PERIODONTAL CARE PLAN

Patient Name Patient

Date of initial exam 8/29/2016

Age 43
Date completed 11/14/2016

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 is a 43 year old male who works as a Sales Representative. He is 6 2 and weighs 260 lbs.
According to his medical history he is generally healthy. However, he had a myocardial infarction in
October of 2013 that was caused from taking diet pills. He had no blockage and was treated with blood
thinners for one month due to the abnormality. It is necessary to delay dental treatment until receiving
medical clearance from a physician if a myocardial infarction has occurred 6 months prior to receiving
treatment. This could alter dental treatment for the patient in the future. It is important to stress to the
patient that periodontal infection is not limited only to the periodontium or to the oral cavity, but that it
can also affect him systemically. There are several studies which show that oral health is related to
cardiovascular diseases. Myocardial infarction falls into a group of heart and vascular diseases called
Atherosclerotic Cardiovascular Diseases which are the leading cause of death in America. Four biologic
pathways are thought to link inflammation caused by periodontal infections to cardiovascular diseases.
Typically, periodontal disease is a risk factor for CVD, but since the patient already has a history of heart
disease this puts him at an even higher risk for future complications. The patient also broke his clavicle in
a bicycle accident in June of 2016 and had an open reduction internal fixation surgery to correct it. Risks
and complications of this surgery can include infection, stiffness and loss of range of motion, damage to
muscles, nerve damage, and pain. All of the previously listed factors may affect the patients dexterity
when it comes to proper oral self- care which may require modifying brushing and flossing techniques in
a way that will be beneficial to the patient.

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)
The patient has not had any dental disease in the past. His chief complaint or reason for visit is for a
cleaning. It has been one year since his last cleaning, so it is very likely that this has contributed to his
periodontal disease and also puts him at an increased risk for caries.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
The patient has bilateral linea alba which can be developmental. He also has a plaque coated
tongue which was caused by a lack of brushing. The patient was not aware that plaque and
bacteria can also adhere to the tongue. He does not currently have any oral habits besides tongue
thrusting. He stated that he used to grind his teeth which shows obvious attrition on the maxilla
and the mandible from canine to canine. His overbite and overjet were within normal limits, but
he did have a midline shift of 1 mm to the left.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification __V__ Periodontal Case Type__II__

b. Gingival Description:
App't 1:
At the initial appointment, the patients gingival condition revealed generalized scalloped
architecture. There was generalized redness on the lingual margins. The margins also had an
edematous/spongy consistency. The patient had generalized rolled margins on the posterior
linguals. He also had bulbous papillae on the mandibular anteriors, facial and lingual. The
papillary and marginal surface texture had a generalized smooth and shiny appearance on the
posterior lingual margins and the surface texture of the attached gingiva had a stippled
appearance. No suppuration was present.
App't 2:
There was no change noted in the patients gingival condition during the second appointment
since no scaling had been done previously. The patients gingiva still revealed scalloped
architecture with red and edematous/spongy tissue generalized at the lingual margins. The
posterior lingual margins were rolled with a smooth and shiny appearance. The mandibular
anterior facial and lingual papillae were bulbous and the attached gingiva had a stippled
appearance. During this appointment, I began to ultrasonic scale the mandibular right
quadrant.
App't 3:
When the patient returned for the third appointment, I noticed a slight decrease in redness of
the mandibular right quadrant. I also noticed a significant decrease in the inflammation on
the mandibular anterior linguals where I had removed some pretty heavy calculus build-up.
The patient had complained of an ulcer that had appeared on the gingiva on the buccal aspect
of #32, but it ended up resolving on its own. Even with the slight decrease in redness, the
lingual margins remained rolled, smooth and shiny, with an edematous and spongy
consistency. The mandibular left, maxillary left, and maxillary right had not been scaled at
this point in time so no changes had been noted from the patients initial periodontal
assessment. All 3 quadrants had generalized, red, smooth, shiny, and rolled margins on the
posterior lingual surfaces. The anterior teeth had red bulbous papillae with significantly more
inflammation on the mandibular than on the maxillary. This was due to the heavy build-up of
calculus on the lingual surfaces of the anteriors. During this appointment, I completed fine
scaling the mandibular right quadrant. I also ultrasonic scaled and began to fine scale the
mandibular left quadrant.
App't 4:
During the patients fourth appointment I noticed a decrease in redness and inflammation on
the lingual surfaces of the posterior teeth and on the facial and lingual surfaces of the anterior
teeth in the mandibular left quadrant. The margins remained rolled and the papillae in the
anterior teeth were still slightly bulbous and irritated. The posterior lingual margins were still
slightly red but the consistency of the tissue was not as spongy as it had been previously and

