Periodontology (DHYG 1311)

Fall, 2015
Student: Meagan Payne
PERIODONTOLOGY CARE PLAN
Patient Name:
Age: 26
Date of initial exam: 8/25/15
Date completed:
1. Medical History:
Jacquelyns Medical History had no systemic conditions notable that may
complicate her dental appointment, however, she has not had a physical in over
5 years. The patient should visit her primary physician each year for a physical to
evaluate her overall health, by not doing so the patient may not know if she has a
disease that can compromise her periodontitis. Currently Jacquelyn only visits
the E.R. for her medical needs, if she can get acquainted with a primary
physician maybe she would be more inclined to go for yearly exams. Also, the
patients lack of oral hygiene care and her gingivas current state of health can
cause her to have systemic problems.
The patient has 3 glasses of wine each week, alcohol can irritate the gum tissue
and when consumed in excess can lead to effects that are detrimental to the
patients health/mental health/and oral cavity. Abusing alcohol can lead to many
physical problems such as strokes, cardiovascular issues, depression, liver
diseases, and GI problems all of which can progress her periodontal disease.
Oral manifestations derived from alcohol abuse are xerostomia, petechiae,
ecchymosis, and increased gingival bleeding. If the patient was to develop
xerostomia this would negatively impact her periodontitis. When saliva production
is reduced and there isnt a sufficient amount to help wash left-over debris away,
it becomes stagnant and adheres to the tooth surfaces for long periods of time.
The bacteria can irritate the gingival tissue in an exaggerated way making it
harder to halt the periodontitis. Tooth erosion may also be seen in a patient
whom abuses alcohol particularly from vomiting. An alcoholic may neglect the
body therefore leading to poor oral hygiene, increasing the risk of dental caries
and progression of periodontal disease. A patient who has an alcohol problem
may experience more stress and begin to brux allowing opportunistic infections
such as candidiasis to develop.
2. Dental History:
Jacquelyn is not currently under the care of a dentist, she only goes whenever
she feels pain. Without the help of a dentist or doctor her periodontitis can
proliferate and cause irreversible damage to her oral cavity. Her chief complaint

for the visit was to have her teeth cleaned. Her last visit was in 2012 where she
had received a cleaning. The patient feels good about the appearance of her
teeth/smile, but currently she is a prophy class 6/ perio case II. Improper dental
care visits and poor oral hygiene habits have resulted in poor plaque control for
the patient and has ultimately resulted in periodontal disease. When plaque is
accumulated on the patients teeth she is more prone to caries, periodontal
disease, and the formation of calculus. Calculus needs to be removed because
its presence makes routine self-care more difficult or even impossible. It is
important for the patient to make it a point to visit the dentist every 3 months for
her recall appointments to assess her periodontal pockets, and to keep track of
active and inactive spots. I believe that the patient lacks information about oral
hygiene and therefore I have deemed her Unaware. Although she does not have
any disabilities that will disable her from performing any of the lifestyle changes
in the treatment plan. If the patient does not comply with routine dental
appointments, and treatment plan, her periodontitis will progress and she can
start to lose her teeth from bone loss.
After informing the patient of her oral cavitys current state of periodontitis she
was concerned about the health of her gums and her complete health. She
expressed that she does not want to ignore the fact that she can lose her teeth if
bone loss continues to occur. I informed the patient that the bone loss that has
already occurred cannot be reversed, but together we can stop the progression.
And she is ready to take the appropriate steps to halting her periodontal disease.
The patient does clench her jaws unconsciously when sleeping and stressed.
This increases the risk of TMJ problems in the future for the patient, it also can
cause wear of the tooth facets, tooth fractures, and possible pulp exposure. If the
patient develops TMJ issues oral hygiene care can decline because of discomfort
and the periodontitis can persist. I suggested a mouthguard to help reduce the
effects of clenching.
Jacquelyn consumes 1 sugar containing beverage daily, sugar consumption
increases the patients risk of developing caries. Exposing your teeth to sugar
alongside poor oral hygiene can result in demineralization of the tooth enamel.
When caries occurs bacteria builds up in the niche that have formed and can
irritate the surrounding tissue and increase the severity of the periodontitis.
3. Oral Examination:
The patient has Maxillary Tori in the hard palate, bilateral linea alba from cheek
biting and clenching. These habits will not cause periodontitis but they can lead
to more severe gum disease by placing pressure on the periodontal ligament and
bone. This will speed up the progression of the periodontitis. The patient has
bilateral Mandibular tori, and a scalloped tongue from her natural occlusion. The
patient was unaware of the permanent damage that clenching could cause to her
teeth and jaw and was advised to wear a mouthguard. I instructed her to also

