GINGIVAL INDEX

PERIODONTAL CARE PLAN

For Scotts Patient

Initial date __9-19-2017__________

Gingival Area

M F D L

3 1 1 2 1

9 0 0 0 0

12 0 0 0 0

19 1 1 1 1

25 1 1 1 1

28 1 1 2 2

TOTAL .67 good

Final date_11-17-17__

Gingival Area

M F D L
3 1 0 0 0

9 0 0 0 0

12 0 0 1 1

19 1 0 0 0

25 1 1 1 1

28 0 0 0 0

TOTAL .33 good

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 PERIODONTAL CARE PLAN

Patient Name__Scott’s Patient Age___34

Date of initial exam______9-19-17________________ Date completed__11-17-17________
Clinician Name ___Scott Sonnier__________________________

1. Medical History: (systemic conditions altering treatment, pre-medication, medical clearance) explain
steps to be taken to minimize or avoid occurrence, effect on dental hygiene diagnosis and/or care.
My patient has a few medical conditions that should be considered before, during, and after his
treatment. His last physical was in June of 2002 and he is in overall excellent health, he may
suffer from undiagnosed health problems, that he may not be aware exists. He is currently not
taking prescription medications other than multivitamins. His blood pressure was a little over
normal at 119/82, at his first appointment he was considered Pre-hypertension. I will be sure to
monitor my patient closely and accurately take and record blood pressure at each appointment.
His pulse, respiration and temperature were all within normal limits, 80,15 and 95.1 deg.
respectively. My patient has had surgeries, although only dental related. He had his wisdom
teeth extracted in 1999-2000. He has never experienced allergic reactions to medications. He
does not require a pre-medication or a medical clearance before treatment. He does not use
tobacco and he does drink alcohol, about a once a week. Alcohol use can contribute to oral
cancer and tooth decay or staining, as well as lower his immune system which would exacerbate
his periodontitis status. Although, his periodontal case is considered at class four, at this moment.
I will explain how to monitor any changes in his oral mucosa that may indicate a disease, and
instruct him how to brush and floss under his lingual retainer often to remove any debris or stain
that may be dwell on his teeth. During chairside patient education, I will educate my patient to
drink frequent sips of water between alcohol consumption use in order to cleanse his teeth and
neutralize the pH.

2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief complaint,
present oral hygiene habits, effect on dental hygiene diagnosis and/or care)

My patient came to our clinic for a cleaning and to help a student/ friend out. He has not had his
teeth cleaned since 2001, at least sixteen years ago. He seems a little aware of how important
frequent dental visits are, but I think he feels like he does not need to go unless he is in pain or
having an issue. He had orthodontics from previous dental visits, his last one being a lingual
retainer in 2001. He says his gums do not bleed when he brushes, but every once in a while,
when flossing around the lingual retainer, and he does not have a tendency to clench and grind,
but I noticed linea alba and trauma to his border of his tongue, although no attrition to his molars.
The bleeding indicates infection, and if left untreated, could worsen his periodontitis. He drinks
about sodas 3 sodas or sugar containing drinks daily, and he does not chew gum. There is sugar
in soda and alcohol, however, so I will do my best to educate him on this subject. He does have a
millimeter or two of recession in just a few areas which does indicate bone loss. He has only a
few pocket depths that are as deep as 4 millimeters, but some of these readings may be higher
due to inflamed tissues and calculus blockades. Not all of these areas bled with probing. There is
no family history of periodontal disease and he maintains his natural teeth. He states that he does
brush twice per day, flosses once a weekly at night, and he rinse with Listerine. He recently
began using colgate. We discussed proper brushing technique, such as angling his brush at a 45
degree angle to get into the sulcus and remove bacteria, but will continue to go into more detail
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at each visit. Due to my patient having recession, he technically has slight periodontitis. He is
willing to come to appointments for proper treatment. Frequent dental cleanings and adequate
home care are imperative in his case, in order to halt disease progression. He is only missing his
wisdom teeth. I will continue to stress the importance of proper home care and frequent dental
visits in order to halt progression on further bone loss and/or any eventual tooth loss. Attrition is
not observed, on any cusps.There are a couple of suspicious areas that I noticed, on all molars
and premolars that Dr. Williams assured me were not decay but deep fissures and would highly
recommend patient for sealants. After his cleaning, I will ask about sealing those teeth. Proper
brushing and flossing education and diet counseling will be helpful in avoiding future decay and
in stopping the progression of periodontitis. My patient also tends to grind his teeth due to linea
alba and trauma to his tongue, although no attrition is present; I have recommended a night guard
to stop prevent wear. Overall, I think my patient is willing to do what it takes to maintain his
natural teeth for life, he may just lack a little bit of knowledge. He does a pretty good job with
his home care, we just need a little more education and correction on a few areas. I believe that
my patient is eager be treated, and I think we will both do our part in order to halt the disease
process that is periodontitis.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
During the head and neck exam, I noted that my patient was hypersthenic but dindt not have any
physical limitations. He has hyperopia but did not use glasses. No abnormal mucosa findings
were noted besides the linea alba and bilateral white nodule shapes trauma to his tongue. He did
mouth breath during sleep. Which could lead to xerostomia in the morning, so educating the
patient on a glass of water near the bed to prevent future decay. His occlusion was classed as a
tendency to a class III on the right molar, a class III on the right canine, a class III for the left
molar, and a class III for the left canine. His overbite is about 1 millimeters, overjet is about 1
millimeters, and mid-line shift about 0 millimeters. His opened bited was noted on teeth #6,7,and
27. His gingiva was scalloped, and had a generalized color of red. This indicates bacteria and
inflammation. I listed the consistency as edematous and spongy in the generalized. He did have
a few rolled margins, around the lingual retainer on both facial and lingual and on posterior teeth.
No suppuration was noted. The surface texture was smooth and shiny around the papilla and
margin, and the attached gingiva. Recession was noted on teeth numbers 27,26,25,24,23,24, all
on the lingual surface, as well as tooth number 3. Recession indicates bone loss which equals
periodontitis. On radiographs, horizontal bone loss was noted on tooth numbers 29,28,21,20,
27,26,25,24,23, and 24. Calculus was also obvious around the lingual bar. My patient is a Case 2
periodontal case due to recession and a Class 4 prophy patient. He has generalized marginal
gingival inflammation.