the gingiva appeared to fit more snugly around the tooth surface. The maxillary left, and right
had not been scaled at this point in time so no changes had been noted from the patients
initial periodontal assessment. Both quadrants had generalized, red, smooth, shiny, and rolled
margins on the posterior lingual surfaces. The anterior teeth had slightly bulbous papillae on
the lingual surfaces. During this appointment, I completed fine scaling the mandibular left
quadrant, ultrasonic scaled, and began to fine scale the maxillary left quadrant.
App't 5:
At the patients fifth appointment, I noticed that the gingiva on the maxillary left appeared to
be much healthier than it was before. The lingual margins of the posterior teeth were still
slightly rolled but were no longer red, smooth and shiny, with an edematous/spongy
consistency. Also, the anterior lingual surfaces no longer had bulbous papilla. The maxillary
right quadrant had not been scaled at this point in time so no changes had been noted from
the patients initial periodontal assessment. The maxillary right quadrant had generalized,
red, smooth, shiny, and rolled margins on the posterior lingual surfaces. The anterior teeth
had slightly bulbous papillae on the lingual surfaces. During this appointment, I completed
fine scaling the maxillary left quadrant, ultrasonic scaled, and began to fine scale the
maxillary right quadrant.
App't 6:
During the patients sixth appointment, I noticed a similar change in the maxillary right
quadrant as I had with the other three quadrants. The gingiva appeared to be much healthier
than before. The rolled lingual margins still remained but there was a significant decrease in
the redness and the spongy consistency of the tissues. Also, the anterior lingual surfaces no
longer appeared to have bulbous papillae.
Appt 7:
At the patients seventh appointment I completed fine scaling the maxillary right quadrant.
Overall, each quadrant appeared to be getting more and more healthy as treatment continues.
Appt 8:
At the last appointment I noticed an overall reduction in redness and inflammation of each
quadrant. The reduction in inflammation was very significant on the lingual surfaces of the
mandibular anterior teeth since that was the area that had the most heavy calculus build-up.
The generalized rolled margins in the posterior lingual surfaces still remained, however, they
seemed to be getting better. The papillae of the lingual surfaces of the maxillary anterior teeth
no longer existed and had significantly decreased in size on the facial and lingual aspects of
the mandibular anterior teeth.

