Student name: Sukirti Misra

PERIODONTAL CARE PLAN (PCP)

Patient Name : _________________ Age: 62 years

Date of initial exam: 09-07-2018 Date completed: _______

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 is 62 years old, she is 5’3” and weighs 160 lbs. She does not have a dentist that she
goes to on a regular basis. I explained the need for regular dental visits similar to physical and
how they are both equally important to identify diseases in early stages. She goes for regular
physical exams and the last one was done in March 2018. Presently the patient is not taking any
medications, but she mentioned some medications she takes on an as-needed basis. These as-
needed medications are Tramadol (for moderate to severe pain), Tizanidine (muscle relaxant) and
an inhaler that is used for seasonal allergies when needed. Patient also takes the following over
the counter medications: Calcium for osteoporosis, Tylenol for arthritis pain, Zyrtec for sinus
problems and Omeprazole for reflux/GERD. Except for Calcium all other medications are also as
taken as needed. Additionally, patient takes vitamin supplements as well. I advised patient to pay
close attention to the medical conditions she listed and notify her doctor if she experiences any
changes or worsening of symptoms. Since she is not on any medications for them regular
monitoring of these conditions is extremely vital. Patient was informed of the correlation between
periodontal disease and arthritis, osteoporosis and smoking. And even though these conditions
directly don’t cause periodontal disease however, their presence makes the patient susceptible to
acquire periodontal disease.
 Patient had a hysterectomy done 37 years ago.
 She had Hepatitis A infection 4-5 years ago due to a needle prick while working in a laboratory.
Patient has no known allergies.
 Patient uses tobacco produces for 10 years in the form of cigarette smoking 1 pack a day. She
mentioned trying to quit unsuccessfully three times and is unsure whether she wants to quit now.
I told the patient there are several benefits of quitting and to not get disheartened if she couldn’t
quit it in the past. I mentioned to the patient that whenever she feels ready to quit I would be
delighted to talk to help her about tobacco cessation in depth. We would work as a team to help
her get rid of the habit and there are several resources available to help her in doing so. Patient
does not use any other tobacco products, alcohol, drugs or other substances. Towards the end the
patient expressed willing ness to undergo tobacco cessation session with me.
 Patient’s vital sign readings are all within normal limits. Her blood pressure was 116/78 and it is
usually in that range. However, it is important to monitor vital signs at each appointment because
the values may vary based on patient’s stress level etc.
  Patient does not require pre-medications or medical clearance based on the medical history
provided.

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’s chief complaint or reason to visit is cleaning. Her last dental visit was 5-6 years ago for
teeth cleaning and that is when her last dental radiographs were done. It had been more than 5
years since her last radiographs therefore I did a full-mouth series of radiographs to look for caries
and bone loss. I also did vertical bitewings to better visualize the bone loss in comparison to the
horizontal bitewings which does not show the full extent of it.
 She mentions that at her last teeth cleaning she experienced a lot of sensitivity on her teeth and
felt that she wasn’t given adequate anesthesia. This experience contributed in her discontinuing
visit to the dentist. I explained to the patient that gum disease is “silent” and the patient may not
have any symptoms at all. However, if ignored the disease progresses with increased amount of
bone loss which is an irreversible condition. Since the bone is holding the tooth in place the worst-
case scenario for patients who do not seek treatment, could be tooth loss. Therefore, it’s very
important for her to maintain regular dental visits. An open communication is important between
the patient and the dental team and I assured the patient that I would do my best to make her
comfortable during the course of treatment. I also emphasized that for me her comfort will be my
top priority and requested her to let me know if she
 She is not happy with the appearance of her teeth/smile because of staining. I explained to her that
the stains on her teeth are due to smoking and coffee. These stains can be removed by professional
cleaning by the hygienist.
 Patient clenches her jaws and did not mention grinding her teeth. However, the clinical exam
shows generalized attrition so it may be assumed that she does it at night without her knowledge.
I recommended using a mouthguard to prevent excessive wear-down of chewing surfaces of teeth.
 There is no bleeding while brushing and flossing. I explained to the patient that tobacco use can
sometimes “mask” signs of gum disease such as bleeding. Therefore, it may be deceptive to
assume that gums are healthy based on no bleeding and we must evaluate other signs for gum
disease. Additionally, there is a positive correlation between tobacco use and gum disease. It is
important to do a thorough clinical exam along with radiographs to determine the correct extent
of gum disease.
 Patient takes sugar containing drink once a day (coffee). I told her to minimize the exposure of
teeth to sugary drink by avoid sipping on coffee for a prolonged time. Alternatively, she can
consume non-sugary foods such as, nuts and cheese along with the coffee to minimize the effect
of sugar exposure on teeth.
 She also chews Trident sugarless gum.
 Patient is currently using a Colgate toothbrush with soft bristles. I applauded the patient for
choosing soft bristles as that is the best option and to focus on the correct technique for brushing.
Patient was able to demonstrate brushing using the Bass technique and I appreciated her for using
it correctly. I reiterated that she brushes for at least 2 minutes and covers all surfaces of the teeth
 for example, the surfaces facing the tongue etc. I also recommended using an electric toothbrush
to make sure she brushes for the entire 2 minutes and better plaque and stain control. She brushes
2-3 times a day and flosses once. She mentioned difficulty in flossing lower front teeth and I
showed her with a hand mirror the calculus built-up on those surfaces. She uses a mouth rinse
(Act) once a day and uses Crest toothpaste. I told her that the most important feature for toothpaste
selection is the presence of Fluoride, since it makes teeth stronger and is beneficial in preventing
cavities. Patient does not use any other home care aids. All in all, patient seems to have fair oral
hygiene practices. For her, it is important to go for regular teeth cleaning and consider quitting
smoking to enhance treatment outcome.
 Her dental IQ can be considered good. She is aware of using correct toothbrushing technique. Her
irregular dental visits were a result of a bad experience at the dental office. It is possible that the
patient follows hygienist recommendations as she seems motivated in having better oral health.