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

a. Case Classification _IV____ Periodontal Case Type__II____

b. Gingival Description: Generalized marginal gingival inflammation

App't r1: 9-19-17

The patient’s architecture is scalloped and the tissue color is generalized red. Redness
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indicates inflammation which is due to the body trying to fight off foreign pathogens. Should
these pathogens remain in the area for too long, his periodontitis could become worse. The
consistency was edematous and spongy on the mandibular anterior teeth. Rolled margins
were obvious on poster maxillary, and mandibulars. The papilla were pointed, as they should
be. This may not continue to stay the same if the disease process is allowed to progress. The
surface texture on the papilla, margins, and attached gingiva was smooth and shiny, which
indicates inflammation and increased blood flow, likely due to bacteria. Currently, my
patient does have periodontitis since he has recession. We know this cannot be reversed.
However, with proper brushing and flossing, I know my patient can halt the disease process
and get back to healthy gingival tissues without gingivitis. He does brush twice a day and
flosses once a week, before bed, so we are slowly getting him on the right track. With a little
bit of technique correction and thorough dental treatment, I believe his oral health can be
restored.

App't 2:26
1st cleaning appointment – mandibular left: At today’s appointment, I plan to observe the
patient’s architecture and hope it is still scalloped like at his previous appointment, and the
tissue color remains red in the mandibular left quadrant. Like previously stated, redness
indicates inflammation. Inflammation is present due to bacteria and if the bacteria is not
removed, the bone and tissues could be destroyed. I plan to use the ultrasonic and fine scaled
the mandibular left quadrant. Following today’s patient ed session about plaque removal
and brushing, I remain confident that the patient wants to improve his oral health and halt
the disease process, and together I believe we can and will achieve this. Next Monday, I will
re-evaluate the mandibular left quadrant and begin on the maxillary left. Our next patient
education session is about flossing and periodontitis, and I will do a follow up plaque and
bleeding score.

App't 3:6
Mandibular left quadrant: At today’s appointment, I plan to observe the patient’s
architecture and color of the mandibular left quadrant, following last week’s cleaning of that
area.
Mandibular right quadrant: I plan to begin cleaning the mandibular right quadrant, which
was red in color and edematous/spongy in consistency, due to bacteria build up, but after
treatment I am hoping for improvement at next week’s appointment. Next Monday, will be
our third cleaning appointment and final patient education session. I plan to go back over his
brushing and flossing techniques, and discuss caries prevention along with needed and
fluoride use. I will also begin cleaning his maxillary right quadrant, and evaluate the tissues
on the mandible for improvement.

App't 4:10
Mandibular right and left quadrants: At today’s appointment, I plan to observe the
patient’s architecture and color of the mandibular right and left quadrants, following the
cleaning of those areas.

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 Maxillary right quadrant: Today, I plan on cleaning the maxillary right which is not near
as inflamed as the mandible was to begin with, probably due to the lingual bar. The tissue has
receded around tooth number 3. I plan to go over his prior patient education session and see
how much he has learned and retained knowledge from previous sessions about brushing,
flossing, gingivitis, and periodontitis. Today is my patients last patient education session, as
we will talk about cavities prevention and the importance of fluoride use.

