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Mayra Quiroz

Periodontal Care Plan

Patient Name: Javier Quiroz Age: 55


Date of initial exam: September 19, 2017 Date completed: October 31, 2017

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.

 The patient currently has no medical problems that will complicate his dental treatment.
His last physical was in May 2017 and stated that the results showed he had good overall
health. Patient has no allergies and is not on any type of medication. He has a physician
in Mexico, however, if any type of medical emergency or problem were to show up at any
time, he faces the disadvantage of not being able to see him immediately to get treated.
There are many issues that could take place within the body that can contribute to
periodontal disease. If these issues go unnoticed than the consequences can affect the
oral cavity and the patient’s overall health. For this reason, I encouraged him to find a
local physician where he can receive health examinations to ensure he remains in good
general health. The patient does not have any history of cardiovascular disease and does
not drink any alcoholic beverages nor does he use any tobacco products. Patient’s medical
history does not display any need for pre-medication nor requires a medical clearance to
continue with his dental treatment plan. His vitals were all within normal limits except for
blood pressure, it was within the standards of stage 1 hypertension. I used this to stress
even more the importance of having a local physician to have that check and controlled
if persisted, since it can potentially lead to heart problems.

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’s chief complaint for visit is for a “cleaning” and feels “good” about the
appearance of his teeth/smile. His last dental visit was in December of 2015 for a tooth
extraction. The procedure and treatment were done at a dental clinic in Mexico. Due to
infrequent dental visits, the patient was unaware of his present dental disease. The
patient stated that his teeth are sensitive to cold, which can signify he has exposed dentin.
He also stated that sometimes when he brushes his gums bleed, a major sign of the active
periodontitis. Infrequent dental visits correspond with overdue professional dental
cleanings that result in calculus accumulation. The patient stated that the last x-rays he
received were bitewings somewhere in the year of 2010. He does not remember taking a
panoramic nor a full mouth set of x-rays. He has a lot of restorative fillings, indicating a
history of improper home oral care. I recommended the patient to find a local dentist as
soon as possible in order to begin having regular dental check-ups after treatment with
me, but then stated that he does not have any dental insurance which is the main reason
why he had not looked for one before. I informed him of the importance of maintenance
recalls and recommended he start having his teeth cleaned on a 3-month recall at LIT or
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dental office to help halt the progression of periodontitis, along with good personal oral
hygiene of course. He uses a soft-medium bristle toothbrush, and brushes once a day with
occasional bleeding on gums. I told him that bleeding is directly related to plaque
(bacteria) accumulation and is a major contributor to periodontal disease. Rinsing,
fluoride and other home care aids are not currently used by the patient. He stated that
he does not floss, which allows plaque to calcify subgingival and in between teeth forming
calculus. All of these oral hygiene habits are contributing factors that have slowly
progressed the patient’s periodontal condition from gingivitis to a moderate form of
periodontitis. If the inflamed area with bacteria of plaque is not adequately removed, this
will cause the progression of his periodontal disease be more severe and could potentially
lead to more destruction of the periodontium.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)

• There were no findings for the extra oral examination. However, during the intraoral
examination all that was noted was a small round papule that measured 2mm located on
the labial mucosa of his lower lip, most likely caused by an accidental bite. He does not
have the oral habits of clenching, grinding, mouth breathing, or tongue thrust.

4. Periodontal Examination: (color, contour, texture, consistency, etc.)

a. Case Classification: 4 Periodontal Case Type: 3

b. Gingival Description:

Appt 1: (9/19/17)

He has scalloped architecture with slight redness generalized on the marginal gingiva. The
consistency of the tissue is slightly edematous/spongy generalized on the mandibular marginal
gingiva. The margins are generalized slightly rolled and the papillae are normal. No suppuration
was evident. The surface texture on the papillary & marginal tissues is generalized smooth and
shiny on the mandibular arch and generalized smooth and shiny on the attached gingiva.

Appt 2: (9/21/17)

He has scalloped architecture with slight redness generalized on the marginal gingiva. The
consistency of the tissue is slightly edematous/spongy generalized on the mandibular marginal
gingiva. The margins are generalized slightly rolled and the papillae are normal. No suppuration
was evident. The surface texture on the papillary & marginal tissues is generalized smooth and
shiny on the mandibular arch and generalized smooth and shiny on the attached gingiva.
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Appt 3: (9/26/17)

He has scalloped architecture with slight redness generalized on the marginal gingiva. The
consistency of the tissue is slightly edematous/spongy generalized on the mandibular marginal
gingiva. The margins are generalized slightly rolled and the papillae are normal. No suppuration
was evident. The surface texture on the papillary & marginal tissues is generalized smooth and
shiny on the mandibular arch and generalized smooth and shiny on the attached gingiva.