c. Plaque Index:
Appt 1: 2.5 Fair
Appt 2: 2.5 Fair
Appt 3: 1.5
Appt 4: 2.2
Appt 5: 1.7
Appt 6: 1.7
Appt 7: 2.5
Appt 8:1.7
d.Gingival Index:
Initial: 1.25
Final: 1.21
e. Bleeding Index:
Appt 1: 16.1%
Appt 2: 16%
Appt 3: 5%
Appt 4: 8.3%
Appt 5: 16.6%
Appt 6: 5.5%
Appt 7: 3.3%
Appt 8: 14.4%
f. Evaluation of Indices:
1. Initial: Patients plaque score was 2.5, which is fair, his bleeding score was .14% and gingival
index was 1.25 which is fair. I feel that both of these can improve greatly as treatment and
patient education continues as long as the patient applies what he has learned to his self-care
methods at home.
2. Final: The patients final plaque score was 1.7 which falls into the good category. The final
score showed a decrease of .8 from the initial plaque score. His final bleeding score was 14.4%
which showed a decrease of 1.7 from the initial bleeding score. His final gingival index was
1.21, which is fair, and showed a decrease of .4 from the initial gingival index. Both the plaque
and the bleeding score fluctuated constantly throughout the patients treatment. I believe that this
could have been due to an inconsistency in patient compliance when it came to home care.
Ultimately, if the patient does not practice good plaque control, this will greatly affect his
disease progression leading to more damage to the periodontium such as an increase in bone loss
and loss of attachment.
g.Periodontal Chart: (Record Baseline and First Re-evaluation data)
1. Baseline: The patient had generalized 4 and 5mm pockets and one localized 6mm pocket. There
were 4mm pockets on the MF of #11, MF/ML of #13, MF/DF of #14, ML of #15, L of #17, DL
of #18, MF of #22, DF of #23, DF of #26, MF of #27, and the MB/DB/DL of #30. There were

5mm pockets located on the ML of #14, MB of #16, DL of #17, ML of #18, DB of #31, and the
DB/DL of #32. The patient also had a 6mm pocket located on the DB of #18. There was
generalized recession noted on #9 L, #10 L, #14 L, #22 L, #23 L, #24 L, and #26 L/F. The
periodontal pockets could complicate treatment by making it more difficult for the patient to be
able to reach those areas with just brushing and flossing. Other dental aids may be necessary to
recommend to the patient for at home use. The areas of recession may cause the patient to have
some hypersensitivity and increases his risk for root caries since the root of the teeth are
exposed. This could potentially lead to decay or tooth loss which would negatively affect the
patients periodontal disease by increasing the number of bacteria in their mouth or by increasing
bone loss in the extraction area due to a loss of support.
2.First Evaluation: At the re-evaluation appointment the patient still had generalized 4 and 5mm
pockets and one localized 6mm pocket, however, there was a significant reduction in
periodontal pockets throughout the whole mouth. The only 4mm pockets remaining were on the
DB of #3, DF of #9, MB of #13, M/L of #17, DL of #18, and the F/DB of #32. The remaining
5mm pockets were on the, DL/MF of #17, DF of #18, DF of #19, and the DL of #32. The
patient also had one 6mm pocket located on the DF of #17.
5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions)
The patient was a Class I occlusion. Teeth# 1 and # 16 were extracted. He still had tooth # 17 and # 32
which were supra erupted. He had attrition on #6-#11 and #22-#27 from grinding his teeth in the past.
There were occlusal tooth colored restorations on tooth #2, #15, #17, #18, #30, and #31. There was
also one suspicious area on the occlusal of #18.

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

App't 1: At the first appointment I will review the patients medical/ dental history, take a new
plaque/bleeding score and gingival index, complete gingival description, ultrasonic the
mandibular right quadrant, and then perform a full periodontal charting on the same quadrant.
Once I finish periodontal charting, I will go back and fine scale the mandibular right quadrant.
During patient education, I will be teaching the patient about plaque and brushing. I will start off
by defining plaque and the explaining the importance of removing it with self-care methods such
as brushing and flossing twice daily. For short term goals, I will also teach the patient the correct
brushing method and modify it as necessary to fit his needs. I will also use my flip book to show
the patient pictures of plaque and what it can cause if it is not removed. The long term goal for
this session will be to reduce the patients plaque score by .5 each appointment to have a score of
1 or less by the last appointment.
App't 2: At the second appointment I will review the patients medical/dental history, take a
new plaque and bleeding score, complete gingival description, ultrasonic the mandibular left
quadrant, and then perform a full periodontal charting on the same quadrant. Once I finish
periodontal charting, I will go back and fine scale the mandibular left quadrant. During patient
education, I will be teaching the patient about periodontitis and flossing. I will start off by
defining periodontitis and explaining to the patient that it is not irreversible but that the
progression of the disease can be halted by removing plaque efficiently. For short term goals, I
will also teach the patient the correct flossing method and modify it as necessary to fit his needs.
The patient will also be informed that he should have regular 3-4 month recall appointments