App't 5:17
Mandibular left an right quadrants: At today’s appointment, I plan to evaluate the
mandibular right and left quadrants together.
Maxillary right quadrant: Evaluate this quadrant.
Maxillary left quadrant: Today, I plan to clean the maxillary left which completes all of the
quadrants.

App't 6:25
Today, I plan to complete a my perio assessment on my patient and hope to noticed
improvement in all quadrants. I do predict to see soreness and redness in some areas as they
may still be healing from previous treatment. Hopefully this means that the infection is no
longer present in these areas. Treatment will aid in the halting of his periodontitis. The
surface texture of the papilla and margins should be considered smooth and shiny, but
healing, and the attached gingiva was overall stippled, which should indicate that the tissues
are attached tightly to the bone.

c. Plaque Index: App’t 1_4.2_ 2_1.8____ 3_1.12____ 4__1.5___ 5_1.5_6__.5__7_.67__

d. Gingival Index: Initial _.67_____ Final __.33___

e. Bleeding Index: App’t 1_4.76%__ 2_4. 76__ 3_5.55%_ 4_5.55%_ 5_4.76%_ 6_3.57% __

f. Evaluation of Indices:
1. Initial He does a good job cleaning most of his teeth. While he did have generalized
inflammation, he does have localized bleeding. With observable redness and bleeding on
probing it is clear the tissue in infected by bacteria that has destroy the bone in some
areas of his mouth. His highest numbers on the gingival index were a one. His brushing
technique does need some work, as he tends to scrub, but I think that can be easily
corrected. The most work is needed cleaning the distal and lingual on posterior teeth.
This can be achieved with correct brushing, and flossing of interproximal spaces around
the lingual bar. His gingival index score is currently .67, which is good, but with the
correct treatment and home care, he should improve by our final appointment.
2. Final We have seen major improvement since the initial gingival index in early
September. My patient was very motivated during all patient ed sessions, and he was

5
 able to easily retain, repeat, and apply the skills he was taught. I believe the improved
homecare as well as being treated in our clinic has helped to improve his overall oral
health and halt the progression of his disease. His bleeding score and plaque scores both
have declined significantly since we began treatment. One area the was commonly noted
on applying the disclosing solution to his teeth was located the lingual aspect of his
lower anterior teeth, around his lingual bar. We corrected his brushing and saw a change
on the following week. I sent him home with some floss threaders and Glide floss, as he
stated the floss he was using had a tendency to shred in some areas. Hopefully he will
see results and stay motivated after trying the product. We have changed his brushing
technique to rolling at a 45 degree angle and he says he began to floss more at night. I
explained that by doing flossing 2 times a day, he can help halt the progression of
periodontitis, which he is motivated to do. There were several areas with deep
subgingival calculus so since that has been removed, the tissue is returning to a healthier
state. Overall, my patient responded well to suggestions and treatment, and I think we
will continue to see his oral health improve.
g. Periodontal Chart: (Record Baseline and First Re-evaluation data)
1.Baseline_ My patient did have only one area of a 4mm pocket at his first appointment.
This pocket was located on the facial of number 24. Several areas of recession are noted.
Number 3 has 1mm of recession on the buccal, and number 14 has 2 mm recession on
the buccal side. Localized recession was noted on number 27,26,25,24,23,22, and 21 all
with a similar pattern of a 1mm of recession on the lingual side. His recession may be
due to incorrect brushing, his clenching habit, and/or incorrect flossing, and undisturbed
bacteria that is causing the gingival tissues to recede away from the pathogenic toxic
release.
2.Firstevaluation
Today, my patient did not have a 4 mm pocket on the facial of tooth 24.This indicates that
periodontal disease that was present during the initial visit has been removed, and allowed
the tissue to return a healthy state. A normal pocket depth is within 1-3mm, and since he
does not have pockets deeper than what is considered normal. Based on these clinical
evidence, we know that periodontal pathogens were removed from the infected area and
destruction has been halted. Deeper pockets are harder to clean and can increase the risk
and severity of periodontitis. The only pocket that was deeper than the rest was a 4mm
pockets on the facial of tooth number 24 that has returned to a healthy state. No other deep
pockets were noted. All the areas of recession remained the same number as the baseline.
There were several areas on the maxillary and mandibular where the tissue was right at the
CEJ, so the patient has a 0 for tissue height; this was also the case at baseline, this indicated
the disease has not progressed. Teeth with early signs of recession included tooth number
4,5,6,20 and 29 on the facial side and 8 on the lingual side. Overall my patient does still
have periodontal disease, and while none of his pockets have increased in depth, with the
proper dental education and thorough dental cleaning, ability to maintain good oral care,
and keep up with regular dental check-ups. We should see an improvement in his overall
oral health. I placed no Arestin capsules due to lack of 5mm or deeper. Overall, the
treatment rendered to my patient should aid in the health of his periodontium, and by his
recall in the spring he has developed a routine with the patient education I have taught him.

