Periodontology (DHYG 1311)

Fall, 2020
PERIODONTAL CARE PLAN (PCP) Template

Use this template to write your care plan and submit through BB.
Care Plan Part 1 submission will include Template items #1-8, using findings from initial patient
appointment.
Care Plan Part 2 submission will include entire PCP Template with all items completed.

Patient Name: Patient X Age: 49

Date of initial exam: October 2020 Date completed: December 2020

1. Medical History: (systemic conditions altering treatment, pre-medication, medical clearance, explain
steps to be taken to minimize or avoid occurrence, effect on periodontal diagnosis, progression, and/or
care)
Patient is a 49-year-old, self-employed male and is relatively in good health. Patient has an
established medical home; however, he does not visit regularly. His last physical examination was about
15 years ago. Patient claims that the medical doctors do not give him physicals anymore. His last medical
doctor visit was around 10/ 14/2020 (reason for visit was not disclosed). Going so long without a physical
examination means that Patient X is at risk for having undiagnosed systemic diseases that may affect his
oral health (such as diabetes). Undiagnosed systemic diseases also mean that I would not know how to
tailor my treatment plan or methods to prevent a medical emergency.
All the patient’s vital signs were within normal limits except for his blood pressure. His
respiration was 16 breaths per minute (easy, deep, normal). The patient’s pulse was 84 beats per minute
(+2 irregular but within normal limits). His temperature was 97.7 F, which is normal. His blood pressure
was 139/96, which pushes him into stage 2 hypertension. The patient has a history of high blood pressure
and heart murmur. He is not taking any medication for high blood pressure. He was diagnosed with a
heart murmur about 30 years ago and is not taking any medications for it. Patient X previously
experienced sinus problems but is currently not experiencing any problems. He drinks alcoholic
beverages once a month and is a nonsmoker. He has no known allergies to medications or food and is
ASA II. Due to his high blood pressure, Patient X is at an increased risk for a hypertensive emergency in
the dental chair. This risk increases if he were to be given local anesthesia with epinephrine. During the
treatment process I will monitor his vital signs and limit or avoid epinephrine. I will also sit him up
slowly and let him rest for about 2 minutes before standing, to avoid orthostatic hypotension.
Hypertension increases his risk for, and progression of periodontal disease, due to its effects on blood
flow to the periodontium. (The white blood cells that would help fight off periodontal pathogens are not
as readily available at the site of infection.) The hypertension will influence his periodontal status by
worsening or overexaggerating the disease process.

2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief complaint,
present oral hygiene habits, effect on periodontal diagnosis, progression, and/or care)
The patient very recently visited a dental office (October 22, 2020) where he had a consultation.
Bitewings were taken and he was told that he needed a deep cleaning due to deeper periodontal pockets
which indicates periodontitis. Since his x-rays were insufficient for diagnosis, I took an FMX with
horizontal bitewings on October 30, 2020.
Patient X does not get regular dental cleanings. The patient has history of orthodontic treatment
and has gotten his one premolar in each quadrant removed. Patient has wisdom teeth extracted. His chief
complaint is that he wants a deep cleaning. The patient experiences temperature sensitivity when eating or
drinking. He brushes with a hard bristle, manual toothbrush to “remove the junk” from his teeth. He
brushes once a day using the Fones and vibratory methods with moderate pressure for about 50 seconds
and does not floss. Patient X uses various toothpaste brands. He uses mouth rinses about once a week. He
Periodontology (DHYG 1311)
Fall, 2020
has poor plaque control and experiences bleeding on brushing. His present oral hygiene habits increase
his risk for periodontal disease. His poor plaque control puts him at an increased risk for periodontal
attachment loss, caries, and poses an oral-systemic link due to the uncontrolled high blood pressure.
Patient X has a low dental I.Q. about periodontal disease and how to prevent/control it. Nevertheless, he
seems very interested in improving his oral health. The patient’s attitude and curiosity about the process
and what he can do to improve his oral status makes me believe the treatment will have a positive
outcome. Together, we will be able to halt the disease progression.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation, effect on
periodontal diagnosis, progression, and/or care)
 Extraoral examination: Patient X has a mesognathic facial profile and pyknic body type. Patient
has myopia (developmental).