Appt 4: (10/5/17)

He has scalloped architecture with slight redness generalized on the marginal gingiva, however
there has been less redness on maxillary right quadrant. The consistency of the tissue is slightly
edematous/spongy generalized on the mandibular marginal gingiva. The margins are
generalized slightly rolled, however it is less on the maxillary right. The papillae are normal. No
suppuration was evident. The surface texture on the papillary & marginal tissues is generalized
smooth and shiny on the mandibular arch and generalized smooth and shiny on the attached
gingiva.

Appt 5: (10/12/17)

He has scalloped architecture with slight redness generalized on the marginal gingiva, however
there has been less redness on maxillary and mandibular right quadrants. The consistency of
the tissue is slightly edematous/spongy generalized on the mandibular marginal gingiva. The
margins are generalized slightly rolled, however it is less on the maxillary and mandibular right.
The papillae are normal. No suppuration was evident. The surface texture on the papillary &
marginal tissues is generalized smooth and shiny on the mandibular arch and generalized
smooth and shiny on the attached gingiva.

Appt 6: (10/18/17)

He has scalloped architecture with slight redness generalized on the marginal gingiva, however
there has been less redness on maxillary right quadrant and mandibular arch. The consistency
of the tissue is slightly edematous/spongy generalized on the mandibular marginal gingiva. The
generalized rolled margins have reduced notably. The papillae are normal. No suppuration was
evident. The surface texture on the papillary & marginal tissues is generalized smooth and shiny
on the mandibular arch and generalized smooth and shiny on the attached gingiva.

Appt 7 (10/31/17)

He has scalloped architecture with now a pink-to- red color on the marginal gingiva. The
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consistency of the tissue is slightly edematous/spongy on the mandibular marginal anterior


gingiva but less than the previous appointment. The margins are slightly rolled around the
mandibular anterior area. The papillae are normal. No suppuration was evident. The surface
texture on the papillary & marginal tissues is generalized smooth and shiny on the mandibular
arch and generalized smooth and shiny on the attached gingiva.

c. Plaque Index: Appt 2: 2.3/Fair 3: 1/Good 4: 0.6/Good 5: 0.3/Good 6: 0.5/Good


7: 0.3/Good

d. Gingival Index: Initial: 1.3/Fair Final: 0.6/Good

e. Bleeding Index: Appt 2: 19% 3: 19% 4: 19% 5: 11% 6: 6% 7: 3%

f. Evaluation of Indices:

1. Initial: Evaluating these indices simply gave additional proof that the patient has poor overall
oral health. These indices allow us to see where the patient sits in regards to the patient’s
prognosis of periodontal case type III, moderate periodontitis. The plaque index of his first
appointment was 2.3 or fair. He has moderate generalize plaque with large amounts of
accumulation found in the mandibular anterior facial area as well as the interproximal and
facial areas of the posterior teeth. This value is greatly linked to why he has generalized gingival
inflammation. His bleeding index was 2% and gingival index was 1.3 - Fair as well. The indices
are rated lower than good because of all of the bacteria that is taking place in his oral cavity.

2. Final: My patient’s plaque score and bleeding score have improved throughout the course of
his treatment. Although during the first few 2-3 appointments the numbers remained fairly the
same, after beginning the patient educations sessions they began to lower. I praised him each
time because it proved to me that he was doing his part at home and it also motivated him to
continue in doing so. Nevertheless, the goal is to reach 0 for both scores so there still is room
for improvement.

g. Periodontal Chart: (Record Baseline and First Re-evaluation data)

1. Baseline: Patient has generalized pocket depths ranging from 3-4 mm on maxillary teeth
lingual side and localized depths ranging from 3-4 mm on mandibular teeth facial side.
These measurements indicate an early sign of unhealthy pocket depths. The patient needs to
be educated on it in order to stop further progression of receding pocket depths and
periodontitis. With proper brushing and flossing, the patient can help his tissues regain some
attachment to the teeth. The patient currently has no recession and is missing tooth #1, #14,
#16, #18, #19, #30, and #31. Patient has no mobility or suppuration.
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2. First re-evaluation: After cleaning all of my patient’s quadrants, we waited two weeks to
allow the tissues to heal before having him come back in for his re-evaluation appointment. I
then did full perio charting and noticed a lot of improvement in his pocket depths. Although
there still are a few, lot of the 4mm pockets (maxillary linguals and mandibular facials) have
gone down to 3mm which are now considered WNL. However, my patient had one pocket
depth of 5mm (his highest) on the mesial of #32 and unfortunately it is still there, proving that
periodontitis truly is irreversible. I hope that the Arestin I placed there will help it go down to a
3-4 mm pocket. The majority of CAL’s have gone down to 0-1 which is great! As for the pockets
with 1-3mm, there were a few changes but the majority stayed the same.