brush her tongue with her toothbrush from back to front each time she brushes. If
the patient allows the plaque to build up after 4 days of stagnation it can become
detrimental for the oral tissue.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification: 6

Periodontal Case Type: 3

b. Gingival Description:
Appt 1: Full-Mouth Generalized scalloped architecture, generalized red color,
generalized edematous/spongy consistency, margins are generalized rolled with blunted
papillae. No suppuration, papillary and marginal surface texture is smooth/shiny,
attached gingiva is generalized smooth/shiny.
Appt 2: Maxillary R Generalized scalloped, generalized red, generalized
edematous/spongy, generalized rolled with blunted papillae, smooth/shiny papillary,
marginal, and attached.
Appt 3: Maxillary L Generalized scalloped, generalized red, generalized
edematous/spongy, generalized rolled with blunted papillae, smooth/shiny papillary,
marginal, and attached.

Appt 4: Mandibular R Generalized scalloped, generalized red, generalized

edematous/spongy, generalized rolled with blunted papillae, generalized smooth/shiny
surface texture (papillary & marginal), generalized smooth/shiny surface texture
(attached), and generalized Smooth surface texture (attached).

Appt 5: Mandibular L Generalized scalloped, generalized red, generalized

edematous/spongy, generalized rolled with blunted papillae, and generalized
smooth/shiny surface texture (papillary & marginal).
Appt 6: Full-Mouth- Generalized scalloped, generalized pink (WNL), Generalized
consistency was tight against teeth, Localized Edematous/Spongy #15, 16. Margins
were WNL, Papillae were WNL, No Suppuration, Surface texture (papillary, marginal)
was smooth, and surface texture of attached was stippled.

c. Plaque Index:

Appt 1: 2.6 2: 1.3 3: 1.2 4: 0.8 5: 0.7 6: 0.2

d. Gingival Index:

Initial: 1.54 (Fair) Final: 1.04 (Fair)

e. Bleeding Index: Appt 1: 8.6% 2: 8.6% 3: 1.9% (only on indicator teeth) 4: 1.9%
(only on indicator teeth 5: 2.7% 6: 7.5% (Full Mouth)