instead of once every 6 months. The long term goal for this session will be to halt the progression
of periodontitis by 6 to 12 months.
App't 3: At the third appointment I will review the patients medical/dental history, take a new
plaque and bleeding score, complete gingival description, ultrasonic the maxillary right quadrant,
and then perform a full periodontal charting on the same quadrant. Once I finish periodontal
charting, I will go back and fine scale the maxillary right quadrant. During patient education, I
will be teaching the patient about caries. For short term goals I will start off by defining cavities
and explaining the demineralization process. I will also teach the patient about how eating
carbohydrates and drinking acidic drinks lowers the pH of the saliva which feeds bacteria and
aids in the demineralization of tooth structures. I will also discuss fluoride with the patient and
emphasize its role in the remineralization process. A fluoride treatment for at home use will be
suggested and the patient will be referred to the dentist. The long term goal for this session will
be for the patient to have tooth #18 extracted within the next 6 to 12 months.
App't 4: At the fourth appointment I will review the patients medical/dental history, take a new
plaque and bleeding score, complete gingival description, ultrasonic the maxillary left quadrant,
and then perform a full periodontal charting on the same quadrant. Once I finish periodontal
charting, I will go back and fine scale the maxillary left quadrant to complete the full mouth
scaling. Patient education will be reinforced at chairside and I will go back over anything that the
patient does not understand.
App't 5: At the last appointment I will review the patients medical/dental history, take and
evaluate a new plaque/bleeding score and gingival index, complete gingival description and then
perform a full periodontal charting. Next, I will do plaque free. Then, I will place Arestin in all
5mm pockets or higher. Patient education will be performed at chairside which will include
information about Arestin and what it is supposed to do.
7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony
crests, thickened lamina dura, calculus, and root resorption)
The patients radiographs showed mild horizontal bone loss on the upper right, upper left,
and lower right quadrants. There was also calculus on the distal of #4, the mesial of #15, the
mesial of #20, the distal of #27, the mesial of #28, and the mesial of #31.
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.

August 29, 2016:

Treatment during the initial appointment included the patients medical/dental history, vital
signs, pre-rinse, head/neck exam, periodontal assessment, dental charting with x-rays, risk
assessment, informed consent, and taking the patients initial plaque score/bleeding
score/gingival index. A vertical BWX survey was also taken during this appointment in order
to assess the patients bone level. After all of the assessment data was collected, I explained
to the patient that he has slight periodontitis. I also explained to him that he had some

