

11. Explain
the
importance
appointments
12. 3 month recall

of

regular

dental

Patient Education
LTG 1: Patient will reduce plaque score
STG: Patient will brush 2 minutes and with different
technique
STG: Patient will floss 3 times a week
STG: Patient will define plaque
Evaluation method: Plaque score / Patient convo
Oral Hygiene Instruction: Brushing
Time Frame: End of treatment
LTG 2: Patient will halt progression of periodontitis
STG: Patient will define periodontitis
STG: Patient will demonstrate appropriate brushing and
flossing
STG: Patient will reduce bleeding
STG: Patient will complete treatment at LIT
Evaluation Method: Probing / Patient convo
Oral Hygiene Instruction: Flossing
Time Frame: 3 months
LTG 3: Patient will get current caries restored
STG: Patient will define a cavity and ways to prevent it
STG: Patient will make a appointment
STG: Patient will follow through with appointment
Evaluation Method: Patient convo
Oral Hygiene Instruction: Review brushing and flossing
Time Frame: 6 months
LTG 4: Patient will manage xerostomia
STG: Patient will use fluoride mouthwash daily at home
STG: Patient will buy biotene
STG: Patient will use biotene
Evaluation Method: Patient convo

Time Frame: End of Treatment

LTG 5: Patient will use a nightguard
STG: Patient will buy a night guard
STG: Patient will wear at night
Evaluation Method: Patient convo
Time Frame: End of Treatment
6. Radiographic Findings:
She has moderate horizontal bone loss generalized on all areas
besides upper anteriors. Bone loss is a risk of active periodontitis. Has
mild horizontal bone loss on teeth #s 8,9,10. Showed suspicious areas
on # 3, 31,30, 29,18,27,14,13,12,11,18,19. Cavities can contribute to
periodontitis because they increase plaque biofilm retention. Leaving
them untreated can give plaque an area to grow and change into a
gram negative anaerobic environment, making periodontitis a higher
risk.
7. Journals
Appt 1: 8-20-2015
The treatment I provided today consisted of me first reviewing
my patients health history and I took her vitals, where everything came
back normal. I then began doing paperwork. I did a head and neck and
intra oral cancer screening. Where the only positive findings found
where TMJ pops and deviates to the left, small tori on hard palate,
Bilateral linea alba from cheek biting, mandibular exotosis, patient
grinds, clenches, and mouth breathes at night. I then did a periodontal
assessment where my patient had all positive findings for periodontitis.
She then got classed as a case 3 periodontal case, and was approved
to be my periodontal patient. I took vertical bitewing x-rays to see her
bone level. We did dental charting with x-rays and found a few cavities
as well as attrition. I then began doing full periodontal charting but did
not get to finish at this appointment. My patient told me she would
love to be my periodontal patient and agreed to come in each week for
multiple weeks. I educated her that she has periodontitis and explained
to her what periodontitis was and how important it is for us to halt the
disease. Her learning level would have to be fair, because she knows
the basics but can learn a lot through patient education with me. I
expect this to work out great, I feel confident with my patient and
confident about the treatment! We ran into no complications.

Appt 2: 9-1-2015
The treatment I provided today is we reviewed over her
medical history and did vitals, everything came back normal. I then
took one retake x-ray. I did her plaque score which was 1.7 (Good). I
documented her gingival Index as a 2.1 which is considered poor. I also
got a bleeding score of 60%. We then completed her full periodontal
charting except for the lingual surfaces of teeth # 22-27. I also did a
risk assessment, which she was low risk for oral pathology but high risk
for perio and restorative factors. I then had all the information I needed
to make her treatment plan on her informed consent and had her sign
it. I then did her first patient education session where we went over all
her long term goals and short term goals I have set for her to
accomplish. Her first long-term goal is to reduce plaque score. The
short-term goals are brushing for two minutes with new technique,
begin flossing 3 times a week, and she will be able to define plaque. I
then taught her what plaque is, how it can cause periodontitis and
cavities, which are problems she currently has. We also went over
multiple ways to prevent plaque. After I taught her to do circular
motions and also bass technique we discussed putting toothbrush at 6
and 12 Oclock in order to better get linguals of anterior teeth. She
practiced on the typodont, then went to the sink and practiced the
technique. We put disclosing solution on and saw a difference. We then
discussed that we are a team and I encouraged her to do all of this at
home. After I began ultra sonic on her mandibular right. My patient is
very excited to get educated to better her oral hygiene. She was
unaware of periodontitis and that she had the disease. Her learning
level is still fair she is learning, but has a lot more to learn about her
disease and ways to halt it, as well as preventing getting more cavities.
Now that I have taught my patient the correct way to brush her teeth I
expect great changes in her plaque score at the following
appointments. She showed great enthusiasm on learning all of these
new techniques and eager to begin brushing and flossing correctly. We
ran into no complications.
Appt 3: 9-8-15
The treatment I provided today is we reviewed over her
medical dental history as well as took vitals, all came back normal. I
then took a plaque score which was a 0.6 (good) which was much
better than last appointment. Also took a bleeding score which went
down as well to a 51%. Beginning flossing 3 times a week and using
the new brushing technique has seemed to already really benefit my