5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth,


occlusion, abfractions)

 Mid-line shift: 2mm to the left


 Right/Left canine occlusion: I / I
 Right/Left molar occlusion: unclassifiable due to missing molars on both arches
 Overbite: 3 mm / WNL
 Overjet: 2 mm / WNL
 No open or cross bite
 Attrition on mandibular anteriors and maxillary canines
 Patient has no abfractions
 Patient does not have any mal-relation groups of teeth

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

Appt 1:

 Check completion of statement of release, acknowledgment of HIPAA, and patient


appointment practice form. Review medical/dental history, pre-rinse, take FMX to
evaluate bone loss and caries detection, intra/extra oral exam, begin periodontal
assessment, begin dental charting with x-rays, acquire plaque and bleeding score
 Learning level: unaware. Patient displays poor plaque control, which is shown to the
patient on the facial, buccal, and lingual surfaces, as well as the interproximal of all
teeth. Patient is not aware of severity of his bone loss. Brushing at a 45-degree angle is
explained to patient in order to adequately remove plaque.

Appt 2:

 Review medical/dental history, pre-rinse, acquire plaque and bleeding score, finish
periodontal assessment, finish dental charting, complete risk assessment, complete
informed consent, acquire gingival index, get plaque score and bleeding score
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 Learning level: The patient is becoming more aware of his disease and is becoming
involved and interested in the treatment to halt the progression of it

Appt 3:

 Review medical/dental history, acquire plaque and bleeding score, pre-rinse


 Patient Education Session I: Plaque/brushing
 Briefly discuss all patient education topics as well as long and short-term goals before
beginning the session to ensure they are realistic and attainable:

LTG 1: Reduce plaque score to .8 by re-evaluation appointment

STG: Define plaque – soft white sticky substance

STG: Demonstrate proper brushing technique on typodont and himself – bass method

STG: Reduce plaque score by .3 at every appointment

LGT 2: Halt progression of his periodontal disease by last recall appointment

STG: Define periodontitis – inflammation of the gingiva with loss of bone

STG: Demonstrate proper flossing technique on typodont and himself

STG: Minimize pocket depths to 3mm or less by re-evaluation appointment

LGT 3: Importance of 6-month recall appointment

STG: Preventive appointments help you remain in good oral health

STG: Look for local dentist or decide to stay at LIT by last appointment

STG: Schedule 3-month recall appointments to ensure disease is being halted

• Patient will learn what plaque is by using the information and pictures in my flipbook,
and how it affects the oral cavity
• I will demonstrate the toothbrushing Bass Method technique on a typodont, explaining
the importance of positioning the tooth brush at a 45-degree angle towards the gum in
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order to effectively remove the remaining plaque that sits within the gingival sulcus or
“space”
• I will then show the patient to brush his front teeth using a vertical motion to remove
the plaque that sits on the lingual side, since he has a lot of build-up in that area
• He will then practice the demonstrated techniques on the typodont to ensure he has
correct understanding of it
• I will explain to the patient that the tongue has a large amount of bacteria from plaque
and should also be brushed vertically at least 4 times, which will help avoid bad breath
• The patient will understand the importance of brushing at least twice a day with a soft
bristle toothbrush
• I will then have the patient go to the sink and place disclosing solution on his teeth. It
will be explained to him that the solution allows us to see what areas were missed that
still have plaque and in result see where he needs to brush more effectively
• Next, I will have the patient sit back down and ask him questions about the session
• Lastly, I will state that we are a TEAM and that although I will do my part to improve his
oral health, it is crucial that he too does his part at home too. If he ever has any
questions for me I will be more than glad to answer them.
• Once the patient education session is done, we will go back to the cubicle and have him
sit back in the chair.
• Local/Topical anesthesia will be placed if needed before beginning to ultrasonic and fine
scale the first quadrant

Appt 4:

• Review medical/dental history, acquire plaque and bleeding score, pre-rinse


• Patient Education Session II: Periodontitis/flossing
• Briefly go over last patient ed of plaque and brushing and allow patient to demonstrate
previous skill taught before beginning today’s session
• Praise patient for the short-term goals he has met
• I will explain to the patient what periodontitis is using the information and pictures of
my flipbook. The inadequate removal of plaque and non-use of flossing has led him to
be at this periodontal disease state. The damage at this stage is NON reversible, so it is
crucial to halt the disease as soon as possible to prevent further destruction
• I will explain the importance of removing interproximal plaque with flossing since a
toothbrush cannot easily reach those areas, using my flipbook as an aid, and that he
should try to do it at least 2-3 times per week
• I will demonstrate how to wrap floss around fingers and how to correctly floss on a
typodont: curve the floss into a “C” shape around tooth, going up and down several
times against it. Use a clean section as you move from tooth to tooth. Avoid snapping
the floss between teeth
• I will then have him practice and show me the flossing technique on the typodont
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• Next I will take him to the sink, apply disclosing solution to his teeth and have him floss
first then brush. I will re-apply disclosing solution to let him see what areas he removed
plaque and what areas he missed to see where he needs to floss more effectively.
• After, I will have the patient sit back down and ask him questions about the session
• Lastly, I will state that we are a TEAM and that although I will do my part to improve his
oral health, it is crucial that he too does his part at home too. If he ever has any
questions for me I will be more than glad to answer them
• Once the patient education session is done, we will go back to the cubicle and have him
sit back in the chair. I will evaluate his tissue response to the scaling done at the
previous appointment and periodontal chart.

 Local/Topical anesthesia will then be placed if needed before beginning to ultrasonic


and fine scale the second quadrant

Appt 5:

• Review medical/dental history, acquire plaque and bleeding score, pre-rinse


• Patient Education Session III: 6-month re-call appointments
• Briefly go over last patient ed of periodontitis and flossing and allow patient to
demonstrate previous skill taught before beginning today’s session
• Praise patient for the short-term goals he has met
• I will then have the patient go to the sink and apply disclosing solution to his teeth. He
will demonstrate both the brushing and flossing techniques will evaluate his use of the
techniques as well as the result he gets from them
• We will discuss how recall appointments, whether it be 3 or 6 months apart, help keep
patients on track to maintain good oral health
• After, I will have the patient sit back down and ask him questions about the session as
well as go over the main points. I will remind him to brush at least twice a day and floss
2-3 a week – if not the disease will progress and thus more destruction will occur
• We will discuss getting him on 3-month recall whether it be at the LIT clinic or at a
dental office to ensure that the progression of the disease is being halted
• Lastly, I will state that we are a TEAM and that although I will do my part to improve his
oral health, it is crucial that he too does his part at home too. If he ever has any
questions for me I will be more than glad to answer them.
• With it being the last patient education session, I will thank him for his time and effort
before heading back to the cubicle
• Once we’re back in the chair, I will evaluate his tissue response to the scaling done at
the previous appointment and periodontal chart
• Local/Topical anesthesia will be placed if needed before beginning to ultrasonic and fine
scale the third quadrant
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Appt 6:

• Review medical/dental history, acquire plaque and bleeding score, pre-rinse


• Chair-side Patient Education: Explain the importance of regular dental care visits and
how keeping up with his oral hygiene will help halt the progression of his disease
• Evaluate his tissue response to the scaling done at the previous appointment and
periodontal chart
• Local/Topical anesthetic will be placed if needed before beginning to ultrasonic and fine
scale the fourth and last quadrant

Appt 7:

 Review medical/dental history, acquire plaque and bleeding score, pre-rinse


 After waiting 2 weeks, I will evaluate his tissue response to the scaling done at all
previous appointments
 Obtain final gingival index and periodontal charting
 Chair-side Patient Education: Review skills of brushing and flossing and re-explain any
topics that the patient may still be uncertain of. Go once more over his long and short-
term goals to make sure they are being met
 I will then provide the antimicrobial Arestin for better pocket healing and re-attachment
 Lastly, I will have him be plaque free before applying fluoride

7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony crests,
thickened lamina dura, calculus, and root resorption)

 Patient has generalized mild-moderate horizontal bone loss in both arches


 Visible calculus on the mesial of teeth #17 and #3
 Teeth #2 and #3 have close root proximity
 Defective restoration on the distal of #5 – must be restored properly to avoid
demineralization around the restoration or even formation of a carious lesion
 No loss of crestal lamina dura, root anomalies, furcation’s, periapical pathology, or
adverse crown to root ratio can be seen.
 All these findings have put the patient in the LIT Periodontal Case type 3

8. Journal Notes: (Record in detail the treatment provided, oral hygiene education, patient
response, complications, improvements, diet recommendations, learning level, short and long
term goals, expectations, etc.) The progress notes should be written by appointment date.