f. Evaluation of Indices:
1. Initial- #3 had moderate inflammation and mild BOP, #9 had mild inflammation
and no BOP, #12 Moderate inflammation and BOP, #19 had moderate
inflammation and BOP, #25 had moderate inflammation and BOP, #28 had
Moderate inflammation and BOP. The BOP is associated with active
periodontitis. Overall the patient experienced Moderate/ heavy bleeding
throughout the mouth. Her first plaque score revealed a fair score indicating
inadequate plaque removal. Pt. was taught how to properly brush her teeth
and says she will implement her new skills, which will lower her current
indices and we should start to see a difference in her periodontal health.
2. Final- #3 had Mild inflammation no BOP, #9 Mild inflammation no BOP, #12
Mild inflammation no BOP, #19 Mild inflammation no BOP, #25 Mild
inflammation no BOP, #28 Mild inflammation no BOP. Overall the patient
experienced slight bleeding #6, 15, 16, 17, and 18. Her first plaque score
revealed 2.6 Fair score, and at the final post periodontal appointment it
revealed an amazing .2 Good score indicating that the patient has decrease
the infection in her gingiva tremendously. Her immaculate home self-care has
reduced her progression of periodontitis at the moment.
g. Periodontal Chart: (Record Baseline and First Re-evaluation data)
1. BaselineQuad. 1:
Pt. has multiple 4mm pockets/ #2D17F, 30D- 5mm P.D. / #3D- 6mm P.D.
Pt. has no clinical recession
Gen. 1-3 mm C.A.L. / Most severe are #6D, 3L- 3mm C.A.L
Full Mouth:
No suppuration, furcation, pain on percussion, or mobility.
She is experiencing mild horizontal bone loss around #8, 9, 10, and 11. There
is subgingival/supragingival calculus throughout.
#9 recurrent decay. The recurrent decay can progress the periodontitis if not
pt. does not have it restored.
Missing #32.
#1, 16, 17 are erupted.
Quad. 2:
Pt. has multiple 4mm pockets/ 15MDB, 16MDBL- 5mm pockets/ 14D, 17D6mm pockets
Pt. has no clinical recession
Gen. 1-3mm C.A.L. / Most severe are 12D, 13M, 14D, 15D, 16MBD has 3
mm C.A.L.
No suppuration, furcation, pain on percussion, or mobility.

Quad 3:
Pt. has multiple 4mm pockets/ #17D- 6mm Pocket, #17F-5mm Pocket
Pt. has no clinical recession
Gen. 1-2mm C.A.L.
No suppuration, furcation, pain on percussion, or mobility.
Quad 4:
Pt. has multiple 4mm pockets/ #30D-5mm Pocket
Pt. has no clinical recession
Gen. 1-3mm C.A.L. #31 3mm most severe
No suppuration, furcation, pain on percussion, or mobility.

2. First evaluationFull Mouth:

Pt. has multiple 4mm pockets/ #15MD, 16DL-5mm pockets
Pt. has no clinical recession
Gen. 1-3mm C.A.L. # 15MD most severe
No suppuration, furcation, pain on percussion, or mobility.
She is experiencing mild horizontal bone loss around #8, 9, 10, and 11. There
is subgingival/supragingival calculus throughout.
#9 recurrent decay. The recurrent decay can progress the periodontitis if not
pt. does not have it restored. #16B has visible decay and patient is aware that
if she does not have it restored that is can progress her periodontitis
Missing #32.
#1, 16, 17 are erupted.

5. Dental Examination:
No caries visual clinically or through radiographs, no attrition, 1 mm Midline shift to the left, Patient is a class I on the Left and right molar and
canine relation. The patient has three of her 3 rd molars which are hard to
reach with a bulky toothbrush, I suggested patient use a longer shafted
toothbrush or an electric toothbrush to remove plaque. Insufficient removal
of plaque in the 3rd molar region can cause periodontitis to persist. Patient
had a 4 mm overbite, no overjet, open bites, or cross bites. No
ROTATIONS. Pt. has TCRs on 3, 7, 8, 9, 10, 14, 18, 19, 30, 31. Some with
defective margins, I suggested the patient have the restorations rerestored because it increases her risk of developing recurrent caries. If the
patent was to have recurrent decay this can progress her periodontitis.

6. Treatment Plan:
Appt 1: 8-25-15
1. Health History/Vitals
2. Pre-Rinse
3. FMX
4. Head and neck/ Intra Oral Exam
5. Periodontal Assessment
6. Started Dental Charting with x-rays
7. Gingival Index
8. Plaque Score/ Bleeding Score
9. Risk Assessment
10. Informed Consent
11. Chairside Pt. Ed: Brushing