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

EXTRAORAL AND INTRAORAL EXAM:

There were no significant findings on extraoral exam. No lymph nodes were enlarged and TMJ
findings were within normal limits. There was an atypical finding of palatine midline tori and I
explained to the patient that it does not require treatment unless it is inflamed or has a
pathology. Additionally, patient has a white coated tongue and explained to the patient that it
indicates presence of bacteria and it maybe a cause of bad breath. I talked to the patient about
cleaning the tongue gently with either a toothbrush or a tongue cleaner available at any
supermarket.

ORAL HABITS:

Grinding and clenching almost without knowledge. Grinding possibly during night time based
on generalized attrition. I explained to the patient on how the excessive grinding and clenching
forces are detrimental to the health of the periodontium. It is visible on radiograph in the form of
generalized widened periodontal space. Nightguard is strongly recommended for this patient
based on the extent of attrition.

OCCLUSAL EXAM:

Molar: Class I on both right and left side.

Canine: Class I on both right and left side.
Overbite: 2 mm
Overjet: 4 mm
Midline shift: 1 mm to the right side.
No open bite or cross bite.
Patient has excessive overjet and a midline shift, these findings along with crowding of lower
anterior teeth indicate malocclusion. Malocclusion causes abnormal masticatory forces on the
teeth and adversely affects the periodontal health. Additionally, presence of mal-positioned teeth
 contributes to increased plaque and calculus retention as they are harder to clean. A consultation
with an Orthodontist was recommended for crowding of lower front teeth. However, the patient
mentioned that the orthodontist did not recommend treatment for her because of extensive bone
loss. I advised patient to take extra time in brushing and flossing the areas where the teeth are
mal-positioned.

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

a. Case Classification: VII Periodontal Case Type: IV

b. Gingival Description: Generalized severe periodontitis with localized moderate bleeding.

App't 1: September 7th, 2018 (Baseline)

Architecture: Scalloped- generalized
Color: Pink- generalized and Red- lower anterior teeth
Consistency: Fibrotic- generalized and Edematous/spongy- lower anterior teeth
Margins: Rolled- generalized
Papillae: Blunted-generalized and Bulbous- between #24,25
Suppuration: None
Texture (papillary & margins): Smooth and shiny- generalized
Texture (attached): Smooth and shiny-generalized.

App't 2:
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App't 3:
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App't 4:
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App't 5:
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App't 6:
 c. Plaque Index:
App’t 1: 2.5 (Fair)
2_____ 3_____ 4_____ 5_____

d. Gingival Index:
Initial: 1.79 (Fair) Final _____

e. Bleeding Index:
App’t 1: 50%
2_____ 3_____ 4_____5_____

f. Evaluation of Indices:

1. INITIAL:
 The patient’s initial assessment showed that she had severe Generalized Periodontitis with moderate
localized bleeding. Localized bleeding maybe due to her tobacco use as the tissues become fibrotic
and mask the signs of inflammation. Hence it should not be considered healthy or absence of
inflammation.
 She has Generalized severe horizontal bone loss Additionally, she has generalized widened
periodontal ligament space and loss of crestal lamina dura.
 Patient’s Plaque score was 2.5 which is evaluated as being Fair. However, the goal is to achieve a
more ideal score of 0. The result of disclosing the selected teeth shows the patient needs to focus on
the following areas: #3- facial/mesial/distal, #14- the mesial/distal/facial, #19- mesial/distal/lingual,
#24-mesial/facial and #30- distal/lingual aspects. Better results can be obtained by proper brushing,
flossing, and routine dental visits.
 The Gingival index assesses severity of gingivitis based on the collection of color, consistency, and
BOP. Patient’s initial GI score was 1.79 which is considered Fair. As stated before, the goal is to get
her to 0 which will indicate healthy tissues. Her score was a consistent moderate inflammation on the
teeth evaluated with a few teeth with a less inflammatory signs. As described previously, signs of
gingival inflammation should be treated with caution as they may be masked due to the effects of
tobacco use by the patient.
 The patient’s Bleeding score was 50% which is relatively high. Her bleeding points were generalized
throughout her whole mouth. Most of the bleeding came from the molar teeth. This aligns with the
presence of deep periodontal pockets on those teeth. Bleeding points by quads: UR(#3,8)- 2 facial and
3 lingual surfaces, UL (#14)- 2 buccal 2 lingual surfaces, LL (#19,24)- 4 facial and 2 lingual surfaces
and LR (#30)- 2 facial and 1 lingual. This information shows the severity of her periodontal disease,
 bleeding in deep periodontal pockets and lack of routine dental cleanings. The patient needs to
practice meticulous oral hygiene to lower her plaque, gingival, and bleeding indices. It is important
to note that patient’s bleeding score may be actually higher and due to smoking the tissue is fibrotic
and does not bleed. This should be explained to the patient and tobacco cessation should be stressed-
upon.
 All three of the above indices are associated with periodontitis. If the patient applies all directions that
we will discuss in patient education sessions such as correct brushing method and flossing techniques
she can lower these scores greatly. Thus, even though periodontitis is not reversible however, the
disease process will be halted and further bone loss can be prevented. Patient needs to understand that
since her disease is at an advanced state it is even more important to act immediately and maintenance
by regular dental visits is crucial.

2. FINAL:
___________________________________________________________________________________

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

1.BASELINE:

 Patient’s periodontal assessment shows several pocket depths (PD) beyond the normal range of 1-
3mm. PD by quadrants: UR- molars have PD ranges from 4-8mm with the most severe reading for
#2- mesio-lingual at 8mm and # 3-disto-buccal at 7mm. #2 and 5 have 6mm PDs. UL- most severe
reading is at 6mm for # 11, 12, 14 and 15. LL- highest PD is 7mm for #19 on disto-buccal surface.
LR- highest PD is 6mm for # 29 and 31. It is important to note that patient had bands of subgingival
calculus and it prevented the probe from gathering the correct PD. For a more accurate PD it would
be advisable to re-record the reading after scaling has been completed.
 Tissue height: Patient has gingival recession for the following maxillary teeth: #2= 2mm, #3= 3mm,
#4= 1mm, #5= 2mm, #6= 1mm, #10= 1mm, #11= 2mm, #12= 3mm, #13= 1mm, #14= 3mm, #15=
2mm. All of the maxillary recession was on the facial side of the teeth. For mandibular teeth: #24=
4mm on facial aspect of the tooth surface. Similar to PD, gingival recession maybe incomplete due
to the presence of bands of supragingival calculus and will have to be re-recorded to obtain an
accurate reading. There was no suppuration associated with any teeth. Gingival inflammation was
generalized to the marginal and papillary areas with rolled margins. At each appointment one
quadrant will be scaled and a periodontal assessment will be repeated to obtain an accurate clinical
attachment loss (CAL) levels.

2. First evaluation
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5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions)

Missing has no wisdom teeth, they were extracted in her teens. There is generalized attrition on all
occlusal surfaces and cusps of posterior teeth and incisal surfaces of anterior teeth. There is toriversion
of teeth # 9 (disto-version), #21 (disto-version), #24 (disto-version) and # 26 (mesio-version). #23 is
in lingual version. These malpositioned teeth act as plaque and calculus retentive areas and I used a
hand mirror to show the patient the extent of calculus on these teeth. It is harder to keep these areas
clean and patient will need to spend extra time brushing and flossing these areas. There is
hypocalcification of teeth #10, 13, 14, 15 and 18. Since the patient has deep pit fissures and grooves
on all her posterior teeth it will be worthwhile to recommend sealants for all posterior teeth. Sealants
will help prevent food from getting stuck and forming cavities in the deep crevices of the teeth.
However, with the state of patient’s periodontal health this is not of top priority and can be performed
at the re-evaluation appointment.