localized areas with pocket depths between 4 and 6 mm. He was already slightly familiar
with the disease due to the fact that his wife has moderate periodontitis and had to have a
tissue graft surgery to replace areas of recession on her mandibular anteriors. However, the
patient did not know what causes periodontitis or how to halt the progression of it. I briefly
touched on the basics by explaining to the patient that periodontitis is a more severe form of
gingivitis. It is plaque induced and causes inflammation of the gum tissues, bleeding,
recession, and bone loss. I also explained to the patient that the damage that has already
occurred cannot be reversed, however, the disease can be halted with meticulous oral care
and effective plaque control. Then, I went on to discuss the proper tooth brushing method by
teaching the patient the bass method. For this appointment, I noted the patients learning level
as unaware. He seemed to be interested in improving his oral health, however, I was
slightly concerned about there being a lack of motivation. Since the patient knew me
personally, I was worried that he may not take me seriously which could potentially
complicate treatment. I hope that as treatment and patient education continues that the patient
will realize how important his oral care is, not just for his oral health, but also for his overall
health.
September 12, 2016:
Treatment during the second appointment included updating the patients medical/dental
history, vital signs, pre-rinse, taking a new plaque/bleeding score, and beginning to ultrasonic
the mandibular right quadrant. This appointment also included patient education session #1
which was over plaque and brushing. During patient education, I discussed the patients long
and short term goals with him and told him that we could modify them to fit his needs if
necessary. The long term goal for this session was to reduce the patients plaque score by .5
each appointment to have a score of 1 or less by the last appointment. The short term goals
included teaching the patient the correct brushing method and using the flip book to show
him pictures of plaque and what it can cause if it is not removed. I began the session by
showing the patient pictures of plaque and informed him that it was a white, naturally
acquired biofilm that sticks to the teeth, and contains numerous amounts of harmful bacteria.
This is why it is crucial to mechanically remove plaque by brushing and flossing at least
twice a day. I explained to him that when plaque is not removed, it can harden and turn into
tartar, which has to be removed by a dental professional at routine cleanings. Plaque
accumulation and tartar can both cause gingivitis, periodontitis, and caries. I explained to him
that removal of plaque is crucial in halting the progression of periodontitis. Next, I went into
more detail about the bass method. While demonstrating on the typodont, I instructed the
patient to tilt the toothbrush at a 45 degree angle to the gums, use a quick back and forth
motion covering 2-3 teeth at a time, and overlap a previously brushed tooth when moving to
the next area. I explained to him that tilting the toothbrush at a 45 degree angle helps to clean
the gingival sulcus. The patients plaque score did not improve but his bleeding score went
down .1% since the last appointment. His learning level for the second appointment remained
as unaware.
September 19, 2016
The third appointment included updating the patients medical/dental history, vital signs, pre-

rinse, taking a new plaque/bleeding score, completing ultrasonic scaling on the mandibular
right quadrant, beginning to fine scale the mandibular right quadrant, and full periodontal
charting the mandibular right quadrant. This appointment also consisted of patient education
session #2 which was over flossing and periodontitis. The long term goal for this session is to
halt the progression of periodontitis by 6 to 12 months. The short term goals include teaching
the patient the correct flossing method, defining periodontitis, and informing the patient that
he should have regular 3-4 month recall appointments instead of once every 6 months. I
began by explaining that periodontal diseases are induced by plaque with early periodontal
disease causing inflammation of the gum tissues and bleeding which is gingivitis.
Periodontitis is a more severe form of gingivitis. The difference between the two is that with
periodontitis, not only will you have the inflammation of the tissue and bleeding, but it will
also include loss of attachment or tooth- supporting structures. I also explained to him that,
unlike gingivitis, periodontitis is not reversible. However, he can halt the progression of the
disease with preventive measures. In our last session I explained to him what the gingival
sulcus is and that the loss of attachment that were talking about with periodontitis is when
the junctional epithelium has migrated 2 or more mm towards the root. This creates what is
called a periodontal pocket. The problem with this is that plaque can extend deep into the
pocket and cause continued damage and migration of the junctional epithelium. Also,
periodontal pockets can make it more difficult to clean all the way down to the bottom of the
pocket with just tooth brushing alone and can result in less healing. So in order to maintain
periodontal health it is important to combine self- care with professional cleanings every 3 or
4 months. I began teaching the patient how to floss correctly by showing him first how to
wrap the floss around his middle fingers so that he will be able to use his thumbs and pointer
fingers to be able to move the floss around more comfortably in all areas of his mouth. I then
demonstrated the correct flossing method on the typodont while instructing the patient to
make a C shape around the tooth and to make sure that the floss is reaching into the
gingival sulcus as much as possible. After demonstrating on the typodont, I had the patient
stand in front of the mirror and the sink to practice flossing and modified his technique as
necessary. The patients plaque score improved by 1 point which moved him from the fair
category into the good category. His bleeding score also improved greatly going from 16%
down to 5%. His learning level for the third appointment remained as unaware.
September 26, 2016
This appointment included updating the patients medical/dental history, pre-rinse, taking a
new plaque/bleeding score, completing fine scaling the mandibular right quadrant, ultrasonic
scaling the mandibular left quadrant, beginning to fine scale the mandibular left quadrant,
and full periodontal charting on the mandibular left quadrant. Patient education session # 3
was also included in this appointment which was over caries and fluoride. The long term goal
for this session is for the patient to have tooth #17 extracted within the next 6-12 months. The
short term goals include defining cavities, explaining the demineralization process, teaching
the patient about how the diet affects the oral cavity, and discussing the role of fluoride in
remineralization. I began by explaining to the patient that a cavity is a hole in the tooth that is
caused by softening of the hard tooth structures. There are 4 conditions that must be present
simultaneously for a cavity to form which include a susceptible tooth, a sufficient quantity of
bacteria, frequent consumption of carbs, and occurrence over a period of time. In the initial