Appt 1 (September 19, 2017): Treatment: reviewed medical and dental history, pre-rinsed,
took FMX survey to check bone level and for any cavities, began periodontal assessment, did
intraoral and extra oral exams. There were no complications while taking the x-rays or during
the exams. Patient Education: I showed him how to correctly brush his teeth using the bass
method, so that the bristles of the soft toothbrush can get under the pocket and remove the
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plaque. His learning level is involvement. He drinks 2-3 cokes a week, so for diet
recommendation I told him to bring it down to 1-2 cokes to lower sugar intake and prevent
cavity rate. His response was that he agreed and felt he would be able to do that.

Appt 2 (September 21, 2017): Treatment: reviewed medical and dental history, pre-rinsed,
finished periodontal assessment, completed dental charting with x-rays, took plaque score,
bleeding score, and initial gingival index, risk assessment, and inform consent. We calculus
detected to see if he was eligible to be my perio patient and he was. I explained to him that we
will be having patient education sessions for the next three appointments so that he can learn
more about his oral disease and how to be able to stop it and prevent it from reoccurring again.
I had no complications during the appointment.

Appt 3 (September 26, 2017): Treatment: reviewed medical and dental history, pre-rinsed,
took plaque score and bleeding score. He showed improvement in lowering his plaque score.
First patient education session: reviewed his long and short term goals, taught him the
definition of plaque and its role in the development of periodontal disease. We discussed the
Bass method brushing technique, demonstrating on a typodont and using my flipbook pictures,
that the brush needs to be at a 45 angle towards the gum line to remove the plaque that is in
the pocket. I also stated the importance of brushing at least 2x per day for 2 minutes and
tongue brushing doing 3-4 strokes to prevent bad breath. We went to the sink to test his new
learned skill and he did great. At the end of the session, he seemed confident in reaching these
goals and the only thing that we modified was his old method of brushing to the correct bass
method. The learning level at this appointment is involvement. After, I perio charted and
ultrasonic scaled maxillary right and began to fine scale it. No complications during treatment.

Appt 4 (October 5, 2017): Treatment: reviewed medical and dental history, pre-rinse, took
plaque score and bleeding score. Second patient education session: we reviewed the topics
from the previous education session as well as long and short term goals. The patient showed
improvement in brushing due to the lowered plaque score recorded and attained all the STGs
from the first patient education session. After, I taught the patient the definition of
periodontitis and how it affects the oral cavity. We also discussed flossing and how it’s essential
to remove plaque in between teeth where the brush cannot reach, especially on the distal of
tooth #8. I demonstrated to the patient the “C-method” and the seesaw technique when
inserting the floss using a typodont. We then went to the sink to test his new learned skill and
he did great. The patient’s learning level at this appointment is action. After, I perio charted,
ultrasonic and fine scaled mandibular right and finished fine scaling maxillary right. There were
no complications during the treatment.

Appt 5 (October 12, 2017): Treatment: reviewed medical and dental history, pre-rinsed, took
plaque score and bleeding score. Third patient education session: we reviewed the topics from
the previous session as well as long and short term goals. He showed improvement in flossing
due to the lowered plaque and bleeding score recorded and attained the first two STGs from
the second patient education session. I explained to him the importance of having re-call
appointments to maintain good oral health. I told him that dental cleanings along with his oral
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home care will ensure his periodontitis doesn’t reoccur. We then went to the sink to test one
last time the previously taught techniques of brushing and flossing and did good once again.
After, I perio charted, ultrasonic and fine scaled mandibular left. Applied 5% fluoride varnish.
There were no complications during the treatment.

Appt 6 (October 18, 2017): Treatment: reviewed medical and dental history, pre-rinsed, took
plaque score and bleeding score. The patient showed improvement in brushing and flossing due
to the lowered plaque score recorded and attained all the STGs from the third patient
education session. I perio charted, ultrasonic and fine scaled maxillary left (last quadrant). I
polished, flossed, and ensured he was plaque free before applying 5% fluoride varnish.
There were no complications during the treatment. Patient education: I recommended him to
rinse with warm salt water for the areas that were slightly inflamed around the maxillary
incisors. I then explained to him that at the next appointment I would be applying Arestin, an
antibiotic that is applied to the deep pockets he has in his mouth. I emphasized the importance
in home care to successfully complete the treatment and maintain good oral health. The
learning level at this appointment is action.