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

App't 1:
 Review medical/dental history
 Pre-rinse
 FMX to view carious lesion and bone loss, along with vertical bitewings
 Head/Neck Examination
 Dental charting with FMX x-rays
 Periodontal Assessment
 Initial Bleeding Score
 Initial Plaque Score
 Risk Assessment
 Inform Consent with referral to Periodontist for advanced Periodontitis
 Take several pictures with the intraoral camera
 Learning Level: the patient is aware of good oral hygiene practices. However due to other factors
such as excessive amounts of calculus and tobacco use she scored fair evaluation on plaque
score and gingival index. I explained the importance of brushing for the entire 2 minutes and
angle the toothbrush at 45-degree angle to remove plaque on the marginal gingiva. Flossing is
important to remove the remaining plaque on the interproximal surfaces of the teeth. This will
be easier for the patient to accomplish after scaling has been completed and bands of calculus is
removed.

The assessment findings help to assess patient’s specific need, formulate a treatment plan and education
sessions that are designed to custom-fit the patient.
Treatment Plan-Patient Education Sessions for future appointments:
App't 2:

 Review medical/dental history

 Pre-rinse
 Bleeding and Plaque Score
 Assess gingival condition
 Ultrasonic and fine scale the lower right (LR) quadrant with anesthesia
 Full periodontal charting on LR with CAL
 Fine scale LR
 Patient Education session 1: Plaque and Brushing
 Progress notes and confirm appointment 3
 I will discuss the long and short-term goals to the patient through the data collection that I have
obtained. I would ask the patient if these goals are attainable and will figure other different
techniques that can help the patient to achieve these goals.

 Patient Education #1: Plaque & brushing

LTG- Reach a plaque score closer to 1 or less by last visit

STG-Patient will define plaque
STG-Patient will reduce gingival inflammation
STG-Patients will demonstrate correct brushing technique and to reduce plaque score by 0.5 at each
subsequent visit

Steps for Lesson 1: Plaque and brushing

 Teach topic (what it is) use flipbook/other visual aids
 Teach skill (brushing) by demonstration on typodont
 Allow patient to demonstrate skill learned at the sink and correct as needed
 Show where improvement is needed (disclosing solution – visual aid)/compare plaque scores
 Ask follow-up question to assess learning level
 Encourage patient by positive reinforcement
 Summarize the next session by a brief statement
 Let patient know that we are a TEAM

App’t 3:

 Review medical/dental history

 Pre-rinse
 Bleeding and Plaque Score
 Ultrasonic UR quadrant with anesthesia
 Fine scale maxillary-UL
  Full Periodontal Charting on UR with CAL
 Patient Education session 2
 Progress notes and confirm appointment 4

 Patient Education #2: Periodontitis & flossing

LTG-Patient will halt the progression of periodontitis disease

STG- Patient will define Periodontitis
STG- Patient will reduce gingival bleeding score of 10% or lower by each appointment and
shows improvement of reduction of periodontal pockets
STG-Patient will demonstrate flossing techniques

Steps for Lesson 2: Periodontitis and flossing

 Discuss goal attainment from last session (compare plaque score/bleeding scores)
 Ask about and briefly discuss last session about plaque
 Explain the inflammation/periodontitis connection along with the effects of smoking on
periodontium
 Visual aids (flip chart/paperwork/x-rays)
 Teach Periodontitis- define it
 Teach Skill (Flossing) use typodont to demonstrate
 Let patient demonstrate skill learned/correct as needed
 Show patient where she needs improvement (disclosing solution – visual aid)
 Ask to assess learning level
 Encourage patient
 Summarize and brief statement of next session
 Reiterate TEAM relationship

App’t 4:

 Review medical/dental history

 Pre-rinse
 Bleeding and Plaque Score
 Ultrasonic LL quadrant with anesthesia
 Fine scale LL quad
 Full Periodontal Charting LL with CAL
 Last patient education session 3
  Progress notes and confirm appointment 5

 Patient Education #3: Tobacco Cessation

LTG-Patient will stop smoking

STG-Patient will understand the importance of tobacco cessation
STG-Patient will understand the correlation between smoking and periodontitis
STG-Patient will use nicotine substitutes instead of smoking