 Intraoral examination: Patient X has a coated tongue (etiology: bacteria) and scalloped tongue
(etiology clenching). The attrition on his anterior teeth is evidence that the patient grinds his
teeth. Patient is unaware of his clenching and grinding habits. Patient has a palatal torus. Fordyce
Granules bilaterally are noted on his buccal mucosa (etiology of both is developmental). He also
has posterior exostosis in both arches. He has recession mostly on his mandibular arch, and it
ranges from 1-2mm.This may be due to excessive brushing forces, the hardness of the bristles,
and/or bacteria in plaque biofilm. Recession and poor plaque control have contributed to the
periodontal diagnosis.

 Occlusal Examination
Molar right: class I Molar left: class 1 Overbite: 3mm Midline shift: none
Canine right: class I Canine left: class I Overjet: 3mm Open bite: none
Cross bite: none
4. Periodontal Examination: (color, contour, texture, consistency, etc., effect on periodontal diagnosis,
progression, and/or care)

a. Periodontitis Stage: III Periodontitis Grade: B Extent & Distribution: Generalized

Describe determining factors/ etiology behind Stage, Grade. & Extent of disease findings:
He has generalized horizontal bone loss ranging from 15% - 33%, most of which is in the
anterior teeth. His periodontal pockets ranged from 1-7mm which indicates loss of attachment. Probing
depths above 5mm means that he is a periodontal stage III. The patient has generalized recession ranging
from 1-2mm (etiology may be a combination of excessive force with a toothbrush and bacteria). An
increase in recession exposes the roots of the teeth. Since the roots of teeth are more readily susceptible to
acids, they may develop root caries faster. Evidently the patient can lose his teeth as a result.
He is a grade B due to bone loss/age calculation (within the 0.25 to 1 range). The extent of his
disease progression may also be attributed to infrequent dental visits. The patient accumulated a lot of
plaque above and below the gum line that attributed to his periodontal disease. The bacterial infection
moved beyond the gums to infect the associated none, resulting in periodontitis. The infrequent dental
exams can attribute to his periodontitis, and can result in oral pathologies such as caries and oral cancers
to go undiagnosed. As all of these various infections persist, they continue to affect each other in a
bidirectional relationship.

b. Gingival Description: (describe by quadrant at each appointment)

Appointment 1 (initial): Gingiva in Max R presented as follows:

Periodontology (DHYG 1311)
Fall, 2020
 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Max L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Mand L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Mand R presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Appointment 2:
Gingiva in Max R presented as follows:
 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
Periodontology (DHYG 1311)
Fall, 2020
 Surface texture of attached gingiva – stippled

Gingiva in Max L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Mand L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Mand R presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Appointment 3:
Gingiva in Max R presents as follows:
 Architecture – scalloped
 Color – red (molar lingual area)
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Max L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
Periodontology (DHYG 1311)
Fall, 2020
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Mand L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Mand R presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Appointment 4:
Max R :
 Architecture – scalloped
 Color – red (molar lingual area)
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled
The upper right quadrant was less red and edematous than all other quadrants. There was less bleeding in
this quadrant since this was the only area that was treated.
Max L:
 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled
Mand L:
Periodontology (DHYG 1311)
Fall, 2020
 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled
Mand R:
 Architecture – scalloped
 Color – Within normal limits
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Appointment 5:
Gingiva in Max R presents as follows:
 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Max L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled

Gingiva in Mand L presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled
Periodontology (DHYG 1311)
Fall, 2020

Gingiva in Mand R presented as follows:

 Architecture – scalloped
 Color – red
 Consistency – edematous/spongy
 Margins – rolled
 Papillae – bulbous
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny
 Surface texture of attached gingiva – stippled
There was less redness and inflammation in all quadrants except the lower right, since that was the only
remaining area to be treated. The gingiva of the lower left appeared to have recession in the anterior
lingual teeth. This may be due to bacteria and infection. Bleeding was minimal on upper right, but non-
existent in the other quadrants
Appointment 6:
Max R :
 Architecture – scalloped
 Color – red (2L, 3L 8 F)
 Consistency – WNL
 Margins – rolled (2L, 3L)
 Papillae – WNL
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny (2L, 3L, 8F)
 Surface texture of attached gingiva – stippled
Max L:
 Architecture – scalloped
 Color – red (15L, 9F, 13L)
 Consistency – WNL
 Margins – rolled (15 L, 9F, 13L)
 Papillae – WNL
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth and shiny (15 L, 9F, 13L)
 Surface texture of attached gingiva – stippled
Mand L:
 Architecture – scalloped
 Color – Red (19 F/L)
 Consistency – WNL
 Margins – WNL
 Papillae – WNL
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth
 Surface texture of attached gingiva – stippled
Mand R:
 Architecture – scalloped
 Color – red (25-27, 29)
 Consistency- rolled
 Margins – Rolled (25-27)
 Papillae – WNL
Periodontology (DHYG 1311)
Fall, 2020
 Suppuration – none
 Surface texture of papillary and marginal gingiva – smooth
 Surface texture of attached gingiva – stippled
Gingiva in all quadrats showed some signs of healing. There was evidence of disease in some areas,
however it was still an improvement from the previous sessions. There was no bleeding on probing.
Recession was generally noted in the mandibular anterior lingual area.

c. Plaque Index: Appointment 1: 1.7 (good) 2: 1 (good) 3: 1.6 (good) 4: 0.7 (good) 5: 0
(excellent)

d. Gingival Index: Initial: 2.9 (poor) Final: 1.4 (fair)

e. Bleeding Index: Appointment 1: 33% 2: 19% 3: 11% 4: 5% 5: 0%

f. Evaluation of all indices and effect on periodontal diagnosis and/or care:

1. Initial appointment (baseline):
After brushing during the appointment, the patient had a good plaque score of 1.7. Before
brushing, plaque was thick and generalized. It could be seen supragingival and subgingival. Proper
brushing and flossing can remove this. Patient had a bleeding score of 33%, which can be attributed to
poor plaque control as well. On the gingival index, his score was poor at 2.9. According to the periodontal
risk assessment, the patient is at a high risk for periodontal disease. The attributing factors are as follows:
 Poor plaque control
 Personal history of periodontal disease
 Infrequent dental care
 Radiographic loss of crestal bone
 Chronic bleeding on probing
 Bruxing
 Exposed root surfaces/erosion/abrasion
 Prior caries experience /5 or more restorations
 Infrequent dental exams
 Cariogenic diet

2. Final appointment (re-evaluation):

After completing treatment, there was a huge improvement from baseline. The patient modified
his oral hygiene habits. He now uses a soft manual toothbrush, increased his brushing and flossing
frequency, and reduced his plaque and bleeding scores tremendously. The patient has better plaque
control, therefore his risk for periodontal infection has decreased. His final bleeding score was 0% and his
final plaque score was 0 (excellent) compared to 33% and 1.7 at baseline. His gingival index went from
poor at 2.9 to fair at 1.4, which is also a great improvement. Due to his root exposure from recession, the
patient is at risk for developing root caries. He already has multiple restorations, and a high caries risk
that can be attributed to his diet. Since the patient has decided to have regular dental visits, most of these
risk factors for periodontal disease and caries may be reduced or detected early enough to halt the disease
progression.

g. Periodontal Chart: (Record Baseline and Re-evaluation data, effect on periodontal diagnosis,
progression, and/or care)
1. Initial appointment (baseline):
Periodontology (DHYG 1311)
Fall, 2020
In the initial appointment, the patient’s periodontal pockets ranged from 1-7mm. He had 1mm of
recession on the facial of #14, 19, 24, 25, 30, and 31. There were areas of 2mm recession on the facial of
# 20 and 29. His highest probing depths were on 14D (5mm facial), 18D (5mm facial and lingual), and
31D (6mm facial; 7mm lingual). These deeper readings are at a higher risk for disease progression
because of the inability to clean the deeper pockets with just toothbrush and floss. It should be noted that
there were some areas the probe could not enter the pocket completely due to hindrance from calculus
deposits. Additionally, areas of recession are hidden beneath the calculus, particularly on the mandibular
anterior teeth. These areas will be reassessed after ultrasonic and fine scaling.

