Manessah Cox

PERIDONTAL CARE PLAN

Patient Name
Date of initial exam: September 16, 2015

Age: 29 (30 by end of treatment)

Date Completed: November 17, 2015

1. Medical History: (systemic conditions altering treatment, pre-medication, medical clearance) explain steps
to be taken to minimize of avoid occurrence, effect on dental hygiene diagnosis and/or care.
This patient has no systemic conditions that would alter any treatment. Patient does not require any pretreatment medications or medical clearance. The patient was diagnosed and hospitalized with a kidney stone 2-3
weeks before date of screening (9/1/15). Patient was taking ibuprofen on occasion for pain and the antibiotic
Ciproflaxin for the kidney stones but by his 3rd appointment (9/22/15) he had stopped taking it. The patient is
currently on no medications (9/29/15).The patient has been treated multiple times for kidney infections. The
patient has recurrent allergies that cause sinus issues, issues began 5- years ago. Patients vitals began with prehypertension at screening appointment and first exam appointment. Patients vitals then progressed to Stage 1
Hypertension at appointments 3 and 4. Patients pulse and respirations have been within normal limits each
appointment.
2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief complaints, present
oral hygiene habits, effect on dental hygiene diagnosis and/or care).
The patients reason for dental visit was because he was concerned with frequent bleeding of his gingiva.
Patients last dental visit was more than 8 years ago; he received two root canals from a past injury. He was hit
in the mouth with a cricket ball in 2001 which caused pain and a chip on the mesial of #9. The patient feels
bad about the appearance of his smile but is very motivated to do everything he can to improve it. The patient
has gone through the first patient education session over plaque and is interested in adopting the proper
brushing method. Patient also understands that he has periodontitis and knows that it means he has some bone
loss. He is very concerned about the bone loss and motivated to do what it takes to prevent anymore bone loss.
The patient is very concerned about the frequent bleeding of his gums but understands after his first patient
education that the treatment I am giving him will help to heal his mouth and reduce/eliminate gingival bleeding.
The patient also has sensitivity to hot and cold ever since his injury with the ball in 2001. The patient drinks 2-3
sugar drinks a day and it has been explained to him that he should try to brush after every meal/sugar drink to
reduce sugar on the teeth. He is motivated to do so. This patient is extremely concerned with his oral health and
is honestly motivated to complete the treatment and keep up with frequent exams to maintain a healthy mouth.
3. Oral Examination: (lesions noted facial form, habits and awareness, consultation).
This patient has clicking of the TMJ often but it does not cause him pain. The patient had lineal alba on the right
buccal mucosa, etiology: mild cheek biting. He also had generalized melanin pigmentation on his attached
gingiva due to developmental pigmentation. Patient said he did not clench or grind but examination of the teeth
showed otherwise.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
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a. Case Classification: V Periodontal Case Type: III