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5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions) My patient is missing all third. He says he had surgery on those extracted. There
are no metallic restorations present and no TCR’s, a lingual bar is present and he did have
braces at a young age. Also, suspicious areas were noted but turned out to be stained deep
fissures, that Dr. Williams suggested sealants.

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

All appointments will include:
- Reviewing medical and dental history
- Pre-Rinse
- New plaque and bleeding scores
- Gingival assessments and notes
- Ultrasonic scaling and fine scaling 1 quad / wk
- Full perio charting per quad
- Chair side patient education

LTG 1: Bring plaque score down to .1 or less. (Reduce plaque score by .5 per each
appointment)
STG: Define plaque
STG: Define and demonstrate proper brushing
STG: Evaluate (and correct if needed) patient’s brushing method with typodont and also
on self.

LTG 2: Halt disease progression of periodontitis

STG: Define periodontitis
STG: Define and demonstrate correct flossing technique. Continue flossing each night, just
work on technique.
STG: Reduce bleeding score by 1% at each appointment.

LTG 3: Reduce sugar drink to one a day

STG: Define caries and explain process
STG: Discuss diet counseling and how a lower pH effects enamel and caries process
STG: Discuss and educate on benefits of fluoride use

App't 1: 9-19-17
The patient’s architecture is scalloped and the tissue color is generalized red. Redness
indicates inflammation which is due to the body trying to fight off foreign pathogens. Should
these pathogens remain in the area for too long, his periodontitis could become worse. The
consistency was edematous and spongy on the mandibular anteriors. Rolled margins were
obvious on poster maxillary, and mandibulars. The papilla were pointed, as they should be.
This may not continue to stay the same if the disease process is allowed to progress. The
surface texture on the papilla, margins, and attached gingiva was smooth and shiny, which
indicates inflammation and increased blood flow, likely due to bacteria. Currently, my
patient does have periodontitis since he has recession. We know this cannot be reversed.
However, with proper brushing and flossing, I know my patient can halt the disease process
and get back to healthy gingival tissues without gingivitis. He does brush twice a day and
flosses once a week before bed, so we are slowly getting him on the right track. With a little

7
bit of technique correction and thorough dental treatment, I believe his oral health can be
restored

App't 2:26
1st cleaning appointment – mandibular left: At today’s appointment, I plan to observed the
patient’s architecture and hope it is still scalloped like at his previous appointment, and the
tissue color remains red in the mandibular left quadrant. Like previously stated, redness
indicates inflammation. Inflammation is present due to bacteria and if the bacteria is not
removed, the bone and tissues could be destroyed. I plan to use the ultrasonic and fine scaled
the mandibular left quadrant. Following today’s patient ed session about plaque removal
and brushing, I still remain confident that the patient wants to improve his oral health and
halt the disease process, and together I believe we can and will achieve this. Next Monday, I
will re-evaluate the mandibular left quadrant and begin on the maxillary left. Our next patient
education session is about flossing and periodontitis, and I will also do a follow up plaque
and bleeding score.

App't 3:6
Mandibular left quadrant: At today’s appointment, I plan to observed the patient’s
architecture and color of the mandibular left quadrant, following last week’s cleaning of that
area.
Mandibular right quadrant: I plan to begin cleaning the mandibular right quadrant, which
is still should be red in color and edematous/spongy in consistency, due to bacteria, but I am
hoping for improvement at next week’s appointment. Hopefully by removing this, next week
we will see an improvement. Next Monday, will be our third cleaning appointment and final
patient education session. I plan to go back over his brushing and flossing techniques, and
discuss caries prevention along with needed and fluoride use. I will also begin cleaning
his maxillary right quadrant, and evaluate the tissues on the mandible for improvement.

App't 4:10
Mandibular right and left quadrants: At today’s appointment, I plan to observed the
patient’s architecture and color of the mandibular right and left quadrants, following the
cleaning of those areas.
Maxillary right quadrant: Today I plan on cleaning the maxillary right which is not near as
inflamed as the mandible was to begin with, probably due to the lingual bar. The tissue has
receded around tooth number 3. I plan to go over his prior patient education session and see
how much he has learned and retained knowledge from previous sessions about brushing,
flossing, gingivitis, and periodontitis.

App't 5:17
Mandibular left and right quadrants: At today’s appointment, I plan to evaluated the
mandibular right and left quadrants together.
Maxillary right quadrant: Evaluate this quadrant.

