Periodontology (DHYG 1311)

Fall, 2015
Student: Rachel Musselwhite
PERIODONTOLOGY CARE PLAN
Patient Name:
Age: 28
Date of initial exam: 8/25/15
Date completed: 10/13/15
1. Medical History:
My patients last physical was February 2014. She needs to keep
going every year for a physical because any diseases that she is
not aware of that affects her over all health can have some kind
of affect on her periodontitis.
She has seasonal allergies but only takes medication over the
counter when she has symptoms. Depending on what
medications she takes could possibly cause xerostomia. She
needs to understand that if this happens that having dry mouth
will slow her saliva glands down that is a natural defense to help
keep and clean out her oral cavity so she needs to drink plenty of
water or chew sugar free gum to help her saliva glands. Dry
mouth allows bacteria to stay on the teeth and this can cause
progression of her periodontitis.
She uses Tobacco products. She smokes Cigarettes and she
smokes 1 pack per day. She has been a smoker for 8 years and
has recently tried to quit 3 times in the past. After talking to
Elizabeth she tells me that she still wants to quit smoking and
that she wants to make an appointment with her health care
provider about options she can try to quit smoking. Smoking can
cause many affects on her periodontal health. These affects can
include impaired inflammatory response and immune response,
more attachment loss, furcation involvement, tooth loss, deeper
probing depths, and impaired healing response. For every 10
pack-year increment, there is a 1 mm mean attachment loss.
Steps to be taken to help minimize smoking habits are to cut
back on a few cigarettes a day, join help groups on trying to quit
smoking, talk with ones healthcare provider on ways to help quit
smoking.
She also has occasional alcoholic beverages once month. Alcohol
can irritate her gum tissue and it can cause poor eating habits,

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Fall, 2015
which can lead to nutritional deficiencies. Nutritional deficiencies
can lower her immune system and increase gum disease.

2. Dental History:
Chief complaint for this visit is a check up and to have her teeth
cleaned. Her last dental visit was April 2012. When talking to her
about why she hasnt had regular cleanings she said that she
hasnt had insurance in a while and she made sure her kids were
taken to the dentist first before her. She is currently a prophy
class 6. Improper dental visit can result in improper plaque
control that can result in direct damage to the gingival tissue
causing alteration of the natural contours of the tissue. Improper
visits can affect her periodontitis because she is not removing
the harmful bacteria from her teeth that can cause progression in
her disease and without regular visits we are not able to keep
track and make sure her periodontitis is inactive and watch for
active sites. Her dental IQ is fair but she was not taking any
action in having good oral hygiene. After my two patient Ed
sessions and explaining to her what plaque and periodontitis is
and proper brushing and flossing I am confident that she will
change her oral hygiene habits and apply the education that I
have taught her and the techniques that I have shown her to her
daily life.
When talking to her she seems really concerned about the
appearance of her bottom teeth and wants to make sure she
gets them taken care of before she could have possible tooth
loss. She wants to quit smoking and she seems to be determined
in keeping up with her regular checkups after we are done with
her treatment so she doesnt have any more recession or bone
loss.
Some of her oral hygiene habits included clenching. She says she
only realizes it at night. This can cause TMJ problems and
headaches. Having pain in her jaw could cause her to not want to
floss or avoid hygiene habits all together because of the pain she
is already having in her oral cavity. Not using proper oral hygiene
and leaving the bacteria in the mouth can cause progression of
periodontitis. Also the pressure that she puts on her teeth can
cause alveolar resorption.

Periodontology (DHYG 1311)