b. Gingival Description:
Appt 1:
(9/16/15) The patient has cleft architecture on the lingual of 24, 25 and 26, the remaining teeth were
scalloped. The gingiva was generalized red in color. Consistency was edematous/spongy generalized.
The margins were rolled in the posterior facial and lingual, anterior facials in both the maxillary and
mandibular. Papillae was generalized bulbous with blunted on 9, 10,11,21,22. No suppuration. Surface
texture of papillary, marginal and attached was smooth and shiny, generalized.
Appt 2:
(9/22/15) At appointment 2 no ultrasonic/scaling had been done so the gingiva was still very much the
same as the first appointment.
Appt 3:
(9/29/15) The most recent appointment, no ultrasonic had been done in the previous appointments due to
radiographs being taken, paper work and full periodontal charting. The gingiva was slightly redder than
the previous appointments after periodontal charting due to irritation from probing.
Appt 4:
(10/6/15) The mandibular right had been ultrasonic in the previous appointment so there was a slightly
less redness to the gingiva.
Appt 5:
(10/14/15) In the previous appointment, mandibular right had been fine scaled and showed a great
reduction in redness. The maxillary right had been ultrasonic but redness was still noticeable in this
quadrant and the maxillary left and mandibular left quadrants at this appointment.
Appt 6:
(10/29/15) Healing was visible in the mandibular right and maxillary right quadrants; they had been
completely untrasoniced and fine scaled by this appointment. Maxillary left was showing less redness
but had not been fine scaled until this appointment so the color was red but not as red and inflamed as
the previous appointment.
Appt 7:
(11/3/15) Maxillary right and left, along with mandibular right quadrants were visibly less red and
healthier than when we first began. Mandibular left had reducing red color but still had to be fine scaled
so I believe it could have shown a much healthier appearance.
Appt 8:
(11/17/15) The final post calculus appointment. The patient showed a great reduction in red color. His
gingiva had turned into a more pink like color, less puffy and inflamed. The condition of his gingiva
showed to be much healthier clinically than when we first began treatment.
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c. Plaque Index:
Appt 1: (not taken due to 2 hour appointment and FMX.)
Appt 2: (not taken due to paperwork being checked and full periodontal charting.)
Appt 3: 3.2
Appt 4: 1.16
Appt 5: 0.3
Appt 6: 0.6
Appt 7: 0.5
Appt 8: 0.6
d. Gingival Index:
Initial: 1.5
Final: 1.25
e. Bleeding Index: (was not taken until appointment 3)
Appt 3: 32%:
Appt 4: 12%
Appt 5: 10%
Appt 6: 9%
Appt 7: 18%
Appt 8: 16%
f. Evaluation of Indices:
1. Initial: His Plaque Index was fair along with Bleeding and Gingival Index. He has the potential to
improve all 3 scores greatly.
2. Final: Over 8 appointments with ___ his gingival index decreased by .25 which is great! His plaque
index went down each appointment until his last post Cal appointment, it increased by .1. I feel like that
was probably due to having a week off from seeing him and reminding him of the importance of keeping
up with proper brushing and flossing. He was also increasingly stressed over school, so I feel that his
oral health was not one of his main priorities. His Bleeding index also decreased the first four
appointments but then at appointment 7, his bleeding score doubled. It decreased when he returned for
his post Cal appointment. Its discouraging to not have a complete reduction in bleeding but he did have
a lot going on and I do believe he slacked off on his part with brushing and flossing at home.

g. Periodontal Chart: (record baseline and first re-evaluation data)

1.Baseline: This patient had a highest probing depth of 6mm on the lingual of 32. He had very
generalized pockets of concern that were 4-5, mainly in the posterior. He had attachment loss on edge of
#9. He also had class 1 furcation on the lingual of #18 and lingual and facial of 32. He had attachment
loss on 9(lingual and facial), 10, 24,25,26,27 (lingual). His highest CAL was 5 on the facial/distal of 14
and the lingual/distal of 9.
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2. First Re-Evaluation: When ___ returned for his Post Calculus appointment, in his reevaluation of
periodontal charting his gingival conditions healed greatly! ___had no pockets above 4 mm, meaning his
pocket depths of 5-6mm healed! He did have a high CAL of 5 on the lingual of #10. He had attachment
loss on the lingual of #23-27 which was present at the baseline evaluation. He also has some attachment
loss on #9 buccal and lingual and #10. Arun still had class 1 furcations on lingual of #18 and
buccal/lingual of #32. Overall his gingival condition based on his periodontal charting healed greatly.

5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions.)
The patient had no caries or areas of concern. He had a metal alloy restoration on the lingual of #9, and a
missing restoration on the lingual of #10. He had a chip on the incisal edge of 9. He had slight attrition on the
incisal edges of #6, #11 and #27 caused by slight clenching/grinding at night without the patients realization.
The patient had occlusal examination of 1s all around, molar and canine. He had no open-bite, cross-bite,
midline shift and his overbite and over jet was within normal limits. He does not mouth breath or have a tongue
thrust. The patient had class 1 furcation on tooth 32 facial/lingual and 18 lingual.
6. Treatment Plan: (Include assessment of patient needs and education plan)
Appt 1:
(9/16/15): Medical/Dental history was taken, pre-rinse was done. FMX was ordered to check for bone loss
levels. Periodontal assessment and Head and Neck were started but not finished. Chair side patient education
was over flossing twice a day to help with gingival bleeding. Patient learning level was self-interest.