2. Final appointment (re-evaluation):

At the re-evaluation appointment, the patient’s pocket depths ranged from 1-5mm. His highest
pocket depth has reduced by 2mm, making it easier for him to clean at home with floss and tooth
brushing. It is also a sign of healing, and that the treatment has worked. Since there is a reduction of
periodontal pathogens, there is a chance that the patient will become a stable periodontal patent if he
maintains his regular visits and home care. There is recession ranging from 1-2mm on teeth #8, 14, 19,
20, 23-27, and 29. The majority of the 2mm recessed areas were located on the linguals of the mandibular
anterior teeth and the facials of the mandibular premolars. This may be the result of toothbrush abrasion.

5. Dental Examination: (caries, attrition, midline position, mal relation of groups of teeth, occlusion,
abfractions, effect on periodontal diagnosis, progression, and/or care)
The patient is missing the following teeth: #1, 5, 12, 16, 17, 21, 28, 32. Tooth #3 has an occlusal,
amalgam restoration. Tooth #4 has a distal, occlusal amalgam restoration. Tooth#14 has 2 occlusal pit,
amalgam restorations. Tooth#18 has an occlusal and buccal pit composite. Tooth #30 has an occlusal
amalgam restoration. Tooth #31 has an occlusal and buccal pit amalgam restoration. All anterior teeth
have attrition on the incisal edge. Tooth #23 is chipped on the incisal edge.

6. Treatment Plan: (Include assessment of patient needs, appropriate treatment, and education plan-
include both chairside and formal education plans)

Appointment 1:
 Covid screening
 Medical and Dental History
 Statement of release
 HIPAA
 Appointment practice
 Vital signs
 Pre-rinse
 Head and neck exam
 Dental Charting
 Periodontal Assessment
 Plaque Score – 1.7
 Bleeding score - 33%
 Risk Assessment
 Gingival index -2.9 (poor)
 No referrals
 Informed consent
 Chairside patient education: a brief summary of periodontitis. Explained that periodontitis is a
bacterial infection and means there is a loss of bone and supporting structure of the teeth. If the
Periodontology (DHYG 1311)
Fall, 2020
process is not halted, the patient can lose teeth. Brush and floss to remove bacteria that can cause
the infection.
 TM: Preparation
 Intra oral pictures
 Payment for treatment
 Documentation
Appointment 2:
 Update medical dental history
 Covid screening
 FMX to evaluate bone level and detect pathology
 Chairside patient education: these 20 x-rays will help to diagnose any cavities or pathologies that
would not normally be seen by just looking in your mouth. The lead apron will help reduce
radiation absorption.
 TM: Action
 Documentation
Appointment 3:
 Covid screening
 Update medical and dental history
 Plaque score
 Bleeding score
 Patient education session 1: Plaque and brushing
 LTG 1: Patient X will lower his plaque score to below 1 by the end of treatment.
 STG 1: By the next appointment, Patient X will be able to define plaque and identify it
with the help of disclosing solution and a mirror.
 STG 2: By the end of the appointment, he will demonstrate the bass technique and how
to effectively remove plaque.
 STG 3: By the next visit Patient X will increase his brushing from once to twice a day
at least two days per week.
 I will start the patient education session by identifying the long-term goals I have planned
and will ask the patient if these goals are realistic enough for him. Modifications will be
made if needed. With the use of the flip book, his x-rays, and his intraoral pictures I will
explain what plaque is and demonstrate the bass technique on a typodont. I will then ask
the patient to demonstrate the technique on the typodont. Using a patient mirror, I will
show Patient X the areas he missed with disclosing agent on his teeth, and we will
practice the bath method in his mouth to ensure proper technique and adequate biofilm
removal. I will make any modifications to the technique, if necessary. At the end of the
session, I will encourage the patient to use this technique for proper biofilm removal and
remind him that the treatment can only be effective if we work together as a team.
 TM
 Ultrasonic and fine scale upper right quadrant.
 Full periodontal chart and CAL upper right quadrant
 Documentation
Appointment 4:
 Covid screening
 Update medical and dental history
 Vital signs
 Plaque score
 Bleeding score
 Patient education session 2: Periodontitis and flossing
Periodontology (DHYG 1311)
Fall, 2020
 LTG 2: By the end of treatment, Patient X will halt the disease state of his periodontitis to
become a stable periodontitis stage 3 grade B by lowering his bleeding score to 0.
 STG 1: By the end of the appointment the patient will be able to define periodontitis
and understand that it will worsen unless he improves his oral hygiene and has regular
professional cleanings.
 STG 2: By the end of the appointment Patient X will be able to demonstrate proper
flossing
 STG 3: By the next appointment Patient X will reduce his bleeding score by at least 2%
 I will start this session by reiterating the 3 patient education goals, and then noting the
goal we will be focusing on that day. I will ask the patient to define plaque and
demonstrate the bass technique to ensure that he understands what we have covered. I
will use my flip book and the patient’s x-rays to explain periodontitis and demonstrate
flossing in the patient’s mouth. I will use a patient mirror and disclosing solution. I will
then ask the patient to demonstrate flossing and make any modifications necessary. At the
end of the session, I will encourage the patient to start flossing and remind him that the
treatment can only be effective if we work together as a team.
 TM
 Ultrasonic and fine scale upper and lower left quadrants
 Full periodontal and CAL on upper left quadrant
 Documentation

