Brittany Ryder

Periodontal Care Plan

Periodontal Care Plan
Patient Name:
Age: 52
Date of initial Exam: September 23, 2016
Date of completed Exam: November 11, 2016

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.
Mr. is a 52 year old male, he does not have any systemic conditions that would alter any
treatment and does not require pre medication or medical clearance. His would describe his
general health excellent and his last physical was in December of 2015. The patient does not
currently take any prescription medications. The patient does have seasonal sinus problems. If
the patient has sinus problems during an appointment, I would consider more of a semi supine
chair position to prevent drainage into his throat. I would educate the patient about how allergies
and sinus problems can affect his oral health. Sinus problems can cause the patient to breathe out
of his mouth which may lead to dry mouth, I can educate the patient to have frequent sips of
water and for excessive dry mouth I suggested a saliva substitute, such as biotene. I would also
educate the patient that mouth-breathing has an increase chance of the potential of caries risk, I
educated about brushing, flossing, and use of mouth rinse two times a day. The patient revealed
he drinks alcoholic beverages, beer in particular, five times a week. I explained to the patient the
risk associated with beer, that it is acidic, staining, and causes dryness; all of these risk factors
contribute to Mr. periodontal condition. I suggested to the patient if he were to drink, to drink
water after every beer. The patients blood pressure slightly pre-hype, this is currently not a
concern but to regulate his blood pressure so make sure it remains the same and does not have a
sudden, drastic increase. His pulse, respiration and temperature was all within normal limits.
2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief
complaint, present oral habits, effect on dental hygiene diagnosis and/or care)
The chief complaint and reason for the visit is to clean teeth, his last cleaning was in 2012, but
does not remember the dentist who treated him. I suggested to the patient that he should have his
teeth cleaned every 3-4 months to halt the progression of periodontal disease. Mr. dental history
revealed that he had serious problems with previous dental treatment, when I questioned the
patient about this response, he replied, he had a filling but nothing major. The patient likes the
appearance of his teeth and smile. The patient believes to have had a full mouth x-ray in 2012,
but I recently took a full-mouth series on September 23, 2016; this was to gather baseline data
and to detect possible carious lesions, sub gingival calculus and bone levels. The patient does
have sensitivity at times when he eats pruns and raisins. The patient had a no response to the
following: gums bleeding when brushing and flossing, clenching, grinding, wear a denture or
partial, does not have many cavities when he has a dental check-up, dry mouth, and gum. He
drinks less than 2-3 sugar-containing diet, or sport energy beverages daily; he stated he does not

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Periodontal Care Plan
drink soda at all. The patient seemed to be very acceptive of treatment and had a positive attitude
towards his oral health and halting the progression of his periodontitis.
3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
An extra and intra oral exam was performed on Mr.. The only finding for general physical was
that the patient wears glasses and has myopia. No findings were present on the patients extra
oral exam. The intraoral exam concluded that the patient has bilateral linea alba on the buccal
mucosa and mandibular tori on the right side. I then questioned the patient about his oral habits,
the patient stated he sometimes, not often, breathes from his mouth when he has allergies. I
explained to him that mouth breathing dries out the gingival tissues and the decreased saliva flow
can contribute to a buffered pH balance which can cause carious lesions. I suggested he should
have an extra intake on water when this occurs. He responded no to the following: grinding,
clenching, and tongue thrust. His occlusal examination relives that he is a class 1 in right and
left molars and also a class 1 in right and left canine. He has an over bite of 3mm, overjet of
4mm, no midline shift, open bite or cross bite.
4. Periodontal Examination: (color, contour, texture, consistency, etc.)
a. Case Classification: VI Periodontal Case Type III
b. Gingival Description: I performed a periodontal assessment on my patient. The patients
tissues were generalized scalloped. The patient had red and edematous/spongy regions on the
mandibular anterior lingual, #31 disto-lingual, and #16 diso-lingual. His margins were rolled on
the mandibular anterior linguals and also on # 28 disto-lingual. His papillae was generalized
within normal limits except for a blunted appearance between #8 and #9, this is due to the
patients diastema. There was suppuration upon probing on #30 and #31 buccal. The patient has
smooth and shiny papillary and marginal surface texture on the mandibular anterior facial. The
attached surface texture was a stippled appearance.
Appt 1: 9/23/16
At this appointment, I performed a periodontal assessment on my patient. The patients tissues
were generalized scalloped. The patient had red and edematous/spongy regions on the
mandibular anterior lingual, #31 disto-lingual, and #16 diso-lingual. His margins were rolled on
the mandibular anterior linguals and also on # 28 disto-lingual. His papillae was generalized
within normal limits except for a blunted appearance between #8 and #9, this is due to the
patients diastema. There was suppuration upon probing on #30 and #31 buccal. The patient has
smooth and shiny papillary and marginal surface texture on the mandibular anterior facial. The
attached surface texture was a stippled appearance.
Appt 2: 9/28/16
The second appointment, I cleaned the maxillary left and periodontal charted this quadrant.
Slight bleeding was present but no suppuration was present. In all quadrants the tissues were still
the same as the previous appointment- generalized scalloped, red, edematous/spongy and
inflamed. My patients plaque score increased to .50 and his bleeding score was 1.8%

