PERIODONTAL CARE PLAN

Patient NameN/A.
Age 56
Date of initial exam September 4, 2015

Date completed November 24, 2015

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.
Patient has a cardiovascular disease called Supraventricular Tachycardia. He does not have to be
pre-medicated for dental visits. Other than this condition, patient seems to be in good health
condition. However, patient shows high blood pressure (pre-hyp. and Stage 1) at every
appointment. He is not taking blood pressure medication and says his job has been stressful the
past few months and could be the reason for this. All other vital signs have been within normal
limits. His last physical was in 2013.
Dental Considerations with Medications (sotalol, Crestor, Niacin, Aspirin) that I will be aware
of: Monitor vital signs at every appointment, use local anesthetic agents with vasoconstrictor
with caution, consider short appointments, place on frequent maintenance appointments to avoid
periodontal inflammation, chronic dry mouth possible, consider semi-supine chair position
Sotalol is taken for the patients heart condition. The dental considerations that are stated and
associated and concerns for periodontal disease are for the patient to be placed on frequent
maintenance schedule to avoid periodontal inflammation and chronic dry mouth is possible.
Cardiovascular disease and periodontal disease are related in 4 ways. These include periodontal
pathogens induce clot formation by platelets which possibly leads to the blockage of a blood
vessel by a blood clot, a cross reactivity can occur between heat shock proteins that are present in
all life forms and periodontal pathogens that also produce heat shock proteins, periodontal
pathogens get into the bloodstream and invade the blood vessel walls leading to inflammation
and atherosclerosis, , and periodontal infections may contribute to atherosclerosis by continually
challenging the blood vessel walls and arterial walls with proinflammatory cytokines. Lack of
saliva is a concern because saliva plays a huge role in the oral cavity. It helps dislodge microbes
from the teeth and mucosa surfaces and has antimicrobial components that can kill or inhibit
certain microbes. Without saliva, there is an increase chance of oral candidiasis, coronal and
root-surface caries, and excess plaque biofilm formation.
I will monitor vital signs carefully since patient has a heart condition called supraventricular
tachycardia. Being that the patient has a cardiovascular disease, it is very important to halt his
periodontitis and reduce gingival inflammation. I will stress the importance in my patient
education sessions with my patient and be sure he will well aware of the circumstances.
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)
Patient has had irregular dental care, last dental visit was in 1980. Around this year, he had his

last prophy and has had 10 amalgam restorations. He does not presently have a dentist. Patient
has not made oral care a high priority. He has always had fear of going to the dentist. Patient
bleeds while flossing, sensitive to hot and cold, clenches and grinds teeth at night time. Patient
has a high sugar intake daily, having three sugar containing beverages. Patients chief complaint
is wanting to have a cleaning.
3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
Patient did not have any pathogenic lesions noted. Patient has habits of clenching and mouth
breathing. Mouth breathing has a possibility to dry out the gingival tissues in the anterior area.
Clenching can give excessive force to the teeth and periodontium. Patient can have a night guard
appliance made to protect the teeth from wearing down. Patient is aware of the damages
clenching can do to his teeth. Patient has referrals for fillings on #2, 4, 5, 15, & 30. I will have a
patient education session to teach the patient about the caries process and also, another session to
explain how important it is to get these restored and what could happen if he doesnt do so.
Patient is a class IV prophy. Calculus removal is important when trying to halt periodontitis.
Patients facial form is mesognathic.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification 4 Periodontal Case Type II
b. Gingival Description:
App't 1: August 27, 2015
Patients periodontal assessment shows the following:
Achitecture: Scalloped
Color: Generalized RED in the mandibular area
Consistency: Generalized EDEMATOUS/SPONGY in the mandibular area
Margins: Generalized ROLLED in the mandibular area
Papillae: Generalized BULBOUS in the mandibular area
No suppuration
Surface Texture (papillary & marginal): Generalized SMOOTH AND SHINY in the
mandibular area
Surface Texture (attached): Stippled
App't 2: September 4, 2015
Achitecture: Scalloped
Color: Generalized RED in the mandibular area
Consistency: Generalized EDEMATOUS/SPONGY in the mandibular area
Margins: Generalized ROLLED in the mandibular area
Papillae: Generalized BULBOUS in the mandibular area
No suppuration
Surface Texture (papillary & marginal): Generalized SMOOTH AND SHINY in the
mandibular area