Steps for Lesson 3: Tobacco Cessation

 Discuss goal attainment from last session (compare plaque/bleeding scores)
 Discuss new goals
 Teach effects of smoking on oral and overall health
 Teach correlation of Periodontitis and smoking
 Use flipbook
 Review brushing/flossing at sink
 Disclose and evaluate/modify
 Assess learning level
 Discuss recall schedule
 Establish TEAM partnership
 Thank her for her time and effort

Treatment Plan: Debridement for future appointments:

App’t 5:

 Review medical/dental history

 Pre-rinse
 Asses gingival condition
 Bleeding and Plaque Score
 Ultrasonic and fine scale the UL quadrant with anesthesia
 Full Periodontal Charting UL with CAL
 Plaque free and fluoride if there is time
 Progress Notes and schedule 2-week re-evaluation appointment
App't 6:

 Review medical/dental history

 Pre-rinse
 Assess gingival condition
 Final Bleeding and Plaque Score
 Arestin
 Final periodontal charting
 Plaque free and Fluoride if not done earlier
 Progress Notes: Remember 3-month recall, ending gingival statement, and patient learning level
Encourage good oral hygiene habits and thank patient for time

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

Patient has severe horizontal bone loss generalized in all quadrants. Additionally, there is
generalized widened periodontal ligament space and loss of crestal bone. Another significant
radiographic finding is the presence of calculus generalized in all quadrants. These findings indicate
patient’s current state of periodontitis (advanced bone loss). Calculus findings indicate high
prophylaxis class and the need for adequate debridement to help in halting the disease process.
Patient was explained the positive correlation between arthritis, osteoporosis, smoking and
periodontitis. It is possible that these conditions made her susceptible to acquiring Periodontitis.
Also, it is possible that these conditions were instrumental in speeding-up the disease process,
making it more severe and advanced.
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.
___________________________________________________________________________________

9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth
morphology, periodontal examination, recare availability)
_______________________________________________________________________

10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule.
(Note: Include date of recall appointment below.)
______________________________________________________________________________
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing
depths)
______________________________________________________________________________

12. Patient Attitudes and Cooperation

______________________________________________________________________________
13. Personal Evaluation/Reaction to Experience:
______________________________________________________________________________
DATE: 09-09-18 NAME: Sukirti Misra

PERIODONTAL CARE PLAN EVALUATION PART 1

LIT Dental Hygiene PC.9  Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
Competency PC.10  Use critical decision-making skills to reach conclusion about the patient’s dental hygiene needs based on all available assessment data.
PC.12  Provide specialized treatment that includes preventive and therapeutic services designed to achieve and maintain oral health.
PC.13  Evaluate the effectiveness of the implemented clinical, preventive, and educational services and modify as needed.
All information should have evaluated and be correlated to periodontal disease; the progression of, the healing of, and the prevention of. Failure to evaluate and correlate to periodontal disease on this
write-up will constitute loss of points.

Topic area Points Excellent 5 Good 4 Fair 3 Unacceptable 2

Medical History Identifies many systemic conditions
altering treatment, steps taken to avoid
medical problem, effect on dental hygiene
diagnosis and/or care. Relates many
medical history findings to periodontal
disease: its progression, healing, and
prevention
Dental History Identifies many elements of the dental
history, its effect on dental hygiene
diagnosis and/or care. Relates many
dental history findings to periodontal
disease: its progression, healing, and
prevention
Oral Exam Identifies many findings of the oral exam,
steps taken to avoid a medical problem,
effect on dental hygiene diagnosis and/or
care. Relates many oral exam findings to
periodontal disease: its progression,
healing, and prevention
Periodontal Exam
Identifies several systemic
conditions altering treatment, steps
taken to avoid medical problem,
effect on dental hygiene diagnosis
and/or care. Relates several
medical history findings to
periodontal disease: its progression,
healing, and prevention
Identifies several elements of the
dental history, its effect on dental
hygiene diagnosis and/or care.
Relates several dental history
findings to periodontal disease: its
progression, healing, and
prevention
Identifies several findings of the
oral exam, steps taken to avoid a
medical problem, effect on dental
hygiene diagnosis and/or care.
Relates several oral exam findings
to periodontal disease: its
progression, healing, and
prevention
Identifies at least one relevant systemic
condition altering treatment, steps taken to
avoid medical problem, effect on dental
hygiene diagnosis and/or care. Relates at
least one relevant medical history finding to
periodontal disease: its progression, healing,
and prevention
Identifies at least one relevant element of the
dental history, its effect on dental hygiene
diagnosis and/or care. Relates at least one
relevant dental history finding to periodontal
disease: its progression, healing, and
prevention
Identifies at least one relevant finding of the
oral exam, steps taken to avoid a medical
problem, effect on dental hygiene diagnosis
and/or care. Relates at least one oral exam
finding to periodontal disease: its
progression, healing, and prevention
Fails to identify any relevant systemic
conditions altering treatment, steps taken
to avoid medical problem, effect on
dental hygiene diagnosis and/or care.
Fails to relate any medical history
finding to periodontal disease: its
progression, healing, and prevention
Fails to identify any elements of the
dental history, its effect on dental
hygiene diagnosis and/or care. Fails to
relate any medical history finding to
periodontal disease: its progression,
healing, and prevention
Fails to identify any finding on the oral
exam, steps taken to avoid a medical
problem, effect on dental hygiene
diagnosis and/or care. Fails to relate any
oral exam finding to periodontal disease:
its progression, healing, and prevention