stage of tooth decay, the area may appear as a chalky white spot on the tooth surface. During
this phase it can be reversed with remineralization methods which is why it is very important
to identify a cavity early on. Remineralization can occur by frequently applying fluoride to
the teeth. Some sources of fluoride include toothpastes, mouth rinses, and fluoridated
community water. In the second phase, demineralization continues into the dentin toward the
pulp and the third phase is characterized by actual cavitation from loss of enamel. I also
explained to the patient that not only does plaque contain numerous harmful bacteria but that
it is also important for him to know that the composition of plaque is strongly influenced by
the diet. The bacteria feed off of sugars and carbs that you eat, produce acid, and lower the
pH of the plaque and saliva. This is when demineralization of the teeth begins to occur. Other
important factors to consider are the physical form of the food and the frequency of intake.
Chewy, sticky foods remain in the oral cavity for longer periods of time resulting in a longer
exposure to an acid attack. And then longer periods of exposure to carbs leads to a greater
risk of demineralization and less opportunity for teeth to remineralize. If it is a liquid, it takes
20 minutes after each exposure for the pH to return to neutral. If it is a solid, it takes 40
minutes. I instructed the patient that if he were going to snack on carbs, that it is best to eat it
all at one time rather than throughout the day. The same with drinking a soda, drink it all at
one time and then sip on water throughout the day. Saliva provides protection against cavities
by acting as a buffer by diluting and neutralizing acid to maintain a neutral pH so chewing
sugarless gum can help to stimulate salivary flow. I also gave the patient a list of foods that
can cause the pH of plaque to fall below 5.5, which is acidic. I also printed out a list for him
of foods that produce little or no plaque acid so that he may be able to make better snack
choices in the future. To prevent cavities, plaque control, diet choices, and fluoride are all
important factors to consider. The patients plaque score increased by .7 since the last
appointment. His bleeding score also increased by 3.3%. Treatment may be complicated if
the patient does not continue to be compliant with his home care. His learning level for the
fourth appointment remained as unaware.
October 3, 2016
This appointment included updating the patients medical/dental history, pre-rinse, taking a
new plaque/bleeding score, completing fine scaling the mandibular left quadrant, ultrasonic
scaled the maxillary left quadrant, and full periodontal charting the maxillary left quadrant. I
asked the patient if he had been brushing and flossing like I had taught him to and he said
yes. He had improved from not flossing to flossing 3 times in a week which was great.
Chairside patient education included reviewing brushing and flossing. The patients plaque
score decreased by .5 but his bleeding score doubled. His learning level for the fifth
appointment had improved from unaware to self-interest.
October 17, 2016
Treatment during this appointment included updating the patients medical/dental history,
pre-rinse, taking a new plaque/bleeding score, completing fine scaling the maxillary left
quadrant, ultrasonic scaling the maxillary right quadrant, beginning to fine scale the
maxillary right quadrant, and full periodontal charting the maxillary right quadrant. The
patients plaque score remained the same and his bleeding score reduced significantly 10.1%.