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 Maxillary left quadrant: Today, I plan to cleaned the maxillary left which completes all of
the quadrants.

App't 6:25
Today, I completed a new perio assessment on my patient and hope to noticed improvement
overall, in most areas of the mouth. I do predict to see soreness and redness in some areas
may still be healing from previous treatment, because after fine scaling. Hopefully this means
that the infection is no longer present in the area. This will aid in the halting of his
periodontitis. The surface texture of the papilla and margins should be considered smooth
and shiny, but healing, and the attached gingiva was overall stippled, which should indicate
that the tissues are attached tightly to the bone.

7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony
crests, thickened lamina dura, calculus, and root resorption)
No 3rd molars are present. Mild horizontal bone loss was noted on #29,28,21, and 20, bone lose
indicated periodontitis. Periodontitis is a disease cause when calculus that contains bacteria
causes the tissue to recede from the infected area. Calculus was noted on the 26,25,24,23,and 22.
No suspicious areas were noted.

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

App't 1: (9-19-17) At my patient’s first appointment I reviewed his medical and dental history,
allowed him to pre-rinse and went over Statement of Release, HIPAA, Patient Appointment
Practice that was followed by head and intra oral exam. Next, I took a FMX and vertical
bitewings to evaluate his bone level. This was followed by a dental charting and a periodontal
assessment. We discussed the number of appointments that was needed and explained the
treatment that would be rendered in the following weeks. and he said it was fine, that he would
continue to come. Last, I took a plaque score that was 4.3 poor and a bleeding score that read
4.76%, also I did a gingival assessment index that read .67 good and made thorough notes over
his entire gingival appearance. I used the intraoral camera to add pictures to my patient’s file. He
is willing to treated and I think he is eager to change his poor oral habits and learn correct oral
care and is open minded to any recommendation I may have. When I watched him brush at the
sink, I taught showed him the correct brushing method. He is currently flossing once a week
before bed. He has a lingual bar that he avoids flossing, but by showing him a more effective
technique may motivate him to floss those areas. We will find a solution to help him get rid of
bacteria. At our next appointment, we will discuss diet recommendations, note any complications
he may have been having, and I will commend him on any improvements. I will also go over our
short and long term goals and I will always try my best to motivate and encourage my patient.
His learning level right now is self-interest, because he is trying his best and taking action on all
suggestions. He does not want to lose his teeth and he has a good amount of knowledge about
periodontitis.

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App't 2: (9-26-17) At my patient’s second visit, I reviewed his medical and dental history
which had no changes. Following pre-rinse, I then took one retake on the FMX, that was
followed by a plaque score of 1.8 fair, and a bleeding score was 4.76 % .Next, I then took him to
the patient education room and by using the intraoral pictures I was able to show him and
explained that plaque was a white sticky film that is made up of bacteria and food debris. I then
explained how plaque demineralized the tooth’s surface and leads to decay, gingivitis, and
possible periodontitis and tooth loss. I then demonstrated proper brushing, which included
angling a soft tooth brush at a 45 degree angle towards the gingiva and removing plaque from all
the surfaces. I evaluating my patient’s knowledge of brushing by watching him at the sink, he
then was disclosed and was show areas that he was missing when he brushed. Our long term goal
is to reduce the plaque score to .1 or less; by .5 at each appointment. My patient was very
responsive to the education and reciprocated proper form in brushing . I asked him some review
questions and he was able to answer them correctly and he seems interested in changing his
brushing habits. (He uses the “scrub” technique) Currently his learning level was self-interested.
I then had the patient follow me back to the treatment room, where I explained I needed a
difficult calculus patient and wanted to see if he would qualify. He was then screened by two
teachers and qualified. His lower right quadrant and tooth number 2 would be treated on
November 1, 2017, during our difficult calculus test. I then explained that I would use an
ultrasonic device that would flush out the deep pockets of bacteria that would then be followed
by hand scaling the area to remove the extra calculus debris. I began using the ultrasonic on the
mandibular left quadrant that was checked off by teacher and I began to hand scale, but ran out
of time due to the amount of time it took to do a calculus detection. My patient did state that he
could “feel” a difference on his teeth, and that they felt smoother than before. Hopefully this in
itself will be motivating enough for him to return for treatment and to continue frequent dental
visits in the future. His overall periodontium tissue was generalized red, spongy and shiny, that
indicated infection. Next Tuesday, I will evaluate the mandibular left quadrant. Our next patient
education is about flossing and periodontist, and I will also do a follow up plaque and bleeding
score.