Gingival Exam Describes many characteristics of the Describes several characteristics of Describes at least one characteristic of the Fails to describe any characteristics of
& Dental gingival exam by quadrant. Evaluates the gingival exam by quadrant. gingival exam by quadrant. Evaluates one the gingival exam by quadrant. Fails to
Indices many of the indices and relates to Evaluates several of the indices and index and relates to periodontal disease evaluate any index and relate to
periodontal disease relates to periodontal disease periodontal disease

Periodontal Describes many of the findings of the Describes several of the findings of Describes at least one of the findings of the Fails to describe any of the findings of
Chart periodontal examination and relates many the periodontal examination and periodontal examination and relates any to the periodontal examination. Fails to
findings to periodontal disease. relates several to periodontal periodontal disease. relate any to periodontal disease.
disease.
 Topic area Points Excellent 5 Good
Dental Exam Describes many of findings of the dental
examination and relates many to
periodontal disease and the disease
process.
Treatment Plan
Plans Assesses many of the patient education
Treatment & needs. Accurately plans many of the
Patient treatment and patient education sessions.
Education Many of the patient education topics are
appropriate.
Long and Many of the long and short-term goals are
Short-Term developed with the patient. Goals are
Goals provided to the patient.
Radiographic Describes many findings of the
Findings radiographic examination and relates
many findings to periodontal disease.
Writing & Basic Thoughts are highly organized and
requirements logically presented; easy to follow; word
usage is correct and sets a very
professional tone; correct spelling,
grammar, punctuation, capitalization, and
sentence structure. Plan is submitted
within 72 hours with grading sheet. All
records are updated and properly
identified.
TOTAL POINTS
(50 points possible)
Late submissions will not be accepted.
Comments:
4 Fair
Describes several of findings of the
dental examination and relates
several to periodontal disease and
the disease process. .
Assesses several of the patient
education needs. Accurately plans
several of the treatment and patient
education sessions. Several of the
patient education topics are
appropriate.
Several of the long and short-term
goals are developed with the
patient. Goals are provided to the
patient.
Describes several findings of the
radiographic examination and
relates many findings to
periodontal disease.
Thoughts are generally organized
and logically presented; word usage
is adequate and sets a professional
tone; several errors in spelling,
grammar, punctuation,
capitalization, and sentence
structure. Many records are
updated and properly identified.
3 Unacceptable
Describes at least one of the findings of the
dental examination and relates any to
periodontal disease and the disease process.
Assesses at least one of the patient education
needs. Plans at least one of the treatment and
patient education sessions. At least one of the
patient education topics are appropriate.
At least one of the long and short-term goals
are developed for the patient. At least one
goal is provided to the patient.
Describes at least one finding of the
radiographic examination and relates any
finding to periodontal disease.
Thoughts are somewhat disorganized, vague
and difficult to follow; word usage is
sometimes inappropriate and detracts from
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, and sentence structure. Not all
records are updated and properly identified.
2
Fails to describe any of the findings of
the dental examination. Fails to relate
any to periodontal disease and the
disease process.
Fails to assess any of the patient
education needs. Fails to plan any of the
treatment and patient education sessions.
Patient education topics are not
appropriate.
Fails to develop any of the long and
short-term goals. Goals are not provided
to the patient.
Fails to describe any finding of the
radiographic examination and relates any
finding to periodontal disease.
Thoughts are very disorganized,
extremely vague, and difficult to follow;
word usage is often inappropriate and
detracts significantly from the
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, sentence structure. Many
records are not updated or properly
identified
DATE: NAME: Sukirti Misra