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Periodontal Care Plan
Appt 3: 10/12/16
At this appointment, I cleaned and periodontal charted the mandibular left. The mandibular
anterior linguals had a lot of calculus present and were very inflamed due to excessive build up. I
was very impressed with the appearance of the tissues on maxillary left, it showed much
improvement. The margins and the papillae were scalloped, stippled, pink in color and rolled
margins. The tissues of the other 3 quadrants were still inflamed with redness, edematous, and
light bleeding. My patients plaque score decreased to.33 and his bleeding score was 1.2%
Appt 4: 10/24/16
During the 4th appointment, I cleaned and periodontal charted the mandibular right and maxillary
right. The mandibular and maxillary right still had a lot of calculus present and was very
inflamed due to excessive build up. However, the mandibular left showed much improvement. In
the maxillary left and mandibular left the tissues appeared scalloped, slightly pink in color and
stippled. My patients plaque score was .33 and his bleeding score was 1.8%
Appt 5: 11/11/16
At this appointment, I performed a post periodontal evaluation on Mr.. I thoroughly examined his
gingival tissues and was very impressed with the amount of improvement with his oral tissues.
My patient even commented on how well his tissues have been doing and he now has less
bleeding while brushing and flossing. His architecture was generalized scalloped and his color
was pink. Lots of improvement was noted with his pocket depths, tissue height and clinical
attachment levels. His plaque index went from .33 to .33, bleeding index also remained the same
at 2.4%, and his gingival index improved from 2.4% to 1.5%
c. Plaque Index:
Appt 1: .33
Appt 2: .50
Appt 3: .33
Appt 4: .33
Appt 5: .33
d. Gingival Index: Initial- 1.7 Final- 1.5
e. Bleeding Index:
Appt 1: 2.4%
Appt 2: 1.8%
Appt 3: 1.2%
Appt 4: 1.8%
Appt 5: 2.4%
f. Evaluation of Indices:

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Periodontal Care Plan
1. Initial- My patient had a plaque score of .33, which is good as well as his gingival index score
of 1.7 good, and a bleeding score of 2.4%. These score are considered good but are still related to
his periodontal disease; throughout the treatment hopefully the number was further decrease.
2. Final- My patient had a plaque score of .33, which is considered good as well as his gingival
index score of 1.5, and a bleeding score of 2.4%. I was surprised to see that the overall numbers
stayed constant and did not reduce. This could possibly be due to Mr.. not performing his homecare like he stated he is.
g. Periodontal Chart: (Record basline and first re-evaluation data)
1. Baseline: The patient had pocket depths that ranged from 4mm to 9 mm. On tooth number 3,
there was recession of 2 mm on the facial, probing reading of 5 on disto-facial, mesio-lingual and
diso-lingual. Tooth number 11 and 12 had recession of 1 mm on the disto-facial surface. Number
14 facial had recession of 2mm on the facial and 1mm on the lingual surface. Tooth number 15
had a probing depth of 4mm on mesio-lingual and 6 on the disto-lingual. Number 18 had
furcation involvement and had a 5mm reading on the lingual, mesio-lingual, and the facial, a
4mm reading on the disto-lingual and mesio-facial, there was also a 7mm pocket depth on the
disto-facial surface. Tooth number 19 had probing depths of a 4mm on the disto-lingual, mesialfacial and disto-facial. Number 27 had a 4 mm pocket on the mesial-facial. Number 30 had
suppuration present a 5 mm pocket depth on the mesial-lingual and disto-facial and a 4mm
reading on the disto-lingual. Tooth number 31 also had suppuration and was the most severe,
there was probing depths of a 4 on mesial-lingual, 6 on distal-lingual, 5 facial, and a 9 on the
disto-facial. The suppuration indicates that there is bacteria present in the pocket that needs to be
removed. These deep pockets will effect his periodontitis because he is not able to remove
bacteria from the base of the pocket. He will only be able to maintain these deep pockets by
receiving professional cleanings every 3 months.
2. First evaluation
At the first re-evaluation data I overall noticed changes in his periodontal charting. The patient
had pocket depths that ranged from 4mm to 7mm. At baseline periodontal charting, there was 30
pockets present that were over 4mm and the first evaluation, there were 13 pockets that were
over 4mm. I was very impressed with the 9mm pocket on the distal of 31 had shrunk down to a
5mm pocket! This reduction in change is due to the mechanical removal of bacteria and calculus
that I performed on Mr.. throughout his treatment.