Appt 2:
(9/22/15): Medical/Dental history was taken, pre-rinse. Periodontal Assessment was completed along with Head
& Neck Exam and Dental Charting with radiographs. Signed informed consent, risk assessment was completed.
Full Periodontal Charting was completed. Chair side patient education was over mouth rinse to help with
xerostomia, remove bacteria and add fluoride. Asked patient to try and add it into daily routine. Patient learning
level was self-interest.
Appt 3:
(9/29/15): Medical/Dental history was taken, pre-rinse. Plaque score was taken for the first time 3.2, along with
bleeding 32% and gingival index 1.125. Patient Education session 1 was first Long Term goal: Reducing plaque
score. His short term goals are 1. Identifying the right brushing method. 2. Brushing twice a day. 3. Brushing for
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two minutes. 3. Defining plaque. Learning level was involvement. Began ultrasonic scaling the mandibular right
but did not get to fine scale the quadrant.
Appt 4:
(10/6/15): Medical/Dental History was reviewed, pre-rinsed and took plaque and bleeding scores (1.16, 12%).
We completed fine scaling of mandibular right. We did patient education session 2 were we talked about the
second long term goal, Halting Periodontitis. His short term goals are 1. Defining periodontitis. 2. Proper
flossing technique. 3. Flossing twice a day. 4. Frequent recall appointments. Began ultrasonicing maxillary
right.
Appt 5:
(10/14/15): Medical/Dental History was reviewed, pre-rinsed and plaque and bleeding scores were taken (0.3,
10%). Patient Education session 3. We discussed the third long term goal, reducing patient sensitivity. His short
term goals were 1. Fluoride treatment. 2. Rinses and toothpaste with fluoride. I fine scaled maxillary right and
untrasoniced maxillary left.
Appt 6:
(10/29/15): Medical/Dental History was reviewed, pre-rinse, plaque and bleeding scores were taken (0.6, 9%). I
fine scaled maxillary left and ultrasonic mandibular left. Chairside patient education was over flossing in a cshape around the tooth, every day beginning once a day. To clean below the gingiva and interproximal.
Appt 7:
(11/3/15): Medical/Dental History was reviewed, pre-rinse and plaque and bleeding scores were taken (0.5,
18%). I fine scaled mandibular left, completing all four quadrants. I did plaque free and gave a fluoride
treatment via tray. Chairside patient education was over fluoride and how it puts a protective barrier over the
teeth to protect from decay and bacteria breaking down the tooth surface. Learning level was self-interest.

Appt 8:
(11/17/15): Medical/Dental History was reviewed, pre-rinsed, plaque and bleeding scores were taken (0.6,
16%). Post calculus evaluation was completed along with post periodontal charting of all four quadrants.
Chairside patient education was over continuing a routine of flossing and brushing twice a day, using the correct
methods taught during our patient education sessions. Learning Level was Habit. His final gingival statement
was generalized moderate periodontitis with moderate bleeding. Recall of 3 months due to periodontal
condition and he had no referrals.