Appointment 5:
 Covid screening
 Update medical and dental history
 Vital signs
 Plaque score
 Bleeding score
 Patient education session 3: Caries prevention and fluoride
 LTG 3: By the end of treatment Patient X will establish a dental home where he can
schedule regular visits.
 STG 1: Patient will understand the caries process by the end of the appointment.
 STG 2: Patient will understand how his diet can affect caries development by the end of
the appointment.
 STG 3: Patient will understand the benefits of fluoride and begin using fluoride
containing products to help fight cavities.
 At the beginning of the patient education session, I will reiterate the 3 long term goals for
our sessions and then state the goal we will be focusing on that day. I will ask the patient
if he had any complications with the flossing technique and make any modifications
necessary. Using the flipbook and other visual aids (tooth model maybe a video) I will
explain the caries process and how a person’s diet affects it. I will explain the importance
of fluoride in cavity prevention. The risk assessment form will be useful in explaining the
patient’s risk for dental caries. I will also explain the risk for caries on exposed root
surfaces, and how they can progress faster than cavities in the enamel. Using the patient’s
x-rays, I will show how regular dental visits can help in early detection of cavities. At the
end of the appointment, I will thank the patient for his participation, and remind him that
the treatment can only be successful if we work together as a team.
 TM
 Full periodontal and CAL on lower left quadrant
 Oraqix on all teeth of lower right quadrant
 Ultrasonic and fine scale lower right quadrant
Periodontology (DHYG 1311)
Fall, 2020
 Documentation

Appointment 6:
 Covid screening
 Update medical and dental history
 Vital signs
 Plaque score
 Bleeding score
 Full periodontal charting and CAL on lower right quadrant
 Ultrasonic and fine scale lower right
 Patient education session 3: Caries prevention and fluoride
 LTG 3: By the end of treatment Patient X will establish a dental home where he can
schedule regular visits.
 STG 1: Patient will understand the caries process by the end of the appointment.
 STG 2: Patient will understand how his diet can affect caries development by the end of
the appointment.
 STG 3: Patient will understand the benefits of fluoride and begin using fluoride
containing products to help fight cavities.
 At the beginning of the patient education session, I will reiterate the 3 long term goals for
our sessions and then state the goal we will be focusing on that day. I will ask the patient
if he had any complications with the flossing technique and make any modifications
necessary. Using the flipbook and other visual aids (tooth model maybe a video) I will
explain the caries process and how a person’s diet affects it. I will explain the importance
of fluoride in cavity prevention. The risk assessment form will be useful in explaining the
patient’s risk for dental caries. I will also explain the risk for caries on exposed root
surfaces, and how they can progress faster than cavities in the enamel. Using the patient’s
x-rays, I will show how regular dental visits can help in early detection of cavities. At the
end of the appointment, I will thank the patient for his participation, and remind him that
the treatment can only be successful if we work together as a team.
 Evaluate periodontal health
 Post calculus evaluation
 Arestin
 Fluoride
 Patient education on fluoride and Arestin
 TM: Action
 Recall for 3-month appointment (periodontal maintenance in February 2021)
 Documentation

7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony crests,
thickened lamina dura, calculus, and root resorption; effect on periodontal diagnosis, progression,
and/or care).
The patient has large calculus deposits between all his teeth. The amount of calculus may be a
contributing factor to disease progression since it is home to millions of bacteria that cause
inflammation and infection of the periodontium. There is generalized loss of crestal lamina dura and
horizontal bone loss 15%-33% is noted. Widened PDL was seen on #20, #29, #22 and #27. Tooth #4
and #13 appear to have blunted roots.