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

occlusion, abfractions)
The patient had quite an excessive dental examination. Missing teeth were noted on 1,2,16,17
and 32. On the maxillary and mandibular anterior incisal edges there was attrition present due to
grinding. Attrition contributes to periodontitis because it causes erosion in the tooth which can
lead to caries. Tooth number 2 had an occlusal and lingual amalgam restoration. There was a
diastema between 8 and 9. On 14 was an occlusal amalgam restoration. 15 has a distal occlusal,
and distal facial amalgam restoration. Number 18 has an occlusal and facial amalgam restoration

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Periodontal Care Plan
and furcation involvement. There was a suspicious area and a defective amalgam restoration on
the occlusal on 19. Distal torsoversion appeared on number 20. A defective restoration relates to
periodontitis because it harbors plaque and bacteria that can advance periodontitis.
6. Treatment plan (Include assessment of patient needs and education plan)
LTG 1: bring plaque score down to .1 or less
STG: define plaque
STG: define brushing and demonstrate proper techniques
STG: evaluate patient brushing method and make adjustments if needed and reduce plaque score
by .5 at each appointment
LTG 2: halt the progression of periodontitis
STG: define periodontitis
STG: demonstrate correct flossing method and teach patient importance and routine
STG: lower bleeding score to 1% by final appointment
LTG 3: get defective restoration fixed within the next 3 months (#19D)
STG: discuss the effects of a defective restoration
STG: gather fees and find dentist
STG: get defective restoration fixed
6. Treatment Plan: (Include assessment of patient needs and education plan)
Appt 1- 9/23/16:
Mr.. was scheduled for a 3-hour-appointment. Since he was a new patient and came in previously
for a screening appointment, I made sure he filled out statement of Release, HIPPA, patient
practice, and medical and dental history forms. After reviewing the medical and dental history I
took vitals on my patient and had medical history signed off by a pod instructor. I then placed a
bib on my patient and gave him pre-rinse, since the patient already wears glasses I did not
require him to wear safety glasses. I then took a phosphor plate full mouth xray. After xrays, I
did the head and neck exam, periodontal assessment and dental charting. I also did a plaque score
and gingival index score. My patient classed as a prophy class VI and a periodontal case III.
Patient education discussed at this appointment included brushing with a soft toothbrush and to
make sure he angled the toothbrush to reach his back molars, flossing in a C-shape, and the
meaning of periodontitis. Learning level was involvement, the patient said he would be taking
action. His next appointment is scheduled for September 28.
Appt 2During the second appointment, I will review the medical and dental history. The patient will pre
rinse and I will obtain a new plaque and bleeding score. I will then discuss patient education and
talk about plaque and brushing. Once completed, I will seat my patient in my operatory and I
will ultrasonic the first quadrant, complete a full periodontal charting on that quadrant and then
fine scale that quadrant.

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Periodontal Care Plan
Appt 3During the third appointment, I will review the medical and dental history. The patient will pre
rinse and I will obtain a new plaque and bleeding score. I will then discuss patient education and
talk about periodontitis and flossing. Once completed, I will seat my patient in my operatory and
I will ultrasonic the second quadrant, complete a full periodontal charting on that quadrant and
then fine scale that quadrant.
Appt 4During the fourth appointment, I will review the medical and dental history. The patient will pre
rinse and I will obtain a new plaque and bleeding score. I will then discuss patient education and
talk about defective restorations. Once completed, I will seat my patient in my operatory and I
will ultrasonic the third quadrant, complete a full periodontal charting on that quadrant and then
fine scale that quadrant.
Appt 5During the fifth appointment, I will review the medical and dental history. The patient will pre
rinse and I will obtain a new plaque and bleeding score. I will ultrasonic the fourth quadrant,
complete a full periodontal charting on that quadrant and then fine scale that quadrant.
Appt 6During the sixth appointment, I will review the medical and dental history. The patient will pre
rinse and I will obtain a new plaque and bleeding score and gingival index. I will evaluate the
indices and complete a full periodontal charting. I will check my work and fine scale any areas
and remove soft deposits. In the pockets 5mm or higher I will place arestin. Next, I will do
plaque the patient by flossing and polishing and then give a fluoride treatment. I will then answer
any questions my patient may have
7. Radiographic Findings: (crown root ratio, root formation, condition of interproximal bony
crests, thickened lamina dura, calculus and root resorption)
The patient had mild bone loss on 2, 12M, between 8 and 9, 31D and moderate bone loss on 18
D and 31D. Furcation involvement was found on 18. Calculus was present on 18D, 13D, 15D,
12M, 24 M and 25 M. A defective restoration was present on 19 D. Bone loss, furcation
involvement and calculus all is a negative contribution to periodontitis.
8. Journal Notes:
9-23-16:
This is Mr.. first appointment, he arrived at 8:45 and left at 11:45. He was late to his appointment
and I stressed the importance that he needs to be on time to every appointment in order for me to
finish his treatment. I reviewed my patients medical and dental history and questioned any
positive findings: sinus problems, alcohol consumption, recent xrays, problems associated with
previous dental treatment, sensitivity. I questioned the patient about his previous dental office but
he could not remember the name or the location. I then took a full mouth x-ray and vertical