Appt 2: 9-8-15
1. Health History update/Vitals
2. Take one retake on X-rays
3. Pre-Rinse
4. Plaque Score/ Bleeding Score
5. Completed Dental Charting with x-rays
6. UltraSonic Max R
7. Perio Chart Max R
8. Chairside Pt. Ed: Brushing (focus on 3rd molar region)
9. Anesthesia: 5.1 mL Septocaine 4% 1:100,000, 30- short needle. Max R
10. Lollicaine applied to Anterior, posterior, and middle Alveolar
Appt 3
1. Health History update/Vitals
2. Pre-Rinse
3. Plaque Score/Bleeding Score
4. Fine Scale Max R
5.
6. UltraSonic Max L
7. Perio Chart Max L
8. Started Fine Scale Max L
9. Anesthesia: 4% 3.4 mL Septocaine Max L
10. Lollicaine 100% used
11. 1st Patient Ed Session- Plaque; Brushing (Sulcular) Intra Oral camera 2
pictures (1 full smile and 2 teeth picture shows her gingival tissues.
Long Term Goal: Patient will reduce plaque score and maintain it.

Pt. will be able to define plaque (what it is?)

Lower plaque score
Maintain cleanliness of oral cavity
Reduce the amount of bacteria
Pt. will learn how to properly brush her teeth
Pt. will brush tongue

Appt 4
1. Health History update/Vitals
2. Pre-Rinse
3. Plaque Score/Bleeding Score
4. UltraSonic Mand R
5. Perio Chart Mand R
6. Started to fine Scale Mand R
7. Finished fine scaling Max L
8. Anesthesia: 4% Septocaine 1.7 mL
9. Lollicaine 3 pkgs 100% used
10. 2nd Patient Ed Session- Periodontitis; Flossing
Long Term Goal: Patient will halt progression of Periodontitis disease

Pt. will define periodontitis

Pt. will floss 4+ times a week
Complete treatment plan/ recall appointments
Achieve healthier tissue
3 month recall appointments
Brushing Sulcular Method

Appt 5
1.
2.
3.
4.
5.
6.
7.
8.
9.

Health History update/Vitals

Pre-Rinse
UltraSonic Mand L
Perio Chart Mand L
Fine scale Mand L
Finish scaling Mand R
Anesthesia:Lidocaine HCL 2% w/epi 1:100,000 3.4 mL
Lollicaine
3rd Patient Ed Session- Caries; Fl

Long Term Goal: To have any defective restorations re-restored

Save money
Find a dentist
Follow through with the appointment
Use Daily home Fl
Pt. can define caries

Appt 6
1. Health History update/ Vitals
2. Plaque Score/Bleeding Score
3. Gingival Index
4. Arestin
5. Plaque Free (no abrasive prophy paste)
6. Fluoride Treatment
7. Post-Perio evaluation
8. Post Calculus exam
9. Go over goals at chairside
10. Chemical irrigation
11. Sealant #28
12. Referral for recurrent decay, and cavity #16B
13. 3 month recall
14. Pt. Ed chairside: express to pt. how important it is for us to maintain
the health of her gum tissue and to do that she must follow the home
treatment plan I have made for her. She also needs to come in for her
routine prophy check-ups. Failure to do this can result in disease
progression and loss of teeth.

7. Radiographic Findings:
Mild Horizontal Bone Loss on #s 8,9,10,11
Generalized Supragingival/Subgingival Calculus
Recurrent Caries #9
The pt. is experiencing horizontal bone loss on her ant. teeth due to the calculus
that has built-up subgingival and has infected her gums with periodontal disease.
Calculus accumulated underneath the gingival tissue causes infection and after
time attachment loss and causing periodontitis. The bone loss that the pt. has is
irreversible but can be halted. The recurrent caries around the pt. TCR on #9
needs to be restored or it can make the periodontitis worst in that area. The
calculus in the oral cavity needs to be removed, and maintained to achieve a
better state of health for the pt.
Journal 1: 8-25-2105
Today I reviewed Jacquelyns Medical Health History and took her Vital
Signs. Then I started on her paperwork, including informed consent, risk
assessment, head and neck/ intra oral exam, perio assessment, and dental
charting. I took FMX with phosphor plates- lack of dental care. I did her plaque
score 2.6 Fair, Bleeding Score 8.6%. The Patient Pre-rinsed with an antimicrobial
rinse. My patient was classed a VI perio case II. I did some chairside patient Ed
about brushing in the sulcus, explained to the patient about her current gum
disease state. By brushing and flossing her teeth she can start to achieve a