Fall, 2015
She says that she also mouth breaths at night, which can dry out
the mouth. Dry mouth can slow the saliva glands and leave the
bacteria to sit on the teeth. The affect that this will have on her is
her periodontitis can progress and cause more recession or
boneless. Steps to be taken to help are to have her keep water
near her bed for when she wakes up with dry mouth.
She has bleeding when she brushes and flosses. This is a sign
that she has a periodontal disease and that it is active. Having an
active disease can cause progression of that disease. This means
she needs to clean out the bacteria that are in her mouth with
proper oral hygiene and have regular dental checkups to make
sure any build up that has accumulated can be removed.
She contains 2 or more sugar containing drinks per day. Sugar in
the drinks will use the bacteria in her mouth to break down
enamel. If she starts to have a cavity occur the pain from the
cavity could cause her to avoid touching that tooth and the area
around it. This will have her leaving bacteria on her teeth. Any
bacteria left on her teeth will affect her periodontitis and cause it
to stay active.
3. Oral Examination:
She has popping when she open and closes her mouth on the
right side. This can be cause from TMJ issue that result from her
clenching. Clenching can also cause headaches and the pressure
put onto the teeth can cause alveolar resorption.
Her Oropharynx/tonsils are slightly red bilateral. This is cause by
her seasonal allergies. Having periodontitis disease could have
an affect with her overall health maybe causing her to have
allergies. Since she has a disease in one part of her body why
would that not affect her overall health. Also being sick could
cause her to discard her oral hygiene making her bacteria in her
mouth to build and could cause progression of her periodontitis.
She has nicotine stomatitis on the roof of her mouth that is cause
from her smoking. Smoking has lots of affect on the periodontal
health that can increase the progression of the disease and
cause more bone loss, furcation involvement, tooth loss, bacteria
buildup, deeper probing depths and impaired wound healing.
She has a plaque-coated tongue, which is from poor oral
hygiene. The more bacteria that are in her mouth the more that

Periodontology (DHYG 1311)

Fall, 2015
it will progress her periodontitis and keep it active. I have showed
her proper oral hygiene by proper brushing and flossing so this
should help removed the plaque from her tongue.

4. Periodontal Examination: (color, contour, texture,

consistency, etc.)
a. Case Classification: 6
Periodontal Case Type: 3
b. Gingival Description:
Appt 1: Scalloped: Generalized, Red: Generalized and Magenta:
Mand Facial, Edematous/Spongy: Generalized, Rolled: anterior,
Bulbous: Mand Anterior, Surface texture (papillary, marginal, and
attached) is Smooth & Shiny: Generalized, and Inadequate zone
of attachment of #24 and #25 facial.
Appt 2: On her 2nd appointment her overall gingival description
was still the same as the time before because we just started to
remove the bacteria and calculus from her teeth.
Appt 3: Anteriors are still bulbous on the Mand left but not so
much on the Mand Right after cleaning the calculus off. Also I can
see that the Mand R is less red and no longer have a magenta
color to them compared to the Mand L since the calculus and
plaque have been removed allowing the tissues to start to heal.
Its still edematous/Spongy generalized and still rolled on the
anteriors. Surface texture is still Smooth & Shiny generalized.
Appt 4: Anteriors on Mandibular are only slightly bulbous now.
There is no longer a magenta color in this area but just a red
color and this is generalized in her gingiva. She is still smooth
and shiny generalized and no longer has a rolled appearance to
her tissues. Scalloped generalized.
Appt 5: Her Mandibular anteriors are showing a great
improvement in color and texture. She is still smooth and shiny
generalized but is starting to look slightly fibrotic in the Max
Anterior. This could be due to her heavy smoking. Color is red
generalized.

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Fall, 2015
Appt 6: Color is red generalized and smooth and shiny
generalized except for maxillary anteriors, which is slight fibrotic.
Max anterior region is blunted and since the swelling in the
tissues of the mand anterior region has gone down it now has
started giving a blunted appearance as well. This could be due to
all the attachment loss and recession she has in this area and
now the gingiva does not fill the space in between those teeth
completely.
Appt 7: Color is red generalized. Its still smooth and shiny
generalized and still slight fibrotic in the max anteriors. Max and
Mand anterior are blunted. Mand anterior region no longer gives
a bulbous shape to the tissues. Scalloped generalized. There is
no longer a rolled appearance in the anterior regions as well.
c. Plaque Index:
1.5 7: 1.3
d. Gingival Index:
e. Bleeding Index:
6:2% 7:1.5%

Appt

1: 1.3 2: 1.6 3: 1.5 4: 1 5: 2 6:

Initial:

1.2 (poor) Final: 0.25 (good)