While there does seem to be some inconsistency in the plaque and bleeding scores, I think
that improvement can still be expected as treatment continues. His learning level remained at
self-interest for this appointment.
October 24, 2017
During this appointment treatment included updating the patients medical/dental history,
pre-rinse, completing fine scaling the maxillary right, and plaque free. The patient said that
he had still been flossing 3 times a week. The patients plaque score increased by .8 but his
bleeding score decreased by 2.2%. His learning level had improved to involvement for this
appointment.
November 14, 2016
At the last appointment, treatment included updating the patients medical/dental history, prerinse, post-cal, full periodontal charting all four quadrants, taking a final plaque
score/bleeding score/gingival index, placing arestin on #17D, #18D, #19D, and #32D, and
fluoride varnish 5% NAF. During the appointment, I explained to the patient that I was going
to place arestin in areas of his mouth where he had 5mm pocket depths and that it was going
to help those pockets to heal and possibly decrease in depth by 1 mm. After placement, I
instructed him not to brush or floss in those areas for 10 days so that it wouldnt be removed
and could be absorbed for as long as possible. Once I was finished with the arestin, I put
fluoride varnish on the patients teeth and instructed him not to brush or floss for 6 hours, not
to eat crunchy foods, and not to drink hot drinks or alcohol. I also explained that the fluoride
was going to help remineralize his teeth and make them stronger and more resistant to
cavities. The patients final plaque score was 1.7 which was the lowest score that he had
reached throughout treatment. His bleeding score increased significantly since the last
appointment going from 3.3% to 14.4%. His final gingival index was 1.21 which was a
decrease of .4 from the initial score. For the last appointment the patients learning level
remained as involvement.
9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth
morphology, periodontal examination, recare availability)

I believe that the prognosis of the patient is fair. He has the potential to be successful by
taking necessary measures to improve his overall oral health such as proper brushing/flossing
and frequent recalls. He proved to put forth effort in his home care throughout treatment and
just needs to work on being consistent with it. My only concern is that the patient may not
yet realize just how serious periodontitis is which could negatively affect how much effort he
will put forth in improving and maintaining his oral health.
10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule.
(Note: Include date of recall appointment below.)

The patient was referred for a suspicious area on the occlusal surface of #17. The DDS also
suggested to the patient that he should get tooth #17 and #18 extracted as soon as possible in
order to prevent further complications. Since tooth #1 and #16 had already been extracted #17

and #32 were supra-erupting. The patient was placed on a 3-4 month recall and should be seen
again in February of 2017.
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing
depths)

The patients overall gingival health had improvement over the course of treatment. He
showed improvement in his plaque and bleeding score, however, both of these scores
fluctuated throughout treatment. His initial plaque score had decreased by .8, his bleeding
score by 1.7, and his gingival index by .4. The redness and inflammation of the patients
gingival tissues also decreased throughout treatment. The most significant difference was
noted in the patients periodontal pockets and pocket depths which revealed a decrease in
the amount of pockets that measured 4mm or higher.
12. Patient Attitudes and Cooperation:
The patients attitude and cooperation during treatment was great. He was willing to come
for several appointments and was punctual every time. He showed a slight interest in
learning about his oral health and how he can improve it. At times, I wasnt sure if he was
taking me seriously or not. I dont think that he realized just how serious periodontal disease
is. However, he did put forth some effort in his home care routine by flossing at least three
times a week.
13. Personal Evaluation/Reaction to Experience:
I thought that this assignment was a really neat learning experience. I got to see first-hand
how professional dental hygiene care and patient compliance combined together can make a
huge impact on oral health. It was really awesome to get to see all of the changes that were
taking place as treatment continued. This experience was very challenging but I think that it
was very beneficial to me to work with a specific patient throughout the semester and then
evaluating the outcome. It was also very rewarding to be able to apply my knowledge in
order to help someone else to have better health.