App't 3: (10-3-17) At my patient’s third appointment and our second cleaning appointment,
we reviewed the medical history, which had no changes, pre-rinsed, took a plaque score of 1.12
good and a bleeding score of 5.55%. I then took the patient to the patient education room where
we had our second patient education session about periodontitis. I will define periodontitis which
is bone loss and tissue destruction, due to bacteria being present for a period of time. I use his
intraoral pictures to show areas of recession, and also his x rays, which will be helpful in
showing his current bone level. I will educate him on how periodontitis progresses over time and
cannot be reversed, but it can be stopped. I will demonstrate proper flossing which includes
making a C shaped loop around each interproximal tooth surface and getting down into the
sulcus (“space between tissue and tooth”) in order to effectively remove as much bacteria as
possible. Last, I will evaluate my patient’s knowledge of flossing by watching him on the
typodont and at the sink. Our short term goals are to motivate him to continue flossing each night
before bed, but to correct the technique in order to remove as much bacteria as possible; and to
reduce the bleeding score by 1% at each appointment. Our long term goal is to halt the
progression of the disease process. He is really motivated to learn and he is good about his
homecare. We reviewed tooth brushing and plaque and he retained the information that I had
taught him. My patient stated again today that he noticed a difference on the entire mandible

10
now. He says his teeth feel smooth and I think this will continue to motivate him to return for
additional treatment. I believe all of our goals are achievable, as his learning level is self-interest,
because he is interested in learning and wanting to apply it at home. I then explained to the
patient that I needed to hand scale the lower left quadrant and chart his pocket depths, tissue
heights and clinical attachment level. There was an area of tissue height of 0 mm on buccal of 19
and a pocket depth of 0 on the buccal of tooth 20. A 1 mm recession was noted on the lingual
tooth surface of 24, 23, 22, and 21, with a 4 mm pocket depth on the facial of tooth 24. Next, I
ultrasonic and hand scaled the upper left quadrant and charted his pocket depths, tissue height,
and clinical attachment, per tooth. I then had this checked off by an instructor before moving on.
All the pocket depths ranged thru the healthy range, with only one area of recession located on
the buccal of tooth number 14. I did begin to notice how the tissue was already begging to look
healthier in the lower left quadrant that was treated the with the ultrasonic a week before. Next,
Tuesday, I will move onto the maxillary right quadrant. We will complete our third and final
patient education session which is over caries and fluoride use and hopefully his plaque score
will be even lower this time. I am anxious and excited to see my patient improve his oral health.
He remains motivated and I am confident in him with the proper motivation we can get his
learning level to action.

App’t 4 (10-10-17): At my patient’s fourth appointment and third cleaning appointment. I

reviewed the patient’s medical, dental history, pre-rinsed, and took a new plaque that was 1.5
good and bleeding score that was 5.55% and also did a new gingival assessment and make
thorough notes. I then took the patient to the patient education room and began our third and
final patient education session about caries. I defined caries (“cavities”), which are areas of
decay due to plaque being left on the tooth surface for too long. Diet and effective plaque
removal are imperative in avoiding decay and eventual tooth loss. I will educate him on how
caries progress over time and can cause other issues such as broken teeth, or painful abscesses.
Also, sugar or fermentable carbs being left on the tooth or in the mouth for too long, lower the
pH which causes demineralization and/or caries. Proper brushing and flossing are critical, but I d
also educated him on the importance of fluoride to remineralize the tooth structure before decay
occurs. I advised him to drink water often between beverages, in order to cleanse the teeth of the
excessive drop in the pH environment. Our short term goals are to make sure my patient has
enough knowledge to understand effective plaque removal and caries prevention. Our long term
goal is for him to reduce his sugary beverages to one a day. I don’t think he is fully aware that
drinking an excess about of sugary beverages could weaken his enamel and facility the
development of cavities. But he did have a self-interest in reducing the sugar intake. Finishing up
the patient education by covering all the long term goals and I did a quick follow up of previous
sessions, asked if he had any questions, and told him we would likely place him on a 3-4 month
recall following the end of these appointments. I then brought him back to the treatment area to
begin cleaning his maxillary right quadrant. I feel like usually; the maxillary teeth are easier to
clean than the mandibular teeth. That remained the case today. There just isn’t near as much
build up on the maxillary teeth as there typically is on the mandible. I then ultrasonic, and hand
scaled the maxillary right, except for tooth number 2, due to saving that tooth for the difficult
calculus exam. I then measured the maxillary right quadrant’s probing depths, tissue heights, and
clinical attachment levels, per tooth. The upper right quadrant was overall normal pocket depths
with a 1 mm recession on the buccal of tooth 3. I will have all of this checked by an instructor

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before moving on. By this time both the color and inflammation of the left two quadrants have
become less inflamed and a vibrant pink that indicated a movement to a healthier level than the
right untreated side. I re enforce all of the previous patient education sessions, answer any
questions my patient had, and commend him for areas of improvement that were clinically
obvious. He is returning on November first as my difficult calculus patient.We will work on the
mandibular right quadrant and hopefully see a further reduction in his plaque score, being as our
long term goal is to be at .1 or plaque free! His bleeding score on the indicator teeth remains
fairly high; however, it is localized around the lingual bar. I am confident that my patient will
continue and improve on good home care and that by his next visit, we should see improvement
in all quadrants. The learning level at this appointment remains at “self-interested”.