Surface Texture (attached): Stippled

App't 3: September 14, 2015
Patients gingiva appears to be the same as last appointment.
Achitecture: Scalloped
Color: Generalized RED in the mandibular area
Consistency: Generalized EDEMATOUS/SPONGY in the mandibular area
Margins: Generalized ROLLED in the mandibular area
Papillae: Generalized BULBOUS in the mandibular area
No suppuration
Surface Texture (papillary & marginal): Generalized SMOOTH AND SHINY in the
mandibular area
Surface Texture (attached): Stippled
App't 4: September 18, 2015
Achitecture: Scalloped
Color: Localized RED in the mandibular anterior area
Consistency: Localized EDEMATOUS/SPONGY in the mandibular anterior area
Margins: Localized ROLLED in the mandibular anterior area
Papillae: Localized BULBOUS in the mandibular anterior area
No suppuration
Surface Texture (papillary & marginal): Localized SMOOTH AND SHINY in the mandibular
anterior facials
Surface Texture (attached): Stippled

App't 5: October 23, 2015

Achitecture: Scalloped
Color: Localized RED in the mandibular anterior area
Consistency: Localized EDEMATOUS/SPONGY in the mandibular anterior area
Margins: Localized ROLLED in the mandibular anterior area
Papillae: Localized BULBOUS in the mandibular anterior area
No suppuration
Surface Texture (papillary & marginal): Localized SMOOTH AND SHINY in the mandibular
anterior facials
Surface Texture (attached): Stippled

App't 6: November 6, 2015

Achitecture: Scalloped
Color: Localized RED in the mandibular Anterior Facials
Consistency: Localized EDEMATOUS/SPONGY in the mandibular anterior facials
Margins: Localized ROLLED in the mandibular anterior facials
Papillae: WNL
No suppuration
Surface Texture (papillary & marginal): Localized SMOOTH AND SHINY in the mandibular
anterior facials
Surface Texture (attached): Stippled
Appt 7: November 13, 2015
Achitecture: Scalloped
Color: Localized RED in the mandibular Anterior Facials
Consistency: Localized EDEMATOUS/SPONGY in the mandibular anterior facials
Margins: Localized ROLLED in the mandibular anterior facials
Papillae: WNL
No suppuration
Surface Texture (papillary & marginal): Localized SMOOTH AND SHINY in the mandibular
anterior facials
Surface Texture (attached): Stippled
Appt 8: November 24, 2015
Achitecture: Scalloped
Color: Localized RED in the Mandibular Anterior Facials
Consistency: Localized SPONGY in the mandibular anterior facials
Margins: Localized ROLLED in the mandibular anterior facials
Papillae: WNL
No suppuration
Surface Texture (papillary & marginal): Local. SMOOTH AND SHINY in the mandibular
anterior facials
Surface Texture (attached): Stippled
c.Plaque Index: Appt 1) .3 2) .5 3) .8 4) .6 5) .5 6) .3 7) .2 8) 0
Patient did an excellent job applying the brushing and flossing method I taught him and
decreased his plaque score.
d.Gingival Index: Initial-.9 GI

Final-.5 GI

e.Bleeding Index: Appt 1) 8.9% 2) 2% 3) 2% 4) 1% 5) 1% 6) 1.5% 7) 2.7% 8) 1%

Patient decreased his bleeding score tremendously from appointment #1. As a team, we
reduced his gingival inflammation and halted periodontitis.