patient. After I finished ultrasonic on mandibular right. Then we did her

second patient ed session which was over periodontitis and flossing.
We began patient ed by going over all her long and short term goals. I
praised her on lowering her plaque and bleeding score already. I then
began teaching what periodontitis is and how my patient currently has
it. We discussed ways to prevent periodontitis as well as what causes
periodontitis. I went over the difference between gingivitis and
periodontitis. I showed her the bone loss she has on her x-rays as well
as on her full periodontal charting. I then explained why it is so
important to remove interproximal plaque. After I began showing my
patient the proper technique of flossing. We discussed how to properly
wrap it around her fingers and how to do the C shape once at the
bottom of tooth. I also explained to her that I recommend using dental
floss holders because she has a difficult time using her arm. My patient
practiced flossing on the typodont and then on herself. We then
discussed what we will be going over at the next appointment and
discussed how we are a team and encouraged her to continue keeping
up the good work! Once back at the chair we finished full periodontal
charting on the mandibular right. Then fine scaled the quadrant to
finish. The last thing I accomplished at this appointment was taking
two intraoral pictures. My patient was extremely excited to see her
plaque score and bleeding score go down. She was so proud of herself.
After I finished with her first quadrant and she saw the difference she
was so amazed. She told me she could not wait to be finished and is
very ready to halt her periodontitis so she does not get anymore
recession. We did not run into any complications. She has already met
her first long term goal. Her plaque score went down greatly and she
says she began flossing 3 times a week since her last appointment as
well as using her new technique during brushing. She also has an
understanding of plaque! She is so eager to learn and to improve her
oral health I have great expectations that will do so! Her learning level
is action because she is practicing all her techniques into improving
her oral health.

Appt 4: 9/22/ 15
The treatment provided at this appointment was we began
by updating her medical and dental history as well as took vitals which
all came back normal. We proceeded by taking her plaque score which
was 0.67 (good) which remained the same as her last appointment.
Then we took her bleeding score which was 11% which dropped a lot
from her last appointment. We applied 20% benzocaine on her
mandibular left quadrant before beginning ultrasonic. After we

completed ultrasonic and fine scaling her mandibular left quadrant.

Then we went and did her 3rd patient ed session. Her 3rd patient ed
session was over cavaties and reviewing her brushing and flossing
techniques. We began patient ed by going over all of her long term
goals as well as short term goals. I praised her by already completing
her first long term goal and three of her short term goals from her last
appointment. She can define periodontitis as well as lowered her
bleeding score and can demonstrate correct brushing and flossing. We
then went on with defining what a cavity is, what causes a cavity, and
ways to prevent a cavity. I showed her the cavaties she currently has
on her x-rays as well as her dental charting. We then went to the sink
and she showed great brushing and flossing techniques. After we
discussed what we will be going over at her next appointment. We
discussed how we are a team and are in this together. I also told her to
keep up the great work! Once we got back to the chair I finished her
full periodontal charting. My patient was super excited that her
bleeding score came down so much! She does not eat too many
fermentable carbs but I recommended when she did have a coke or a
treat or anything to not snack on them. I also recommended either
brushing after or eating a piece of cheese to lower the PH level back to
normal after eating any fermentable carbs. My patient has shown
overall great improvements! Her learning level Action she is practicing
everything that I have taught her thus far! Her oral health is already
showing great improvements and I have very high expectations that
she will have a healthy mouth by end of treatment as well as after she
leaves. I have had no complications!
Appt 5: 9/29/15
Today we began with reviewing her medical and dental
history as well as taking her vitals, which all came back normal. We
took a plaque score which came out a 0.3 (good) which was lowered
from her last appointment. We took a bleeding score of 13%. I then put
20% benzocaine on her maxillary left. After we completed ultrasonic
and fine scaling on maxillary left. We then did her 4th chair side patient
ed session. Where we discussed What xerostomia is and what it can
cause. We discussed that all of her medications she is currently taking
a lot of them have a side effect of xerostomia. I told her to start using a
fluoride mouthrinse daily. I also told her to buy some biotene products
and begin using them daily as well. I have told her this before at home
so she had already began using ACT daily and using biotene mints
aswell. So she has already met her 4th short term goals. She has not
yet made an appointment to get her cavaties restored but I did
encourage her to do so. She is about to be having a surgery so she told
me to give her a few more weeks. I did praise her for all the goals she