Appt 1:13% 2:6.9% 3:6.5% 4:2% 5:2%

f. Evaluation of Indices:
1. Initial- Excessive bleeding on #25 and moderate to excessive
bleeding #12 and #3. The gingival in these areas are red/spongy
and inflamed. #9 had no bleeding points, which could be due to
smoking. #19 and #28 had slight/moderate bleeding. The
bleeding is associated with active periodontitis. The gingival in
these areas were slight inflamed and red/spongy. Overall she had
moderate/heavy bleeding throughout the mouth. Plaque score
was 1.3 (fair) and Gingival Index 1.2 (poor). After teaching my
patient the proper way to brush and floss I am confident that she
will be able to lower her plaque and bleeding score by the end of
her treatment and be able see a change in her overall oral
health.
2. Final- There is no longer excessive bleeding in any areas. She
only has slight bleeding in #3, 1, 19, and 25. There was no
bleeding on #9, and 28. The gingival in these areas are
slight/moderate red generalized with slightly inflamed tissues.
Since the removal of calculus and the start of her flossing and

Periodontology (DHYG 1311)

Fall, 2015
brushing with the proper techniques that she has been taught
her bleeding has went significantly down. She is showing less
signs of active disease but she still has a few signs of active sites
in only certain areas of her mouth. Her plaque score on her last
visit was 1.3 (good) and gingival Index 0.25 (good). I am very
pleased to see a great change at the end of her treatment
compared to her first appointment.
g. Periodontal Chart: (Record Baseline and First Re-evaluation
data)
1. Baseline- Mucogingival involvement on #24 and #25. Mobility
of a 1 on #24 and #25. Sensitivity to Percuss on #24 and
#25. Inadequate zone of attachment on #24 and #25 facial.
Higher CAL in the anterior region and recession involvement
in anterior region on #24, #25, and #26. Deeper pocket
depths in the molar and premolar regions and on #s 24, 25
&26 of the facial. Have not charted the Maxillary yet because I
am probing by quadrant due to all the heavy calculus buildup
and have not started on the Maxillary quadrants yet.
2. First evaluation- Mucogingival involvement on #24 and #25.
No longer has mobility on #24 and #25. Sensitivity to Percuss
on #24 and #25. Inadequate zone of attachment on #24 and
#25 facial. Still has higher CAL in the anterior region but had
gone down since the first appointment and still has recession
on #24, #25 and # 11 facial. Still have deeper pocket depths
in the molar region but not in her premolar region. Her
pockets depths in general are still pretty much the same but
have went down a little in some areas.
5. Dental Examination:
She has suspicious areas on teeth: #3, #2, #14, #15, #29
and #31. Cavities contribute to periodontitis because of
the increase of plaque biofilm retention. Leaving the
plaque in a place to grow can cause it to grow into gram
negative anaerobic. She also has lingoversion on teeth #24
and #25. She has had one 3rd molar removed and still have
her remaining other three. The 3rd molars are hard to clean
and will be a good place for plaque to build up. She did not
have an overbite or over jet and no midline shift, or cross

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Fall, 2015
bites. Her malocclusions were all class 1 for molars and
canines left and right.
6. Treatment Plan:
Appt 1
1. Health history/Vitals
2. BWX
3. Head and neck/ Intra Oral exam
4. Periodontal Assessment
5. Dental Charting with x-rays
6. Gingival Index
7. Plaque score and bleeding score
8. Risk assessment
9. Informed Consent
10. Start Ultrasonic on Mand R
Appt 2:
1. Update Health History/ Vitals
2. Take one retake on x-rays
3. Intra Oral camera 2 pictures (1 full smile and 1 where it
shows her periodontitis)
4. Plaque Score and Bleeding Score
5. 1st Patient Ed session- Brushing
Long Term Goal: Patient will Reduce Plaque Score
STG: Pt will be able to define plaque
STG: Pt will use proper brushing technique twice a day
STG: Pt will lower plaque score by end of treatment
6. Finish Ultrasonic Mand R
7. Full Perio Charting on Mand R
8. Started Fine Scaling Mand R
Aptt 3:
1. Update Health History/ Vitals
2. Plaque score and Bleeding score
3. Patient Ed session 2 Flossing
Long Term Goal: Patient will hault progression of Periodontitis
disease
STG: Pt will be able to define periodontitis
STG: Pt will floss 4 times a week
STG: Pt will complete treatment with DH clinic
STG: Pt will continue 3-month recall Dental appointments
after treatment
STG: Pt will decrease bleeding score
STG: Pt will decrease plaque score