PERIODONTAL CARE PLAN EVALUATION PART 2

LIT Dental Hygiene PC.9  Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
Competency PC.10  Use critical decision-making skills to reach conclusion about the patient’s dental hygiene needs based on all available assessment data.
PC.12  Provide specialized treatment that includes preventive and therapeutic services designed to achieve and maintain oral health.
PC.13  Evaluate the effectiveness of the implemented clinical, preventive, and educational services and modify as needed.
All information should be evaluated and correlated to periodontal disease; the progression of, the healing of, and the prevention of. Failure to evaluate and correlate to periodontal disease on this
write-up will constitute loss of points.

Topic area Points Excellent 5 Good 4 Fair 3 Unacceptable 2

Periodontal Exam
Gingival Exam & Describes many characteristics of
Dental Indices the gingival exam by quadrant.
Evaluates many of the indices and
relates to periodontal disease
Periodontal Chart Describes many of the findings of
the periodontal examination and
relates many findings to
periodontal disease. Compares
many of the findings to the initial
periodontal examination.
Journal Notes – kept by
appt. date
Treatment provided, Describes many of the treatment
OH education, pt. procedures provided, OH
response, education, pt. response, and
complications complications by appt date.
Improvements, Diet Describes many of the pt.
recommendations, improvements, diet
learning level recommendations, and learning
level. Descriptions are kept by
appt date.
STG & LTG Describes many of the STG &
attained, LTG attained, and expectations.
Expectations Descriptions are kept by appt
date.
Prognosis Describes many prognosis
characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability,
and periodontal examination.
Describes several characteristics of
the gingival exam by quadrant.
Evaluates several of the indices and
relates to periodontal disease
Describes several of the findings of
the periodontal examination and
relates several to periodontal
disease. Compares several of the
findings to the initial periodontal
examination.
Describes several of the treatment
procedures provided, OH
education, pt. response, and
complications by appt date.
Describes several of the pt.
improvements, diet
recommendations, and learning
level. Descriptions are kept by appt
date.
Describes several of the STG &
LTG attained, and expectations.
Descriptions are kept by appt date.
Describes several prognosis
characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
periodontal examination.
Describes any characteristics of the gingival
exam by quadrant. Evaluates an indices and
relates that indices to periodontal disease
Describes any of the findings of the
periodontal examination and relates any to
periodontal disease. Compares any of the
findings to the initial periodontal
examination.
Describes any of the treatment procedures
provided, OH education, pt. response, and
complications by appt date.
Describes any of the pt. improvements, diet
recommendations, learning level, STG &
LTG attained, and expectations. Descriptions
are kept by appt. date.
Describes any of the STG & LTG attained,
and expectations. Descriptions are kept by
appt date.
Describes any prognosis characteristic by
attitude, age, number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
periodontal examination.
Fails to describe any characteristics of
the gingival exam by quadrant. Fails to
evaluate any indices and relate to
periodontal disease
Fails to describe any of the findings of
the periodontal examination. Fails to
relate any to periodontal disease. Fails to
compare any of the findings to the initial
periodontal examination.
Fails to describe any of the treatment
procedures provided, OH education, pt.
response, and complications by appt
date.
Fails to describe any of the pt.
improvements, diet recommendations,
learning level, STG & LTG attained, and
expectations. Descriptions are not kept
by appt. date
Fails to describe the STG & LTG
attained, and expectations. Descriptions
are not kept by appt date.
Fails to describe any prognosis
characteristics by attitude, age, number
of teeth, systemic background,
malocclusion, tooth morphology, recall
availability, and periodontal
examination.
 Topic area Points Excellent
5 4
Supportive therapy Describes many of the
suggestions made to patient
regarding re-evaluation, referral,
and recall schedule. Includes date
of recall appt.
Assessment of changes Describes many of the changes
occurring from trt including
plaque control, bleeding, gingival
health, probing depths.
Pt. Attitudes and Evaluates comprehensively
cooperation patient’s attitude and cooperation
including patient’s mental and
Personal emotional status, temperament
evaluation/reaction to and attitude. Comments on