App’t 5 (11-1-17): At my patient’s fifth appointment I reviewed his medical, dental history,
pre-rinsed, and took a plaque score of 0.5 good and bleeding score of 4.76%. Today, is our
difficult calculus exam day. I explained to the patient that I would be using the ultrasonic on the
lower right quadrant and tooth number two. Patient education included how the ultrasonic
flushes the tissue of bacteria and how I would follow the treatment with hand scaling the excess
debris. The patients learning level was of awareness, because he has been a very reliable patient
all semester and has been informed of how the ultrasonic worked in previous sessions. His tissue
was looking receptive to the treatment. I then measured the patients probing depths, tissue
heights, and clinical attachment level in his lower right quadrant and tooth number 2. The facial
of the mandibular right quadrant was healthy with normal pocket depths. The tissue height was at
a 1 mm on tooth number 28, that indicated recession. Tooth number 2 has a healthy pocket depth
on both the buccal and lingual side and a tissue height level with the CEJ on the buccal side. A
one mm. recession was also indicated on the lingual tooth surface of 27,26, and 25. The lower
right quadrant was not graded because it was strictly for difficult calculus examination.

App't 6 (11-17-17): This is our final appointment, and our post calculus appointment two
weeks post scaling his last quadrant. I reviewed the medical, dental history, which had no
changes. After he pre-rinsed and I then took a new gingival assessment to keep track of his
gingival tissue, this was calculated at .33 good. Next, I took his plaque score at .67 and his
bleeding score at 3.57%. His plaque score at his initial visit was at 4.2 and has dropped to .67 by
the final visit. We did meet our goal of .1 or less by the final treatment. His bleeding score at his
initial visit was 4.76% and at his final visit was at 3.57%. We have not met our goal of 1%
decrease bleeding by each appointment or less, but we have seen significant improvement since
his first appointment, so I am satisfied. Our long term goal was to halt the progression of
periodontal disease, and I think we are on the right track. I informed him that it would be wise to
drink water following soda or any other sugar/acidic beverage. This will cleanse the teeth and
reduce his caries risk. I noted his learning level as “self-interst on the way to action” because he
has stayed motivated and remains interested in learning new things about halting the progression
of periodontitis. I explored the mouth and fine scale all areas to remove any new or residual
calculus. Next, I measured probe depth, tissue height and clinical attachment level of each tooth.
I then polished the whole mouth, that was then checked by an instructor before proceeding to
sealants. I then placed sealants on tooth number 18,19,20,21,31,30,29 ,and 28. This was then
followed by a 5% fluoride varnish. I then compared today’s charting to the measurements from
his base line measurements. No pockets were 5mm or more, so I did not place Arestin to aid in
healing. All quadrants were pink and showed significant improvement from treatment compared

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to the initial visit. I then answered any questions from my patient and place him on a 3 month
recall (3-17-18).

9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth
morphology, periodontal examination, recare availability)

My patient has a good attitude about halting the disease process. He is 33 years old and has all of
his natural teeth minus his wisdom teeth that were extracted at a young age. He is brushing twice
per day and flossing weekly. So I know he has some knowledge of maintaining oral health. I
think he will strive to change his current habits to avoid any progression of periodontitis, tooth
loss, and any chance of systemic disease once he is fully aware of how environmental factors and
their oral manifestations and disease can affect the body systemically. If he is willing to correct
his brushing and flossing techniques and visit the dentist frequently for thorough cleanings, his
gingivitis can be reversed and periodontitis can be stopped. He does have malocclusion
throughout his mouth, no crossbite and a mild overbite and overjet at 1 mm. He will likely be
placed on a 4 month recall for thorough cleanings and fluoride treatments with further education,
I think my patient and I can achieve optimal oral health.

10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule.
(Note: Include date of recall appointment below.)
My patient has been informed and has agreed that he will return two weeks after his last scaling
appointment, on November 11, 2017, to reassess his gingival tissues and overall healing. At this
appointment, all quadrants will be fine scaled and evaluated. He will receive polishing, and a
fluoride treatment, I will place this patient on a 3-4 month recall visit for dental cleanings to help
stop any disease progression from occurring. If my patient does not comply, the risk of
periodontal disease progressing, is inevitable. I will refer him to his family dentist . for a mouth
guard.