Periodontology (DHYG 1311)

Fall, 2015
4. Finish Fine scaling on Mand R
5. Ultrasonic Mand L
6. Full perio Charting on Mand R
Appt 4:
1. Update Health History/ Vitals
2. Plaque score and Bleeding score
3. Patient Ed session 3- Rev Brushing and Flossing
Long Term Goal: Patient will try to cut back/quit smoking
STG: Pt will understand the affects smoking has on
periodontal disease
STG: Pt will cut back on a few cigarettes a day
STG: Pt will make appoint to talk to healthcare provider
about quit smoking
4. Fine Scale Mand L
5. Ultrasonic Max L
6. Full Perio Charting on Max L
7. Fine Scale Max L
Appt 5:
1. Update Health History/ Vitals
2. Plaque score and Bleeding score
3. Patient Ed at chair side
Long Term Goal: Patient will have caries restored
Pt will be able to define the caries process
Pt will schedule appointment for caries to be fixed
Pt will save money for caries to be fixed
Pt will follow through with the appointment
Pt will cut back on sugar containing drinks
4. Ultrasonic max R
5. Full Perio Charting on Max R
6. Fine Scale Max R
Appt 6:
1. Update Health History/ Vitals
2. Plaque score and bleeding score
3. Gingival Index
4. Scale all quadrants
5. Plaque free
6. Post- perio evaluation
7. Arestin
8. Fluoride
9. Reinforce patient ed: Talk about importance of regular
checkups
10. Chemical irrigation

Periodontology (DHYG 1311)

Fall, 2015
11.
12.
13.

Referral for cavities

Referral to periodontics for mucogingival involvement
3 month recall

7. Radiographic Findings:
She has mild horizontal bone loss in the upper right and upper
anteriors of her mouth. This will make her a case 2. But she has
moderate bone loss in her lower anterior region on the facial of
#24 & #25. This area will make her go to case 3 because of the
moderate bone loss she is having in those two teeth. This is all in
relation to her periodontitis disease because of the attachment
lose she has experienced. She has mild widened PDL spaces
generalized, and root anomalies in her upper left and lower right.
They are dilacerations on #18 & #32. She has calculus
generalized throughout her mouth.
8. Journal 1:
Today I reviewed my patients medical history and took
vitals. Then I started on her paper work, which included head and neck/
intra oral exam, periodontal assessment and dental charting. I did her
plaque score (1.3) and bleeding score (13%). I had her fill out a
tobacco form and had her sign her informed consent and I did a risk
assessment on her. Afterwards I did her gingival index form. I started to
do full perio charting but was not able to because I couldnt get around
her calculus so I was told to do it by quadrant. I got to learn how to
use an ultrasonic for the first time and got to start on my first
quadrant, which was Mand R but did not get to finish.
Journal 2:
Today I updated m/d history and took vitals. I took her
plaque score (1.6) and bleeding score (6.9%). I took her two intra oral
pictures, one of her full smile and the other one showing where she
had periodontitis. I did one retake on her BWX. Then I started her first
patient ed session. During this session I went over all her LTGs and
STGs and made sure that there was nothing that she felt needed to be
changed. My first topic was to teach her about plaque. I taught her
what plaque was and how its harmful bacteria and what it can cause if
not removed. She was able to define plaque to me and understood its
meaning. I showed her a proper brushing technique (bass method) and
had her demonstrate it back to me. Afterwards we went to the sink and

Periodontology (DHYG 1311)