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-
Periodontology (DHYG 1311)
Fall, 2020
term goals, expectations, etc.) The notes should be written by appointment date.
10/26/2020
 Covid screening
 Medical and Dental History
 Statement of release
 HIPAA
 Appointment practice
 Vital signs
 Pre-rinse
 Head and neck exam
 Dental Charting
 No Referrals
 Periodontal Assessment
 Plaque Score 1.7
 Bleeding score 33%
 Risk Assessment
 Gingival index 2.9 (poor)
 Informed consent
 Chairside patient education: a brief summary of periodontitis. Explained that periodontitis is a
bacterial infection and means there is a loss of bone and supporting structure of the teeth. If the
process is not halted, the patient can lose teeth. TM: Preparation
 Intra oral pictures – the patient was shocked to see the plaque and calculus visible in his mouth
after taking the intraoral pictures. They seemed to serve as self-motivate him to do better.
 Payment for treatment
 Documentation
10/30/2020
 Updated medical dental Hx
 Covid screening
 FMX
 Chairside patient education: the lead apron is for protection from excess radiation. The x-rays will
be a diagnostic aid to evaluate bone level, cavities, and pathology. TM: Action
11/2/2020
 Update medical and dental history
 Pre-rinse
 Covid screening
 Plaque 1, and bleeding score 19% (both lower than baseline appointment)
 Ultrasonic and fine scaled upper right with use of Oraqix on all teeth in that quadrant
 Pt education: Calculus/tarter is hardened food left between teeth
 TM: Preparation – patient was shocked and disgusted when he discovered what tarter really is. I
informed him that I will teach him how to effectively remove as much food and plaque as
possible from on and between his teeth to reduce the amount of tarter, which can also help halt
his disease progression.
11/09/2020
 Covid screening
 Update medical and dental history
 Pre-rinse
 Plaque score (1.6) and bleeding score 11% (Plaque score increased from previous appointment,
but bleeding score lowered by 8%)
 Patient education: Plaque and Brushing
o LTG 1: Patient X will lower his plaque score to below 1 by the end of treatment.
Periodontology (DHYG 1311)
Fall, 2020
o STG 1: By the next appointment, Patient X will be able to define plaque and identify it
with the help of disclosing solution and a mirror.
o STG 2: By the end of the appointment, he will demonstrate the bass technique and how
to effectively remove plaque.
o STG 3: By the next visit Patient X will increase his brushing from once to twice a day
at least two days per week.
 TM: Action. Patient was very interested in improving his oral health had great interaction. He
demonstrated brushing technique very well.
 Ultrasonic and fine scale upper and lower left quadrants
 Full periodontal and CAL on upper and lower left quadrants
11/20/2020
 Covid screening
 Pre-rinse
 Update medical and dental history
 Plaque score 0.7 and bleeding score 5% (both scores were the lowest of all appointments)
 Patient education session 2: Periodontitis and flossing
o LTG 2: By the end of treatment, Patient X will halt the disease state of his periodontitis to
become a stable periodontitis stage 3 grade B by lowering his bleeding score to 0.
o STG 1: By the end of the appointment the patient will be able to define periodontitis
and understand that it will worsen unless he improves his oral hygiene and has regular
professional cleanings.
o STG 2: By the end of the appointment Patient X will be able to demonstrate proper
flossing
o STG 3: By the next appointment Patient X will reduce his bleeding score by at least 2%
 TM: Action. Patient was interested in how to effectively remove plaque and food from between
teeth. I modified patient’s current flossing technique to incorporate the “C” shape when in
between teeth. He asked about waterpik as an alternative to traditional floss, and I ensured him
that it was also an effective method for removal. Coupons were given for the waterpik so that the
patient could purchase one if desired.
 There was an improvement in the patient's plaque and bleeding scores due to better biofilm
removal after the first patient education session.
 Full perio charting and CAL on lower right quadrant
11/30/2020
 Covid screening
 Pre-rinse
 Update medical and dental history
 Plaque score and bleeding scores were both 0, which were the goals the patient had set for
himself after understanding what the plaque and bleeding scores meant, and what affects them.
 Patient has improved immensely in his knowledge and application of oral hygiene self-care.
o Patient education: LTG 3: By the end of treatment Patient X will establish a dental home
where he can schedule regular visits.
o STG 1: Patient will understand the caries process by the end of the appointment.
o STG 2: Patient will understand how his diet can affect caries development by the end of
the appointment.
o STG 3: Patient will understand the benefits of fluoride and begin using fluoride
containing products to help fight cavities.
 TM: Action. Patient was very engaged in this session. I showed him a video on dental caries, and
expressed the importance of fluoride and regular dental visits as preventative measures. Patient is
interested in making LIT his established dental home, and wants his family members to come in.
Periodontology (DHYG 1311)
Fall, 2020
 Gingival Index 1.4 (fair) - It improved by 1.5 points. There was still some redness in certain
areas, but that could be because more time was needed for the swelling and infection to go away.
 Full mouth periodontal charting with CAL
 Post calculus removal by fine scaling the entire mouth
 Plaque free with fine prophy paste
 Fluoride varnish 5% with post instructions
 Re-call 3 months for periodontal maintenance 2/2021