Appt 7 (October 31, 2017): Treatment: reviewed medical and dental history, pre-rinsed, took
final plaque score, bleeding score and gingival index. Completed full post perio charting and
explored mouth to look for any residual calculus. After, I placed Arestin on the maxillary incisors
and #32. I told him to avoid flossing in the area for 7-10 days. My patient’s response towards
the Arestin was that he liked the idea of how it works and how it helps. Patient education: once
again I emphasized the importance of home care to successfully complete the treatment and
maintain good oral health. Learning level is action. The only complication I had during his whole
treatment process was applying the Arestin, but after the first one I learned the trick of
flattening the tip and it was much easier. He stated that he will return next semester to
continue the maintenance of his oral health.

9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion,


tooth morphology, periodontal examination, recare availability)
I believe that my patient’s overall prognosis is good. He had a good attitude towards the
treatment and seemed surprised yet interested in how plaque was contributing to his
periodontal disease, as well as the brushing and flossing techniques I taught him. However, the
patient still needs to work on getting into the good habit of brushing twice a day and flossing at
least 3-4 a week. He is 55 years old and has the majority of his dentition except for tooth #1, 14,
16, 18, 19, 30, and 31. I stressed to him that to the distal of #8 needs to be extra clean because
of greater susceptibly to caries around the crown. The patient has no systemic background nor
does he take any medications. There are no concerns in regards with malocclusion or tooth
morphology. Although he did have generalized inflammation in his tissues during the
periodontal examination, his cooperation plus the addition of new good self-care habits will
allow him to have a much greater chance in halting the progression of his periodontitis. The
patient has good availability to come back in for recall. He is very flexible and can take off easily
from work. I am positive that he will come to his first recall date in three months.
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10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall
schedule.
During the re-evaluation appointment, I suggested to my patient to be more frequent when it
came to flossing and to try to reach doing it at least 4 times a week. I told him that if he needs
to there are flossing aids, such as the floss picks, that would make the job a little easier for him.
I also suggested him to use a mouth rinse that would aid in reducing the bacteria in his mouth. I
told him to make sure he continues to brush at least 2x per day for 2 minutes so that his
periodontitis does not return. If he does not, he will have to go through this long painful
process once again. He had no referral’s and no areas of decay. He is on a 3-month recall, so I
set up his next appointment to be around the first few days of February of next year.

11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health,
probing depths)
After reviewing the plaque indices of my patient, he has shown improvement of his plaque
control. This proves that he is being successful in completing proper oral home care. Although
there wasn’t a great difference between bleeding scores, a little improvement is better than
nothing and it goes to show that the healing is occurring slowly but surely. His gingival health
has also improved significantly. His gingival index has decreased by 0.7. A lot of his probing
depths have changed by his post evaluation appointment, majority of the 4mm pockets have
gone down to 3mm as well as the CAL to 0-1mm. Overall, my patient has improved greatly in
areas of plaque and gingival health. If my patient continues the proper home care and starts to
get into a routine of dental care, our main goal of fully halting his oral disease can be reached.

12. Patient Attitudes and Cooperation:


My patient’s attitude was positive and attentive. After I explained to him the severity of his
disease, it made eager him to want to get back into a good oral health state. He never
complained about having to come in multiple times. In fact, at each appointment, he would
come in with a motivating attitude. It really made me happy to see that he would remember
the majority of the highlights of the education sessions we had when questioned about them,
because it proved that he really was trying to improve his oral home care and health. He has a
good emotional status which allowed him to view things in a positive way to where it motivated
him to become better. I believe he will be very good at attending regular appointments in the
future.

13. Personal Evaluation/Reaction to Experience:


For me this was a great learning experience. I look back to when I began my first appointment
with my patient and I truly believe that I have learned a lot from completing this periodontal
case. During this project I found myself contributing more time and effort to the gingival tissues
and determining whether they were healthy or unhealthy. It honestly was amazing to see how
the gingival tissues transformed each week after removing the bacteria. This was the first
patient I have had the opportunity to recognize a change in tissue and understand what was
occurring. I believe that this assignment was really beneficial because it further educated me
with periodontitis and allowed me to visually see a real life change from disease to health state.