f. Evaluation of Indices:
1. Initial
I evaluated the indices of teeth #3, 9, 12, 19, 25, 28. There was bleeding points on #12
Mesial, #19 Distal, #25 Mesial, #28 Distal. Total came to be .9 GI.
2. Final
I evaluated the same teeth and the patients gingival index decreased from .9 GI to .5 GI.
On the teeth evaluated I only found one bleeding point on the distal of #28. Patients
overall oral health has improved since day one.
g. Periodontal Chart: (Record Baseline and First Re-evaluation data)
1.Baseline: Patient had 15 pocket depths of 4 and above which were in the mandibular area
on teeth #17, 18, 31, and 32; gingival margins were generalized rolled on mandibular; 11
areas of recession (all premolars, 1st molars, and UR canine); CAL of 6 on #3 and #29;
no suppurations, furcation class 1 involvement on #3; 3 caries found (#2, 15, 30), 11
Amalgam restorations, #1 unerupted, #12 missing, #32 partially erupted, & 7 areas of
abfractions.
2. First re-evaluation: During the first re-evaluation of the patients oral health and
periodontitis, I found 11 pocket depths of 4 on the mandibular molars. There was only one
pocket depth higher than a 4 and that was on the distal of #32. Baseline showed this pocket
to be at 8 mm and this evaluation shows it has reduced to 5mm. The gingival margin was
within normal limits. They showed to be very healthy. Highest CAL was shown on facial
#3, facial #11, and facial #29. This was on teeth with recession of 4 mm. No suppurations
and furcation on #3 was not found. #12 missing, #1 impacted, #32 partially erupted; Patient
has not had #2, 15, & 30 restored. Patient has rotations on several anterior teeth. I
explained how this is a good place for plaque to harbor and to be sure to keep close
attention to those areas while brushing and flossing.
5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth,
occlusion, abfractions) Patient has caries on #2, 15, & 30. Patient has abfractions on #3, 4, 5,
13, 14, 20, & 21. Also, #4 & 5 needs to be filled per Dr. Wiggins. Midline shift is 3 mm to
the left. Occlusion is Class 1 all around. Patient has rotation on #7-9, 22, 24, & 27. Teeth that
are rotated and difficult to keep clean. They also give bacteria an easier place to harbor and
buildup. This will lead to future caries.
6. Treatment Plan: (Include assessment of patient needs and education plan)
Patient Education Long Term Goals, Short Term Goals, and Skill:
Long Term-Reducing Plaque Score
Short Term-Define Plaque: Know where it comes from and what it causes
Short Term-Learn the Bass brushing technique.
Skill-Brushing
Long Term-Stop progression of periodontitis
Short Term-Define periodontitis

Short Term-Demonstrated appropriate brushing and flossing technique

Short Term-Reduce bleeding score
Short Term-Reduce gingival inflammation
Skill-Flossing
Long Term-Getting caries restored
Short Term-Understanding caries process
Short Term-Make an appointment and follow through
Skill-Fluoride
Long Term-Keeping 3rd molars clean or have them removed
Short Term-Know difficulty of keeping clean
Short Term-Tips on how to keep clean
App't 1:
First appointment included updating patients medical and dental history (patient was seen last
semester for radiographs only), statement of release, pre-rinse, completing head and neck exam,
perio. Assessment, dental charting with radiographs, full perio. Charting, risk assessment,
informed consent, bleeding score, & plaque score. Briefly taught patient to brush with light
circular motion and bristles angled under sulcus.
App't 2:
Second appointment included updating medical and dental history, pre-rinse, plaque score,
bleeding score, gingival index, intraoral pictures, and patient education session #1. Session
included stating all long term goals and short term goals. This session will be discussing the long
term goal to reduce plaque score and short term goals of defining plaque and mastering a new
beneficial brushing technique.
App't 3:
Third appointment will include updating medical and dental history, pre-rinse, plaque score,
bleeding score, patient education session #2, and cleaning first quadrant with the ultrasonic and
hand instruments . I will state all long term and short term goals. We will discuss long term goal
of stopping the progression of periodontitis and short term goals of defining periodontitis,
demonstrating the appropriate brushing and flossing technique, reducing bleeding score, and
reducing gingival inflammation. I will also teach the patient how to floss correctly. I will then
use the ultrasonic and hand instruments to clean one quadrant.
App't 4:
Fourth appointment will include updating medical and dental history, pre-rinse, plaque score,
bleeding score, patient education session #3, and cleaning second quadrant with the ultrasonic
and hand instruments. I will state all long term and short term goals. We will discuss long term
goal of getting caries restored and short term goals of understanding the caries process and
making an appointment. I will teach my patient about fluoride. Next, I will use the ultrasonic and
hand instruments to clean the second quadrant.
App't 5:
Fifth appointment will include updating medical and dental history, pre-rinse, plaque score,
bleeding score, having patient education at chairside, and cleaning the third quadrant. I will state
all long term and short term goals. We will discuss the long term goal of keeping the third molars