11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing
depths)
We have seen a lot of change in the past month! While we did not reach our overall bleeding
score goal of 1% by each appointment or more, he has continued the downward trend or stayed
the same by week. His initial bleeding score was 4.76% and today it was 3.57%. While this isn’t
exactly meeting our goal of -1% per appointment, I am still proud. We were able to reach our
plaque score goal of .5 by each visit his plaque at the initial visit was 4.2 and was .67 by his last
visit and is considered “good”. The most common areas that he had issues with plaque control
were the mandibular anterior teeth and then sometimes in the posterior interproximal areas. I
discussed and demonstrated different brushing techniques to help get those specific areas a little
better, and he receptive of the information. Most of the bleeding was noted in the anterior region
around the lingual bar and upon instrumentation and was considered “moderate” at the initial
visit. Moderate bleeding was due to subgingival calculus deposits that irritated the tissue and
facilitated inflammation, but the score decreased to “slight” bleeding upon probing at the final
visit. At the final visit, I observed a major improvement in the periodontium. The papilla looks
better, and it did not bleed near as bad as before. The greatest probing depths was located on the
facial aspect of tooth 24 with a 4 mm pocket at the initial visit, but improved to a healthy pocket

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depth at the final visit. I did not apply of Arestin because all of his pockets were within the
healthy range. His overall gingival health was generalized red, inflamed, edematous and rolled ,
but improved at each appointment. These lingual bar makes home care a bit of a challenge, so he
has been encouraged to return for recall appointments. My patient’s pockets have all returned to
a healthy state and should not be difficult to clean at home. He did have 1 mm of recession on
the buccal of tooth 2,3, 14, and recession noted on the lingual teeth of 27,26,25,24,23,22, and 21.
I recommend he start flossing more to prevent leaving bacteria behind that can lead to
progression of periodontal disease. Most areas have stayed the same or changed by 1-2mm
which is within the margin of error. He may not be able to reverse his bone loss, but he can
restore his gingival tissue to a healthy state and I believe he is motivated enough to make that
happen. A new evaluation will be conducted at his recall appointment on March of 2018.

12. Patient Attitudes and Cooperation:

I could not have asked for a better perio patient. He is extremely eager to learn new
information, applies that information and skill as best he can at home, and he cooperates very
well during all areas of treatment. He was interested and accepting of new brushing and flossing
techniques and also about caries prevention. Probably our least accepted topic was flossing
around the lingual bar, and reducing soda intake. Areas around the lingual bar remained the
most the most inflamed area throughout treatment. I encourage the importance of flossing and
he was given floss threader and Glide floss. He changed his brushing technique and we saw a
decrease in his plaque score each week. He understands he needs to drink water following
alcoholic or sugar containing beverages. He seemed excited about trying out the new floss,
around the lingual bar. He understands he needs to return to Dr. Dean Manning to have the have
a mouth guard made, and he is knowledgeable and motivated in halting the progression of
periodontal disease. Overall, I am very pleased with his treatment and his home care. We may
not have met our long term goals in time, but I know he is doing his best to improve where he
needs to. Maybe our long term goals were a bit out of reach for this time frame, but I am pleased
with his response and acceptance of treatment, and I believe he will stay on the right track.

13. Personal Evaluation/Reaction to Experience:

I enjoyed seeing my perio patient each week.. Overall, I think he spent a combined total of 22
hours in my chair, so seeing that definitely makes me realize how much time goes into quality
treatment and total patient care. While this is not always practical in private practice, I think this
project has helped me to better understand the sequence of events for thorough treatment and
overtime I will be able to improve my own system of cleaning. I think during his appointments, I
became more confident in myself and gained skill and knowledge of different areas of treatment,
such as ultrasonic use and perio charting. Also, he had several deep deposits so working on him
helped me to understand what all is necessary for removing those deposits, and being
comfortable doing so. I was afraid to hurt him since he chose not to receive anesthesia, but I
think it went very well regardless. I made a point to check on him often, and he would give me
appropriate feedback. The entire process was a long experience, but I am glad we made it
through. I learned a lot in the past nine weeks and that gives me more confidence going forward
into next semester and even into my personal career after graduation. Also, it is exciting to see
little changes week by week, which turn into big changes by the end. I enjoyed getting feedback
from my patient, from what is comfortable for him, what could improve the appointment,
teaching him new skills, and information, and also him mentioning feeling a change in his teeth
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each week. It is a good feeling to know that you are helping someone out, by giving them a
quality service while in the chair and teaching them information and skills that they can take
home and apply for the rest of their life. Hopefully, he will remain motivated and keep up with
regular cleanings in the future, to avoid any progression of the disease process.

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