healthier gum tissue, but ultimately she needs a full deep cleaning and to
maintain that cleanliness. If the patient does not change her current dental health
habits she can progress her disease and later lose her teeth. Her learning level is
Unaware, she stated that she felt good about her smile and only visited the
dentist and the doctor when in pain. The patient was also not going far enough
back to reach her remaining 3rd molars when brushing, causing built up debris,
and in turn progressing her periodontitis. The patient agreed to be my
periodontitis patient. There was no complications, improvements at this time. The
diet counseling that I provided for my patient since she stated that she does not
eat a lot of sweets, is that anytime that she eats sticky foods to always drink
water after, or a solid fruit or vegetable.
Journal 2: 9-8-2015
Today I updated M/D History and took Vitals. I took her plaque and
bleeding score. Plaque score lowered tremendously from previous visit to 1.3%
Good, bleeding stayed at 8.6%. So the patient is already achieving a short term
goal toward her long term goal of reducing plaque score and maintaining it. I had
my dental charting with x-rays checked, and started to UltraSonic the Max R
Quad. After I had it checked I Perio Charted the Max R Quad. I did chairside pt.
Ed about focusing her brushing in the sulcus morning and at night for 2 minutes
each time, and flossing her teeth after each meal. By doing this the patient will be
eliminating the bulk of bacteria that is infecting her gums and progressing her
periodontitis. Dr. Williams anesthetized the patient with 5.1 mL Septocaine 4%
1:100,000 with a 30-short needle. I applied Lollicaine the patients Max R Injection
areas. The patient is taking action against her periodontitis and has already
lowered her plaque score. Her bleeding score is still the same indicating
infection. Her learning level is now Action. There were no complications at this
time. The diet counseling that provided for my patient was after she eats anything
with sugar to follow up by eating protein. Cheese, meat, etc.
Journal 3: 9-23-2015
Today I updated Jacquelyns medical/dental Hx, she pre-rinsed, and I took
a plaque and bleeding score both of which dropped drastically. The bleeding
score on the indicator teeth was 1.9%, and the plaque score dropped to 1.2
Good. I then did my first patient Ed. Session. The patient was able to define
plaque perfectly at the end and was very excited that she now knew what plaque
actually can do to her gums. I also taught the patient on the typodant how to
sulcular brush, she stood at the sink and did it perfectly. I preceded to tell the
patient how good she was doing executing the skills that I have shown her to
help maintain a good plaque score. I suggested that the patient purchase an
electronic toothbrush since she is unable to open her mouth very wide and has
three 3rd molars. After patient Ed. I fine scaled her Max R quad, the gingival
tissue was already starting to show a slight difference in color, but it was still red.
The patient was then anesthetized by Dr. German to start Ultrasonincing the Max
L. I numbed the patient with the topical anesthetic Lollicaine then the doctor used