7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony crests, thickened
lamina dura, calculus and root resorption.)
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Moderate bone loss on upper anterior (7-11) lower anterior (22-27) lower left (19-21). Calculus on teeth 7, 8,
10, 23-26, 18, 20, 14, 12, 21, 31, 30, 29 which helps me identify areas that may be difficult to scale. Caries on
10 lingual. Defective restoration on 10 L.
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.
Appt 1: It was exciting to find out through radiographs he was eligible to be my periodontal patient. He
complains often of bleeding, it worries him a lot so we talked about flossing twice a day to help reduce that. He
has researched way to help with it but decided coming to us was the best treatment. He is very excited to start
cleaning.
Appt 2: He was very patient with me today while we finished up all his paperwork and did his full periodontal
charting. We talked about mouth rinses to help with xerostomia and bad breath. He is very involved and wants
to do whatever it takes to get his mouth back in good health. He said his bleeding is not as bad as it had been but
still there sometimes.
Appt 3: We got to take plaque score (3.2) bleeding score (32%) and gingival index ( 1.125) today and he is
aware that his numbers could be much lower so in our first patient education session we talked about the proper
brushing method and using a 45 degree angle to not only brush the teeth but the gingiva also. I gave him a
rundown of the long term and short term goals I made for him. He was very interested in the disclosing solution
we used and plans to buy some for himself so he can see what spots he is missing he is an amazing patient to
work with; he wants to do what he can to make his oral health better.

Appt 4: During this appointment we reviewed medical and dental history, pre-rinsed and took plaque and
bleeding scores. He showed improvement in both, 1.16 for plaque and 12% for bleeding. We were both excited
about that. We continued on with our second patient education session where we talked about halting
periodontitis. His short term goals were over the (1) proper way to floss, in a c-shape that wrapped around the
teeth. (2) Flossing twice a day. We went over the previous patient education session and reviewed what was
taught and also went over the third session. He was very responsive during our session he asked lots of great
questions and remembered exactly what was taught the session before. We went back to the chair and I fine
scaled mandibular right and untrasoniced maxillary right He continued to have his motivated attitude and
seemed very concerned about his oral health. I think showing him my patient education book full of severe
periodontitis cases, scared him. He did not want that to happen to his mouth.
Appt 5: During appointment 5, we reviewed medical/dental history, pre-rinsed and took plaque and bleeding
scores. His scored decreased this appointment compared to his last. Plaque was 0.3 and bleeding was 10%. He
mentioned how he was keeping up with brushing and flossing but flossing twice a day was hard. We went on
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with our third and final patient education session where we talked about prevention of carried with fluoride that
is found in toothpaste and mouth rinses along with the treatment we give at the clinic. We reviewed the past
patient education sessions and he showed me his brushing and flossing methods that I had taught him. His
attitude was still motivated and positive towards improving his oral health. We went back to the chair and I fine
scaled the maximally right and ultrasonic maxillary left.
Appt 6: In this appointment we reviewed medical and dental history, pre-rinsed and took plaque and bleeding
scores. Both had improved since the last visit, 0.6 for plaque and 9% for bleeding. He was in good spirits and
still completely motivated. He was very excited that he has no bleeding when brushing or flossing. I fine scaled
maxillary left and untrasoniced mandibular left. Our chairside patient education was over continuing to floss in
a c-shape method. He complained about flossing twice a day and how it was difficult, so I mention to put it in
his routine to do it at least once a day for now and to use floss picks or toothpicks after meals. They are an
easier, faster method and still remove food debris. So I gave him some samples to get him started.
Appt 7: Medical/Dental History was reviewed, pre-rinsed and a plaque and bleeding score was taken. His
bleeding score increased from the last time, 0.5 and 18%. His bleeding score doubled. He confessed that he had
slacked up on brushing and flossing twice a day because he was busy with school work. So we talked about the
importance and I showed him pictures of what could happen if he continues to slack, that it will become a habit
and his disease will worsen. He promised me he would get back on track! I fine scaled mandibular left and did
plaque free and a fluoride tray treatment. Our chairside patient education was over fluoride and how it puts a
protective coating over his tooth surfaces to prevent decay. His learning level was self-interest.