has met and how she is still working hard towards her other two. She
told me that flossing has now become a habit and her teeth are feeling
so much better already! Her learning level is Habit, all techniques and
flossing have now become a habit. I have run into no complications.
Appt 6: 10/6/15
We began the appointment by reviewing medical and
dental history and taking vitals, which all came back normal. We took a
plaque score of .5 (good) and a bleeding score of 11% which was a
little bit lower than last time. We then completed ultrasonic and fine
scaling her maxillary right. We went on to her 5th long term and short
term goals chair side. I praised her for reaching her last long term goal
and for continuing to work hard toward her other goals. We talked
about getting a night guard and begin using it at night. We talking
about how she grinds and clenches and how she has attrition already
and what that can cause. I told her the night guard can help prevent
any further damage. She told me she already had a night guard and
will begin wearing it at night again. After we did plaque free and
flossed. Ending with educating her on the benefits of fluoride and
applying 2% neutral sodium. She was super excited to be done and
told me her teeth have never felt so clean before! She could see and
feel all the differences and improvements that we have made together.
She had texted me the night before so excited because for the first
time since forever she flossed and had zero bleeding. Her learning
level is habit. We have run into no complications! We are both eager to
see her post perio and post cal in two weeks.
Appt 7: 10/28/15
At her final appointment we began by updating her medical
and dental history and taking vitals which all came back normal. We
took her plaque score of .5 (good) and her bleeding score of 10%. After
we did full periodontal charting and it showed improvements of pocket
depths. We did her final gingival index witch was a 1.04 which dropped
by half from her first gingival index. After we did post cal. We put
Arestin in her 1 5mm pocket on distal of number 10 and I told her not
to floss in that area for 10 days or brush for 24 hours and also told her
that it was an antibiotic and will help heal her pocket. We reinforced
brushing and flossing techniques and how important it is to continue all
her homecare that we have talked about and learned after the
appointment. My patient was very excited to be at her last
appointment and seeing all her improvements made her feel proud and
determined to keep up her hard work. From her first appointment to

this appointment she has shown great improvements in every aspect

of her oral health. Her learning level is habit. Her progress in her short
and long term goals is going very good. She has met all her long term
and short term goals except one, getting her caries restored. She had
surgery a few weeks ago so just needed a few days to make an
appointment to get it done. She is very determined to do this so I am
not worried that she will not meet this goal as well in her near future. I
also set my patient on a 3 month recall. I expect nothing but great
things for my patient. She has learned many things since I first saw her
and her oral health has shown phenomenal improvements, I am so
proud that she has taken everything that I have taught her and applied
it to her every day routine at home. We did not run into any
complications throughout her treatment.
8. Prognosis:
Her prognosis is excellent. Her attitude has shown nothing but
determination. Every aspect of her treatment plan has shown great
improvements and she is meeting all of her goals that I have set for
her. She has taken everything very serious and loves seeing the
difference in her mouth. She has taken every thing that I have taught
her and applied it to her daily routine. Any problems that could have
held her back such as having difficulty using her arm or from all her
medications giving her xerostomia she has fixed. Such as using floss
helpers with long handles to help her floss, and also using an electric
toothbrush. She uses fluoride mouthwash and biotene mints
throughout the day to help manage her xerostomia. By her attitude I
think she will continue these things and become a more regular dental
patient making her prognosis excellent.
9. Supportive Therapy:
After evaluating my patients tissues with her moderate bone loss
as well as being a prophy 5 I have placed her on a 3 month recall. She
has referrals to get her current caries restored and to a periodontist.
Her next appointment should be in 3 months on January, 28th 2016 to
assess her tissue healing response.
11. Assessment of changes:
My patient has improved her plaque score, bleeding score,
probing depths and overall oral health. Her plaque score started out as
1.7 and dropped to a 0.5 by her final appointment. Her bleeding score
started out as 60% and dropped to 10% by final appointment. Her
initial gingival index was 2.08 and dropped by half to a 1.04. Her

probing depths decreased and were almost generalized normal probing

depths. Everything has decreased which shows signs of healing.
12. Patient Attitudes and cooperation:
My patients attitude was awesome! She was happy to be there
and happy to see changes. She was determined to fix the health of her
oral cavity and she proved it. She was never late and never
complained. She was eager to learn and was very easy to work with as
well as schedule. Once she saw changes she would tell me how proud
she was of me and herself for the hardwork we were doing. She was
working hard throughout treatment on her homecare and it really
showed. She was a great patient to work with.
13. Personal evaluation/ Reaction to experience:
I think both me and my patient had a very great experience. I
worked hard and made sure that my patient was getting the best
treatment as possible. I made sure and worked with her individual
needs and praised her when she was doing good. I think this was a
great learning experience to be able to learn about periodontitis in
class and go apply it to our actual patient in a clinic setting. It was a
great learning experience.