Fall, 2015
had her apply the technique to herself and I assisted her with any help
that she needed. Then we disclosed her and made sure that she was
doing a good job and viewed the areas that she worked on. I also
suggested that she use a kids toothbrush so she will be able to reach
and clean her third molars since those are hard areas to reach and
clean. Also suggested she uses sensodyne toothpaste since she will
have root exposure to help with her sensitivity. Her learning level is
involvement because she is ready to start using better oral hygiene
habits. After patient Ed I had the dentist admit anesthesia and then I
finished ultrasonic her first quadrant which was mand right. Then I did
full perio charting in that quadrant. I was able to fine scale but did not
have enough time to finish.
Journal 3:
Today I updated my patients m/d history and took her
vitals. I took her plaque score (1.5) and bleeding score (6.5%). We
started her second patient ed. We went over all her LTGs and STGs
again and review plaque and brushing technique from last patient ed.
Then we discussed Periodontitis and I explained that this is what she
has and the process of how she got it. I had her define periodontitis
back to me and answered any questions that she had. Then I showed
her proper flossing technique and had her demonstrated it n the
typodont. Afterwards we went to the sink and had her practice on her
self and I helped assist her in any trouble that she was having. Then
we disclosed her and made sure that she was doing a good job in the
areas that she worked on. Her learning level is action because she is
already using the brushing technique that was taught in last patient Ed
and she has already lowered her plaque score from her last visit. After
patient Ed I went and finished her fine scaling on her first quadrant
mand R and got it checked. Afterwards the dentist administered
anesthesia to her mand left and then started ultrasonic on Mand L and
got a progress checked to see how I was doing. I did not get it fully
checked but was told to do perio charting on that quadrant for the
remaining of the clinic. I finished full perio charting on that quadrant
and got it checked. Next appointment I plan on finishing ultrasonic on
mand L and have that quadrant fined scaled and do her 3rd patient ed.
Journal 4:
Today I updated my patients m/d history and took her
vitals. I took her plaque score (1) and bleeding score (2%). We did her
3rd patient ed session. We went over all her LTGs and STGs again and
reviewed plaque and periodontitis. Today we went over smoking and
the affects that smoking has on her periodontitis and why its
important for her to try and quit. I gave her some suggestions on how
to try and cut back on smoking and spoke with her about talking to her

Periodontology (DHYG 1311)

Fall, 2015
healthcare provided to try and find ways to help her quit. I had her
repeat back to me the affects that smoking has on her periodontitis. I
had her demonstrate proper brushing technique (bass method) and
flossing on the typodont. Then we went to the sink and had her brush
her teeth and floss and assisted her with any help that she needed. We
disclosed to see the areas where she is still having a hard time at so
she knows where to keep focusing more on when she is brushing and
flossing at home. Her learning level is action because I can tell she is
using the techniques that she has been taught at home and is lowing
her bleeding and plaque score. After patient Ed we went back to the
chair where I finished ultrasonic her mand left and got it checked. I
perio charted and fined scaled mand left and gotten both of those
checked. I then started Max left and the dentist gave her anesthesia in
that quadrant then I done ultrasonic and got that checked but did not
have enough time to start fine scaling on that quadrant. Next
appointment I plan on fine scaling max left and starting on her next
quadrant.
Journal 5:
Today I updated my patient's m/d history and took her
vitals. I took her plaque score (2) and bleeding score (2%). I fine scaled
her max left and got it checked. Then I started on her max right. The
dentist gave her anesthesia in that quadrant and I was able to
ultrasonic and perio charted her max right and got both of those
checked, first ultrasonic and then fined scaled. I did some chair side
patient ed on the process of caries and reviewed how she was doing at
home with her brushing and flossing. I fined scaled her max right but
did not have enough time to have a fine scale check.
Journal 6:
Today I updated my patients m/d history and took her
vitals. I took her plaque (1.5) and bleeding score (2%). I had her max
right fine-scaled check. I also did her post cal on her mandibular
because it had been two weeks for those quadrants. I did some patient
ed on how she has been doing with her brushing and flossing and
talked to her about her smoking. She has not made an appointment
with her healthcare provider about quitting and she is having a hard
time cutting back. I did her plaque free and fluoride (varnish).
Journal 7:
Today was my patients two-week post evaluation
appointment. I reviewed and updated her m/d history and took her
vitals. I took her plaque score (1.3) and bleeding score (0.5%). I did full
perio charting and gingival indices. Compared to her first appointment

Periodontology (DHYG 1311)