clean or having them removed. The short term goals will be knowing the difficulty of keeping
those teeth clean and tips on how to do so. I will use the ultrasonic and hand instruments to clean
the third quadrant.
App't 6:
Sixth appointment will include updating medical and dental history, pre-rinse, plaque score,
bleeding score, using the ultrasonic to clean the final quadrant, plaque free, place Arestin in 5
mm pocket on #18 mesial, and apply fluoride treatment. I will explain what Arestin is and what it
does before applying it. I will then review all of the long term goals and short term goals.
Appt 7: Updating medical and dental history, post perio evaluation, Gingival index, plaque
score, bleeding score, and discuss referrals of having restorations done.
7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony
crests, thickened lamina dura, calculus, and root resorption)
On October 27, 2014, I took a panorex on my patient to view his 3rd molars. On March 2,
2015, I took bitewings for caries detection, and patient bleeds when flossing so I wanted to
view bone level. On the radiographic findings I found mild horizontal bone loss on UR, LL,
and LR. Also, there is a furcation involvement on tooth #3. This detected that patient does
have periodontitis. He is perio type II.
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 24, 2015
On this appointment, I only had my patient there for a short appointment. This was a last
minute appointment because of another patients cancellation. I updated medical and dental
history and statement of release, pre-rinsed, and began the head and neck exam and
periodontal assessment. I ran out of time to get these two checked at this appointment. I
explained to the patient what all I was looking for in each assessment. I explained how it is
important to check the lymph nodes for anything irregular. Patient has popping within his
TMJ. We discussed how clenching can contribute to this. I informed the patient that getting a
night guard can help with the popping and also help with not having much wear on his teeth
from clenching. The patients response to this appointment was understanding and seemed to
be very interested in getting treatment to better his TMJ popping. The only diet
recommendations I considered at this appointment was to try to avoid chewing gum and
anything that will involve aggressive chewing to help with the TMJ. Patients learning level
at this appointment was self-interest. At this moment, I did not have the patients long term
and short term goals figured out yet.
August 27, 2015
I had my patient scheduled for 4 hours. On this appointment, we updated the medical and
dental history, pre-rinsed, patient brushed using a scrub method, plaque score of .3, bleeding

score of 8.9%, completed head and neck exam, periodontal assessment, dental charting with
radiographs, full periodontal charting, risk assessment, and informed consent. We discussed
his habits of flossing once a week and rinsing at night. I explained to the patient that he has
periodontitis and bone loss. I explained to the patient that we would have a patient education
session where we will go into more detail about the disease. Finding out that this patient will
be my perio patient, I explained what this will consist of. We talked about how my goal is to,
with his help, increase his oral health by the end of our treatment. The dentist found 3 caries
and 2 abfractions that will need restorations done. I explained to the patient that brushing too
hard could over time caused these abfractions. Patient agreed that he has always brushed
hard. I taught my patient to brush with a light circular motion with the bristles angled into the
sulcus. The patient was understanding and said he will start doing this because he has
sensitivity on those abfraction areas. There were no complications. Learning level was selfinterest. I expect my patient to have a better plaque score next appointment after learning a
better way to brush.
September 4, 2015
This appointment was an hour and a half long. I updated the medical and dental history; prerinsed; gingival index of .9; documented gingival description; and took 4 intraoral pictures of
the smile, abfraction, and the lingual of the anterior teeth. Patient education session #1
consisted of explaining all his LTG & STG goals and going into detail of the first set of goals
pertaining to plaque. I taught patient that plaque is caused by bacteria, that is looks soft
white-yellowish and able to scratch off with your fingernail, and it turns into calculus if not
removed by brushing & flossing. I reviewed the correct brushing method that we discussed
last appointment. I had the patient demonstrate it on the mouth model. We went to the sink
and the patient performed the technique and did well. I disclosed patient and he had removed
all the plaque. Patients bleeding score went down to 2%. Diet recommendations made at this
appointment was to try to cut back on coffee because of the stain that is formed on the
patients teeth. I explained the caffine and acid can break down the teeths mineralization.
Learning level for this appointment was involvement. Patient is progressed and achieved the
goal of knowing what plaque is and applying the brushing method. I expect my patient to
have a better plaque score of .5 next appointment.
September 14, 2015
I updated the medical and dental history, pre-rinsed, plaque score .8, bleeding score 2%,
documented gingival description, and finished patient education session #2. This consisted of
discussing the LTG of stopping the progression of periodontitis, and STG of knowing what
periodontitis is, how it develops, and signs. I showed the patient his radiographs and where
the bone loss is. We talked about how we will reduce the bleeding score, which will be a sign
of a healthier gingiva and no inflammation. I explained the importance of flossing and how it
reaches areas that brushing is unable to. I used the Reach Access flosser aid so it is easier for
the patient to hold the handle and be able to reach the areas that are hard to because of his big
hands. I demonstrated then the patient performed on the mouth model than at the sink in his
own mouth. The patient did an excellent job and there was no plaque left after disclosing. I
applied .2mL of cetacaine on the facials of the molars and began to ultrasonic the lower right
quadrant. Patient responded well with all the different things we discussed and the treatment
provided today. The plaque score was higher today than last time. I made sure the patient