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

I believe he has a good prognosis. The patient had a great attitude, was involved in the treatment,
asked questions, and arrived on time for every appointment. He has no systemic known systemic
diseases that can alter or negatively affect his periodontal health, nor does he engage in any social
activities, like excessive drinking or smoking, that can exacerbate the periodontal disease progression.
The post periodontal exam showed an improvement in his oral health in the form of decreased
bleeding, improved color, texture, and shape of the gingiva. He agreed to come for the recall
(periodontal maintenance) appointment with me in February 2021 and to establish a dental home.

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

I suggested that the patient have a recall around the end of February 2021 in order to maintain the
healthy state of his periodontium, and to halt the disease progression. Other suggestions made, was to
increase his flossing frequency to at least 3 times a week when he gets comfortable with the proper
technique. He has no referrals. The patient’s probing depths decreased, now he bleeds less on brushing
and flossing. After the cleaning, more recession was visible on the mandibular anterior teeth.

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 periodontal diagnosis and/or care)

The patient’s bleeding tendency decreased impressively at each appointment, and he noted
decreased or halt of bleeding on brushing and flossing during home care. He also noticed a
difference in the appearance of his gums and the feel after the removal of calculus from the
mandibular lingual anterior teeth when compared with the initial intraoral pictures. His plaque score
had also decreased after learning how to effectively identify and remove the plaque biofilm. He has
switched from a hard bristle brush to soft, uses the modified bass technique for plaque removal, and
incorporates flossing into his oral care routine. The probing depths now range from 1-5mm with
slightly healthier looking gingiva (attached, marginal, and papillary) that does not bleed. This shows
that treatment was successful. The appearance may have been better if the post cal appointment was
more than 2 weeks after initial treatment. If the patient is compliant with his come care keeps regular
dental visits, he can change his periodontal status from active to stable. This can be evaluated in the
periodontal maintenance appointment. Once the patient maintains his oral health status, he can move
from a grade “B” to an “A” if there is no additional periodontal loss over 5 years.

12. Patient Attitudes and Cooperation:

The patient was fully engaged and cooperative. He asked question during patient education sessions about
the short- and long-term goals. The patient was willing to modify his home care habits to improve his oral
Periodontology (DHYG 1311)
Fall, 2020
health status. The patient was intent and determined. For example, as I mentioned his short-term goals, he
would become competitive and ask if I can make the goal a little more challenging. Like instead of
lowering his bleeding score by 2% every appointment, he wanted to attempt to lower it to 0% by the end
of treatment. He came on time for every appointment or notified me within an appropriate amount of time
when he could not.

13. Personal evaluation/ educational progression with this experience:

Patient education took some getting used to, for me. I know what needs to be done, and
said, but organizing my thoughts and words in a way that is coherent and easily understandable was
my biggest challenge for the first session. By the second patient education session, I was more
confident, and I believed that I was effective in conveying the necessary information, engaging the
patient, answering his questions, and maintaining his interest. As I move forward, I would like to
discover more educational methods and analogies that can reach each patient based on their level of
understanding and capabilities. I thoroughly enjoyed watching as the patient went from a state of
disease to health. I hope that when he comes from his periodontal maintenance appointment, I will
be able to see a greater improvement in home care no disease progression.