3.4 mL septocaine 1:100,000 and a 27 short needle. I ultrasoniced the Max L and
started to fine scale. The patients learning level is Self-Interest.
Journal 4: 9-28-2015
Today I updated Jacquelyns medical/dental Hx, she pre-rinsed, and I took
a plaque and bleeding score both dropped again since her last appointment from
1.2 good to .8 by lowering her plaque score she is achieving a short term goal to
maintaining a low plaque score. The patient has also been flossing a short term
goal to achieve her long term goal of halting periodontitis. I commended the
patient on her amazing home care that she has been applying to her every day
oral care routine. She has purchased a sonicare toothbrush which I believe will
help her tremendously in removing bacteria from her 3 rd molars and ultimately her
entire oral cavity more effectively. We had our 2nd patient Ed. Session where I
taught the patient the meaning of periodontal disease, she was able to define it
by the end of out session, and I also taught her how to properly floss her teeth.
She performed it perfectly, and I provided her with a floss stick to floss her 3 rd
molars. The patient remembered what plaque was and defined it for me, and let
me know that she really appreciates her new brushing technique that she feels a
huge different in the way that her gums feel and how clean her teeth seem to be.
I reiterated all of her long and short- term goals, and we proceeded with
treatment. Dr. Williams anesthetized my patient with 4% Septocaine 1.7 mL and I
scaled spots 1B and 5MD on Max. R. and then finished scaling Max. L. I
ultrasoniced Mand. R and started to fine scale Mand. R. The patient seems
excited and ready to finish the fine scaling and see the progression in her Oral
state. LL- Self Interest. I also wanted to note that the patient was still sore from
treatment on Maxillary left and that she had a bruised cheek (hematoma) from
previous LA injection. Diet counseling that I provided the patient was to try and
stay away from soda, but if she does consume to drink it fast so that exposure
time is less.
Journal 5: 10-15-2015
Today I updated Jacquelyns medical History, took vitals, and she prerinsed. I took her plaque score which has continued to drop from .8 to .7 her
home care has shown the progress towards her long term goal of maintaining a
low plaque score. We had our 3rd and final Patient Education Session, over
Caries, Brushing, FL2, and Flossing. The patient was able to define plaque,
periodontitis, and caries by the end of the session. We reviewed all of the
patients long and short term goals, and we preceded with treatment. LA: Dr.
Wiggens- Lidocaine HCL 2% w/epi, 1:100,000 3.4 mL. I ultrasoniced Mandibular
L and scaled Mand. R, and L. The patient had a mild tachycardia. Pt probably
should not use epinephrine. Per Dr. Wiggins. Her Learning Level is now Habit,
and she will return in 2 weeks for her re-evaluation. Diet counseling that I
provided the patient was that when she consumes carbohydrates she needs to
immediately follow up with brushing, rinsing, or flossing to remove the left over
debris so that it does not sit and possibly cause caries or progress her
periodontal disease.

Journal 6: 11-03-2015
Today I updated Jacquelyns medical History, took vitals, and she prerinsed. I took her plaque score which has continued to drop from .7 to a .2 Good.
Her home self-care has increased her chances of halting her periodontal
disease, and she has reached her goal of maintaining a low score. Her bleeding
score throughout her entire mouth went from 8.6% on her initial visit to a 7.5%
showing a decrease in infection. Her gingival index has also dropped to a fair
score of 1.04. I did chairside patient education, express to pt. how important it is
for us to maintain the health of her gum tissue and to do that she must follow the
home treatment plan I have made for her. She also needs to come in for her
routine prophy check-ups. Failure to do this can result in disease progression
and loss of teeth. I also went over all her long and short term goals. I applied
arestin to the teeth that still had periodontal pockets of 5mm, #15,16. I did her
post calculus exam and also full periodontal charting. The dentist discovered a
cavity on the buccal of #16 so we are referring pt. to have it restored along with
the recurrent decay around the restoration of #9. The patient is leaving this
appointment with a learning level of Habit, she has been applying all self-care
techniques I have showed her and it shows in all aspects in the health of her
gingival tissues. Her recall will be in 3 months. Diet counseling that I provided the
patient was that when she consumes carbohydrates she needs to immediately
follow up with brushing, rinsing, or flossing to remove the left over debris so that
it does not sit and possibly cause caries or progress her periodontal disease. Her
ending gingival statement was Generalized, moderate periodontitis with Slight
bleeding.
3rd Appt
1st Patient Ed Session- Plaque; Brushing (Sulcular)
Long Term Goal: Patient will reduce plaque score and maintain it.

Pt. will be able to define plaque (what it is?)