remembered the correct way to brush and showed him the spots he missed. The bleeding
score stayed the same. The learning level was involvement. I expect the patient to increase
his actions towards his goals and have a better plaque score next appointment.
September 18, 2015
This appointment was a short appointment. I had a cancellation to fill for only an hour. I
updated the medical and dental history, patient pre-rinsed, plaque score .6, bleeding score
1%, documented gingival description, finished ultrasonic of the lower right quadrant, and
began fine scaling the lower right. I applied .2 mL of cetacaine to the mandibular anteriors. I
encouraged the patient after seeing the plaque score going down a small amount and to keep
up the correct brushing method and flossing. The learning level was involvement. Patient is
progressing to accomplish his LTG and STG.
October 23, 2015
The patient has had a hard time taking off of work so it has been over a month since his last
appointment. This was a 4 hour appointment and it consisted of updating the medical and
dental history, pre-rinse, plaque score .5, bleeding score 1%, documented gingival
description, patient education session #3, ultrasonic & fine scaled lower left quadrant, and
finished fine scaling the lower right quadrant. I applied .4 mL of cetacaine on the lower left
quadrant. The patient education session consisted of reviewing all LTG & STG and
discussing in detail about caries. We set a goal of getting the caries restored, understanding
the caries process and important of getting them restored. I taught the patient that bacteria is
the cause of caries and gave examples of sugar products that could contribute. I explained
how severe the condition could get and if left untreated then it could have to have a root
canal or extraction because of the decay getting into the pulp. I showed the patient where his
caries are in his mouth and in the radiographs. I taught the patient what fluoride is, how it
works, what is prevents, and where you can find it in. I used examples of the water out of the
faucet and toothpaste. Patient seemed to be interested and asked questions to have a better
understanding of the caries process. Patients plaque score was improved. I gave the patient
diet recommendations of trying to avoid foods and drinks with added sugar. I explained
drinking lots of water can help with the pH level of the mouth. I told the patient if he does eat
anything with sugar, or drink, it would be best to brush his tooth right after. Patients learning
level has improved to action. Patient explained that he is now flossing at least 3 times a week
and it has become easier to take on the habit of doing so. The patients bleeding score has
decreased also. With clinical appearance and the patients response, I feel like his oral health
is improving and becoming healthier by each appointment.
November 6, 2015
On this appointment, the treatment provided was updating the medical and dental history,
patient brushed and pre-rinsed, plaque score .3, bleeding score 1.5%, gingival description,
ultrasonic and fine scaled maxillary left, and took an intraoral picture of the lingual of the
mandibular anteriors to show the patient a before and after picture. Patient education
consisted of going through a quick review of the LTGs and STGs, and the skills that had been
taught. We discussed the difficulty of keeping the 3rd molars clean and demonstrated how to
brush them. I explained why it was hard to reach them. I explained that it is easy for the 3rd
molars to retain plaque and could progress to decay. This could also effect the bone and