Appt 8: This was our post calculus and post periodontal charting appointment. We reviewed medical and
dental history, pre-rinsed and took final plaque. Bleeding and gingival indices for the semester. His plaque score
had increased to 0.6, bleeding had decreased to 16% and gingival index was 1.25 which was a .25 decrease
since the initial appointment. He said with school work he was still slacking on brushing and flossing but doing
better than before. He never skipped a day; just somedays would not get to floss twice. We did our post calculus
appointment which turned out great and his post periodontal charting turned out great too His post perio
charting was very positive; he healed quite a bit and had no pockets greater than 4mm. He still had some areas
over recession but his pockets of 5-6mm had decreased. This was all very good news. He was just as excited as
I was. We reviewed the proper brushing and flossing methods as a part of his chairside patient education and I
stressed how important it was that he continued on with this information to stop the progression of his disease. I
also stressed how important it was for him to come back in 3 months for a recall appointment and cleaning. He
said he would be back and that as much as he loved seeing me every week, he would be very happy to only
have to come back once or twice next semester!
9. Prognosis: (Based in attitude, age, number of teeth, systemic background, malocclusion, tooth morphology,
periodontal exam, re-cares availability.)
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Based on the findings over the past 8 appointments with ____ I think he has a good prognosis. He has all 32 of
his teeth, a few areas of attrional decay and a few spots of clinical recession. He was 29 when we began and is
now 30 with all of his teeth, no caries. He has the knowledge of how to maintain good oral health and has the
positive attitude to use it. He is very motivated and concerned with his oral health. Showing him pictures of
what could happen if he doesnt keep up with his oral health was a great tactic, I think those pictures opened his
eyes to how serious this can get. I believe he has a good prognosis and will return for appointments to maintain
his oral health.
10. Supportive Therapy: (Suggestions to the patient regarding re-evaluation, referral and recall scheduled.)
For him I suggested to continue with brushing and flossing twice a day. No matter the situation always brush at
night after dinner. Try to add in flossing twice a day a minimum of once a day if he has a busy day. His
reevaluation showed positive results, meaning that his gingiva was healing and loss of attachment areas were
healing up. I told him to imagine how much healing could occur if he kept up with the right brushing and
flossing methods twice a day or more. He had no referrals, his 3rd molars were in perfectly and cause no pain or
issues, he had no areas of decay, and the Dentists checked him out to be in great shape. He is on a 3 month
recall, so he will be see next semester around February 17th. He will not come as many times as he did this
semester since he will not be a perio patient but depending on the student he gets it could be a one or two visit
appointment. He is aware and motivated to come back and maintain his oral health.

11. Assessment of Changes: (Including plaque control, bleeding tendency, gingival health, probing depth)
Over the 8 appointments with ____ his plaque and bleeding scores decreased all but one appointment in which
he took the blame for not staying on a steady brushing and flossing schedule. I know he is aware of the right
ways to brush and floss; it is all up to him now to maintain the right schedule with brushing and flossing twice a
day if not more often. He did had great bleeding when we first began and that was one of his main concerns but
over the semester his bleeding decreased and he always kept me up to date that his bleeding at home had
completely stopped. I know this is due to being introduced to flossing, something he barely did before. His
overall gingival health improved greatly, his appearance was no longer red, puffy and inflamed but now, pink
and very pleasing. His gingival index went down by .25 which is great! His probing depths decreased, in his
post periodontal charting he had no pockets over 4mm. Showing that his 5-6mm pockets he had at the initial
charting, healed!
12. Patient Attitude and Cooperation: He is a great patient to have, he was very corporative, very motivated
to improve his health. He had a few slip ups on running late but was always there as soon as possible and stayed
the whole length of time I needed him. He even recruited me more patients that I saw this semester. After seeing
him 8 times over the semester he turned out to be a great friend and patient. I see a good prognosis for his oral
health as long as his keeps up with his part at home.
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13. Personal Evaluation/Reaction to Experience:

This overall experience was definitely a learning one. It taught me allot of patience too. This felt like a project
and it took quite a bit of time and planning but to see his re-evaluation results makes me feel like I did well in
teaching him and guiding him on the right path to good oral health. I think this is a very important lesson to go
through as students to help guide someone to healing, to teach them how to halt their disease and to see positive
changes, makes for a great learning tool. I was not excited for this when we first began but over time, I realized
how much I was learning and benefiting myself as a student. I enjoyed having him as my patient he turned out
to be a great friend of mine and I hope to be the one to recall him next semester.