Lower plaque score
Maintain cleanliness of oral cavity
Reduce the amount of bacteria
Pt. will learn how to properly brush her teeth
Pt. will brush tongue

4th Appt
2nd Patient Ed Session- Periodontitis; Flossing
Long Term Goal: Patient will halt progression of Periodontitis disease

Pt. will define periodontitis

Pt. will floss 4+ times a week
Complete treatment plan/ recall appointments
Achieve healthier tissue
3 month recall appointments
Brushing Sulcular Method

5th Appt
3rd Patient Ed Session- Caries; Fl
Long Term Goal: To have any defective restorations re-restored

Save money
Find a dentist
Follow through with the appointment
Use Daily home Fl

6th Appt Chairside Patient Ed

Long Term Goals:

Patient will reduce plaque score and maintain it.

Patient will halt progression of Periodontitis disease
To have any defective restorations re-restored

Prognosis:
Based on my patients positive attitude, and how her home self-care has improved so
much from our first session I believe that her prognosis will be her being able to halt her
gingival tissue detachment, and alveolar bone loss and maintain health. She is 26 years
old and she has realized that she should not be having these issues right now in her life,
if there is a way to avoid it. The patient has all of her teeth minus # 32, and I think that
she has the knowledge to successfully maintain their health status. The patient has
purchased a Sonicare toothbrush making it easier to brush her erupted 3 rd molars, she
is brushing and flossing a sufficient amount of times each day, along with rinsing. She
now has the knowledge of other oral health aids like a floss stick to reach her molars
since she is unable to open her mouth wide enough to floss posterior teeth. She has
also gotten dental insurance and has found a dentist within her network that is going to

restore her restorations and fill her current cavity. Her final periodontal examination was
very good, and she will be readily available to attend her recare appointments every 3
month.

Supportive Therapy:
My suggestions to my patient regarding re-evaluation is that she should always want to
know the progress that she is making to give her the extra boost whenever she sees
that by doing her home self-care and keeping up with her treatment plan that she is
extending the life of her teeth. My patient is aware that she needs to keep up with what
teeth need to be restored or re-restored so that her periodontitis does not progress and
no more alveolar bone is lost. My suggestion to my patient for recall is every 3 months,
she will be seeing us on February 4th 2016. And then she will have her cleaning at her
dentist then alternate back to us the next 3 months.

Assessment of Changes:
The patients plaque score began at 2.6 Fair and ended at .2 Good. The patient has
almost reached an excellent plaque score, and she knows that by doing so she is
reducing the cavity causing bacteria that had put her oral cavity in such a bad state of
health. Her bleeding tendency throughout that mouth has dropped form the initial 8.6%
to a 7.5% because of her new habit of flossing, she reduced the inflammation and
therefore reduced her bleeding tendency. Her gingival index has decreased from 1.54 to
1.04 showing healthier, tighter gum tissues. Her probing depths have decreased in
almost all areas in the mouth. #s 15, and 16 still have 5mm P.D. but patient is going to
give extra care to those teeth.

Patient Attitudes and Cooperation:

The patients attitude at the initial appointment seemed to me that she was just
completely unaware of what was and could go on in her oral cavity, I feel as if her
attitude toward the treatment was to give 150% to me as her teammate and to herself
throughout, and she did. She knew that she had to start doing something and that she
was in good hands with us at LIT. Her cooperation towards the treatment could not have
been better, she showed up to every appointment ready to learn. She implemented all
the techniques and advice that I provided her, and it showed at each appointment. She
was happy with the outcome of the treatment that I provided her and couldnt have been
more thankful for getting her mouth back to a healthy state.

Personal Evaluation/ Reaction to Experience:

I have honestly had the most pleasant experience with my periodontal patient
Jacquelyn, she was always a joy to be around, and always interested in what I had to
say and teach her. She also never ceased to amaze me with her constant progression

of periodontal health. I have full confidence that she will show up to all her recare
appointments and keep doing her home self-care at the current rate that she has if not
even better. My skills have been amplified after completing this patient I myself have
seen the damage and I have witnessed the improvements, and its a satisfying
experience to say the least. I am thoroughly happy with myself and my patient for being
able to together return her oral cavity to its maximum health.