progress his periodontitis. I told the patient that is is not important to keep the 3rd molars and
would not make a difference in the occlusion or alignment of the teeth if he decides to have
them removed. Patient was very understanding and wants to try good oral hygiene care
before deciding to have them removed. There was no complications with treatment today.
The patients plaque score is increasing and he is doing well with his goals of brushing and
flossing. The learning level at this appointment is action. I expect the patient to keep up the
good job he is doing with his at home care.
November 13, 2015
This was a short appointment of an hour and a half. Todays treatment consisted of updating
the medical and dental history, gingival description documented, patient pre-rinsed and
brushed, plaque score .2, bleeding score 2.7%, ultrasonic and fine scaled upper right, and
patient education. Patient education included a review of all STG & LTG. Patient stated he is
doing well with meeting all these goals except getting the caries restored. I explained again
the importance of getting them restored. The plaque score continues to increase and doing a
great job at brushing and flossing. The patients gingiva is looked healthier and healthier.
Diet recommendations for my patient were discussed again about sugary foods and drinks.
Patient has cut out sodas, however, still drinks sweet tea and coffee. He explained he does not
drink as much coffee as he use to. He is also trying to cut back on fried foods. The patients
blood pressure has been higher than normal the last few appointments and decided to better
his diet, as well as, go to the doctor for a check up. The learning level for this appointment is
action. He is progressing well with his LTGs and STGs. My expectations for next
appointment is to have a better plaque score and bleeding score, even though his scores are
low and doing an excellent job.
November 24, 2015
This is the final appointment. It consisted of updating the medical and dental history, patient
brushed and pre-rinsed, gingival description, plaque score 0, bleeding score 1%, full postperiodontal charting, gingival index .5, plaque free, application of Arestin on #32 in the
lingual distal pocket depth, fluoride varnish, and patient education. Patient education
consisted of talking about Arestin, what it does, showed patient where I was placing it, and
that it will help reduce the pocket depth and remove bacteria. I explained that it acts like an
antibiotic and we will check the pocket in a few months when he comes back for another
evaluation. I instructed patient to not floss in this area for 10 days and to not brush this area
for 24 hours. I also reviewed what fluoride is, which the patient remembered that is
remineralizes the teeth. I told the patient to avoid hot drinks, crunchy food, and alcohol. Also
to not brush for 6 hours. The learning level for this appointment was involvement. I feel like
the patient has not completely made these skills as part of his lifestyle but he is getting better
at working towards his goals. The pocket depths and gingival inflammation has decreased
since the first appointment. I expect good oral health in 4 months when I will get him back
for his recall.
9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion,
tooth morphology, periodontal examination, recare availability)

I have seen a positive difference in the patients oral health within these last few months. The
patient is taking action and doing his part with halting the progression of periodontitis. I
believe the patient will have a good prognosis. Being 57, he has great bone structure and only
slight bone loss in the a few areas. I feel that if he maintains his oral health that he will not
have any issues with losing teeth from periodontal disease. With his medications, only one
has a side effect of xerostomia. The patient has had no signs of xerostomia and maintains
good salivary flow. He has had positive outcomes with gingival inflammation and pocket
depths. This patient is my dad so I have made sure that he is aware of what his oral health
status was and where it should be. He knows now how important it is to keep up with his
teeth and be healthy. He agrees on being on a 4 month recall. The things I am concerned with
that could decrease his prognosis is taking time to get his caries restored and maintaining
plaque control on the rotated teeth.

10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall
schedule. (Note: Include date of recall appointment below.)
I explained to the patient that he will be on a 4 month recall. I will be seeing him between the
months of February and March. I explained that it is important to be seen no later than
March. The patient has agreed to this. At the post perio evaluation, I noticed calculus already
forming on the mandibular linguals so it is important to be on a strict recall. I went over the
patients referrals of his restorations on #2, 4, 5, 15, and 30. I suggested to the patient to
maybe do 2 at a time for money and time management reasons. We discussed that the reevaluation went well and his oral health is responding to our treatment as a team.
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health,
probing depths)
The patient has an overall positive increase with his oral health. The plaque score has
decreased from .3 to 0, bleeding score decreased from 8.9% to 1% (EXCELLENT), gingival
index decreased from .9 to .5 and from generalized red mandibular to only red on the
mandibular facial anteriors, and the probing depths have decreased also. The first evaluation
showed 15 pockets of 4 mm and higher, this included three 5 mm pockets and one 8 mm
pocket. The re-evaluation showed 12 pockets of 4 mm and higher, but with only one pocket
higher than a 4 mm. This was on the 8mm pocket which is now a 5 mm pocket.
12. Patient Attitudes and Cooperation:
My patient has had a great attitude throughout this treatment. He has taken it upon himself
to have a better at home oral health care and understands a lot goes into halting the
progression of the periodontitis. Starting out, I learned the last time he had been to the
dentist was in 1980. Now, he understands that it is important to be on a recall. The patients
cooperation has been tremendous, even though he has been seen in nine appointments.
13. Personal Evaluation/Reaction to Experience:

I am very happy with the outcome of this experience. I am glad we are able to document and
able to really see what good oral hygiene can do for a patient. Personally, it gives me much
delight to see that I helped a patients periodontal disease and to see the satisfaction on the
patients face.