Fall, 2015
her gingival indices have shown significant reduction. And her perio
charting compared to her pervious reading has shown a great
reduction in her mand anteriors facial. She still has signs of active
disease and still has 5mm or greater pocket depths in her molar
regions. She has also shown a big reduction in her gingival bleeding
status. She has lowed her bleeding score significantly since her fist
visit and her tissues look so much better and healthier. She also has no
more mobility on teeth #24 and #25. I got the full perio charting
checked and after wards decided on the areas that I would apply
Arestin. I applied Arestin to teeth #1, 15, 16, 18, 31, and 32. I gave her
instructions on how to take care of those areas while the Arestin is in
her tissues and I also provided her with information on why we applied
the Arestin and the benefits that the Arestin will give her with the
healing of her tissues. I went over again the process of caries and talk
to her about having them restored. I encouraged her to keep up with
her brushing and flossing. I gave her a referal to a periodontics for
teeth #24 and #25 and told her about her 3-month recall
appointments and explained thats why kind of recall appointments
that she will be on for now. Her learning level to me is involvement
because she is taking action in brushing and flossing but I feel that her
outcome will not be as good because of her continuous smoking habits.
She doesnt seem to be in a hurry to try and quit even though she
understands the affects that smoking will cause on her periodontitis.
9. Prognosis: Based on the attitude of my patient I feel that the
prognosis is fair. This is because my patient is taking action on
doing proper brushing and flossing at home. She has shown a
great improvement in her gingival tissues and her tissues are
healing very nicely. She still has a few areas that are showing
signs of active disease because she still has some bleeding. Her
bleeding score has dropped since her first visit. She is 28 and is a
case 3 because of the facials of teeth #24 and #25 but she is
aware of the damage that has been done and is very concerned
about the appearance of those teeth so I know that she will
continue to take care of them. She has 31 teeth because she
has only had one molar (#17) extracted and her other 3rd molar
have already erupted. She has been instructed on using a small
toothbrush like a kids toothbrush to be able to reach back there
because that is hard area for her to keep clean. She has close
contacts between her teeth so she has been instructed on
flossing and says that she has been flossing every other day.
Those close contacts will allow harmful bacteria to collect and
stay there and can cause her periodontitis to progress. She is still
smoking heavily and has not made an appointment to see her

Periodontology (DHYG 1311)

Fall, 2015
health care provider on ways to try and quit. She is having
trouble with cutting back also. She has been giving suggestions
on things to help her try and cut back but she seems to still have
trouble. Since she is not trying to cut back or quit with her
smoking habits this will increase and continue to affect her
periodontitis and cause her to receive build up faster than
normal. Smoking also will inhibit the tissue healing and will delay
the process. After doing her periodontal examination on her twoweek post evaluation she has had a great reduction in probing
depths in her mand anterior region and no longer has mobility on
teeth #24 and #25 so she is doing a great job at keeping that
area clean. She also has a great reduction on CAL on teeth #24
and #25. She still has 5mm pocket depths or greater in the
molar region. She does not have any other disease in her
medical history that could continue to affect her periodontitis but
she needs to go to her yearly physical with her main health care
provider to make sure there is nothing that could cause her
periodontitis to keep progressing instead of halting it.
10.
Supportive Therapy: After doing her re-evaluation I
suggested that she continue to use a kids toothbrush in her
molar region so she will be able to reach and clean her 3rd molars
cause those are a hard place for her to try and keep clean. Also
to use the small kids toothbrush in her anterior region because of
all the attachment loss and recession that she has in that area. A
small kids toothbrush will allow her to tilt the toothbrush into the
gums and clean it out better. She also has been instructed to
floss everyday instead of once every other day and that she
really needs to focus on flossing her mand anterior cause while
doing her re-evaluation she seems to be having food collection in
that area and after doing her plaque score it seems to still be a
problem area where she collects plaque. I gave her a referral to a
periodontist for teeth #24 and #25 facial because she has
mucogingival involvement in that area. I also placed her on 3month recall appointments so we will be able to keep tract with
the progression of her periodontitis and make sure she is keeping
her periodontitis halted. Also since she is going to continue to
smoke she really needs to come back every three months to
watch her and remove any of the buildup that she collects
because with smoking she increases her chances on collecting
build up much faster than someone who doesnt smoke. She has
been informed of the risk she takes on her periodontitis
progressing and having her tissue healing delayed since she is
going to continue to smoke. I let her know that she has reduced
her bleeding score though out her treatment and that her tissues