experience personal evaluation/reaction to
experience.
Writing & Basic Thoughts are highly organized
requirements and logically presented; easy to
follow; word usage is correct and
sets a very professional tone;
correct spelling, grammar,
punctuation, capitalization, and
sentence structure.
Plan is submitted within 72 hours
with grading sheet. All records
are updated and properly
identified.
TOTAL POINTS
(50 points possible)
Late submissions will not be accepted.
Comments:
Good
Describes several of the
suggestions made to patient
regarding re-evaluation, referral,
and recall schedule. Includes date
of recall appt.
Describes several of the changes
occurring from trt including plaque
control, bleeding, gingival health,
probing depths.
Evaluates patient’s attitude and
cooperation including patient’s
mental and emotional status,
temperament and attitude.
Comments on personal
evaluation/reaction to experience
Thoughts are generally organized
and logically presented; word usage
is adequate and sets a professional
tone; several errors in spelling,
grammar, punctuation,
capitalization, and sentence
structure.
Many records are updated and
properly identified.
Fair
3 2
Describes any of the suggestions made to
patient regarding re-evaluation, referral, and
recall schedule. Date of recall not included.
Describes any of the changes occurring from
trt including plaque control, bleeding,
gingival health, probing depths.
Fails to evaluate patient’s attitude and
cooperation including patient’s mental and
emotional status, temperament and attitude.
Comments on personal evaluation/reaction to
experience
Thoughts are somewhat disorganized, vague
and difficult to follow; word usage is
sometimes inappropriate and detracts from
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, and sentence structure.
Not all records are updated and properly
identified.
Unacceptable
Fails to describe any of the suggestions
made to patient regarding re-evaluation,
referral, and recall schedule. Date of
recall not included
Fails to describe any of the changes
occurring from trt including plaque
control, bleeding, gingival health,
probing depths.
Fails to evaluate patient’s attitude and
cooperation including patient’s mental
and emotional status, temperament and
attitude. No comments on personal
evaluation/reaction to experience
Thoughts are very disorganized,
extremely vague, and difficult to follow;
word usage is often inappropriate and
detracts significantly from the
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, sentence structure. Many
records are not updated or properly
identified
GINGIVAL INDEX
Loe and Silness
The purpose of the Gingival Index (GI) is to assess the severity of gingivitis based on color,
consistency, and bleeding on probing. The GI will be determined for our purposes using tooth
#'s 3, 9, 12, 19, 25, 28. Four gingival areas (distal, facial, mesial, and lingual) should be
examined systematically for each tooth.
Procedure
The teeth and gingiva are dried, and under adequate light, a mouth mirror and probe are used.
The probe is used to press on the gingiva to determine the degree of firmness. The probe is
also used to run along the soft tissue wall near the entrance to the gingival sulcus (not at the
base of the sulcus) to evaluate bleeding. (If you do not understand this explanation, see the
figure in Wilkins p. 338-339.
Criteria for Scoring
0 = Normal gingiva
1 = Mild inflammation - slight color changes, slight edema. No Bleeding on probing.
2 = Moderate inflammation - redness, edema, and glazing. Bleeding on probing.
3 = Severe inflammation - marked redness and edema. Ulceration. Tendency to
spontaneous bleeding.
Scoring
Each of the 4 gingival surfaces (distal, facial, mesial, lingual) is given a score of 0 to 3. Each
tooth used will have 4 scores. By totaling the scores and dividing by the number of surfaces
examined, the Gingival Index is determined. Indices range from 0 to 3.
Calculating Example for an Individual.
Gingival Area
M F D L
3 3 1 2 1
9 1 1 1 0
12 2 0 2 0
19 3 1 3 2
25 1 1 1 1
28 2 1 3 2

TOTAL 12 + 5 + 12 + 6 = 35
Gingival Index = Total Score 35 divided by Number of Surfaces 24 = 1.45 GI
Interpretation: According to the suggested nominal scale, the score for this individual (1:45)
indicates only fair gingival health (moderate inflammation). The ratings for each gingival area
or surface can be used to help the patient compare gingival changes toward health at each
appointment.
 SUGGESTED NOMINAL SCALE FOR PATIENT REFERENCE
Rating Scores
Excellent (healthy tissue) 0
Good 0.1-0.9
Fair 1.0-1.9
Poor 2.0-3.0

GINGIVAL INDEX
PERIODONTAL CARE PLAN

Initial date: 9-7-18

Gingival Area

# M F D L

3 2 2 2 2

9 2 2 1 1

12 2 2 2 2

19 2 1 2 2

25 2 2 2 2

28 2 1 2 2

TOTAL: 43
43/24 = 1.79 (fair)
Final date______________________

Gingival Area

M F D L

12

19

25

28

TOTAL___________