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Fall, 2015
look a lot healthier and encouraged her to keep up the good
work. I also let her know that she still has areas of active disease
sites so keeping up with good oral hygiene at home is very
importance for her.
11.
Assessment of Changes: Throughout her treatment she
had done a good job on reducing her plaque score and keeping it
low. She still has trouble with plaque in her anterior regions and
has been instructed to give that area extra time when brushing
and flossing everyday. Her bleeding score had reduced
significantly though out her treatment going form 13% to 0.5%.
She still has some bleeding in certain areas, which are a sign of
active disease in those areas. She still continues to smoke so I
believe that with the removal of calculus and with her doing good
oral hygiene at home along with the combination of her smoking
this is a good reasoning of her bleeding score reducing so
significantly. Her gingival health is now slight/moderate
periodontitis with slight bleeding. Her tissues went from
inflamed and red with magenta color on her mand anteriors to
having only slight red generalized and no magenta color
anymore. Also her tissues went from being bulbous in her
anterior regions to blunted in those areas and having areas of
rolled to none. Her probing depths have reduced slightly in her
molar and premolar region and her CAL has reduced greatly in
her mand anterior region. She had mobility in #24 and #25 and
no longer has mobility in those two teeth. She still has sensitivity
to percussion on teeth #24 and #25. Overall her gingival
appearance has improved greatly and looks so much healthier.
My patient has stated how much better her gums feel now after
her cleaning. The tissue appears to be healing very nicely. Her
only problem she is having is smoking. With her to continue to
smoke she will increase her chances of her periodontitis to keep
progressing instead of keeping it halted and allow for faster
buildup collection. This can cause her tissue to become very
unhealthy again.
12.
Patient Attitudes and Cooperation: My patient has a
good attitude on listening and understanding of the things that I
have suggested and taught her about her periodontal health. She
seems to really be concerned on the appearance and health of
her teeth and is applying the brushing technique and flossing she
has learned to her oral hygiene she does at home. When
evaluating her gingival status and bleeding score you can tell
that she is doing a good job with her home oral hygiene care. Her

Periodontology (DHYG 1311)

Fall, 2015
tissues look so much healthier and her bleeding score has
dropped since her first visit. Even her pocket depths and CAL has
shown a reduction. The only problem is she has not made an
appointment with her health care provider to help find options
that she can do to help quit smoking and has not been able to
cut back on how many she smokes a day. She has been given
instructions on ways to help her try and quit or things to
substitute when she wants a cigarette but states she is still
having trouble. With her continuing to keep smoking she is
increasing her chances of her periodontitis getting worse and
progressing faster. And this is also inhibiting the tissue healing
and delaying it. With the combination of smoking and having her
teeth cleaned and starting good oral hygiene I feel that this is a
reason for the increase reduction of her bleeding score. She has
stated that she defiantly wants to make an appointment to the
periodontics and she is going to make and appointment to have
her cavities restored as well.
13.
Personal Evaluation/Reaction to Experience: Though
out the treatment process and being able to evaluate my
patients oral health it was very interesting to see the gingiva
heal. I was able to see the process in which it healed and I was
able to see each quadrant heal one after the other after cleaning
the quadrants. I was very pleased to see the improvements that
were made at the end of the treatment and being able to have
this learning experience. Comparing her first gingival indices and
perio charting to her last gingival indices and perio charting I was
able to see the difference in her general health and see where
her tissues are healing. She had a great reduction in her CAL in
her mand anterior regions and went from having some mobility
in #24 and #25 to not having it any more at the end of the
treatment. Her tissues healed very well around those teeth. She
still has sensitivity in #24 and #25. She also still has 5mm
pocket or greater in her molar region but you can see that her
pocket depths have reduced a little. She was a class 6 and after
cleaning a class 6 I realized just how hard it was. It was not really
easy for me but it was a very good learning experience.