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Periodontal Care Plan
bitewings using phosphor plates. Next, I completed a head and neck, intra oral, periodontal
assessment, and dental charting. I took a bleeding, plaque score and gingival index. I watched
my patients brushing technique and noticed he was using the rolling method, I then showed
him how to angle his toothbrush into the areas behind his molars to remove all the plaque
biofilm. I did a general patient education session on him and reviewed brushing, flossing, and
showed him the areas that determined he had periodontitis. Learning level was involvement- he
said he will use the new brushing method I taught him. I informed Mr.. about our clinic and that
it will take several appointments before completion of his treatment. He is willing to come back
and is interested in maintaining his oral health. No complications were present at this
appointment.
9-28-16:
During the second appointment, Mr. came into the clinic for a 4-hour appointment. I reviewed
the medical and dental history and he reveled he had no changes in his medical history and took
vitals. I then gave my patient pre-rinse. I took a plaque score.50 and bleeding score1.8% on my
patient. Unfortanely, his plaque score increased so he did not reach his goal of a .1 plaque score
during this appointment. I suggested to my patient that he should receive local anesthesia in the
quadrant I was working on. I explained to him that it will help to reduce the pain and sensitivity
and to help reduce bleeding. Mr.. did not think it was necessary to receive local anesthesia. I told
him to let me know if he is in too much pain and changes his mind. After about 30 minutes of
ultrasonicing, I asked him if he was comfortable and he said yes. I ultrasonic the maxillary left
quadrant, periodontal charted, and then fine scaled during that appointment. I did not have time
to do patient education during this appointment. Although, I then did a chair side patient
education on brushing and plaque. I explained to him that plaque over time hardens to form
calculus. I explained that calculus that calculus can form below the gumline and it needs to be
professionally removed. While brushing, I demonstrated to him how to angle his toothbrush to
remove plaque around his back molars. I also educated Mr.. on flossing and to focus on
removing plaque interproximally. I wold consider his learning level to be involvement because
he said he will be taking action on flossing. My patient asked about what he could do to whiten
his smile. I then recommended to him to use the Crest white strips after the treatment process
was over and it would have a better effect after all the calculus and stain was removed. I
questioned the patient on his diet and he replied that he does not eat sweet or drink soda. But, he
did admit to drinking alcohol; I told him that by drinking alcohol can cause dry mouth and can
lead to cavities. I suggested after he consume alcohol to drink water to prevent these problems.
No major complications were present other than the patient being sensitive in a few areas
beneath the gumline.
10-12-16:
During the third appointment, Mr.. came into the clinic for a 4-hour appointment. I reviewed the
medical and dental history and he reveled he had no changes in his medical history and took
vitals. I then gave my patient pre-rinse. I took a plaque score .33 and bleeding score 1.2% on my
patient. His plaque score did decrease from his last appointment so he is working towards
reaching his long term goal of a plaque score of .1 or less. He is really close to reaching his long

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Periodontal Care Plan
term goal of 1% bleeding score. Mr.. did not think it was necessary to receive local anesthesia. I
then ultrasonic the mandibular left quadrant, periodontal charted, and then fine scaled during that
appointment. The learning level is involvement because I questioned Mr.. if he was using the
new toothbrush technique I taught him and he said yes. I then asked him if he remembered what
I taught him about plaque and he remembered how over time it hardens into calculus. I educated
him to use a moth rinse with fluoride to help prevent cavities and improve the health of his gums.
I questioned the patient if he was drinking water after alcohol and he said yes. No major
complications were present other than the patient being sensitive in a few areas beneath the
gumline.
10-24-16:
During the fourth appointment, Mr.. came into the clinic for a 4-hour appointment. I reviewed
the medical and dental history and he reveled he had no changes in his medical history and took
vitals. He stated that he could not make his appointment the following Monday. I explained to
him that it was an inconvenience for me and that I would have to alter his treatment plan, he was
apologetic about it. I became very nervous that I would not be able to complete two quadrants in
this one visit, but I made it work. I then gave my patient pre-rinse. I took a plaque score .33 and
bleeding score 1.8% on my patient. Again, Mr.. plaque score remained the same as his last
appointment. He is working towards reaching his long term goal of a plaque score of .1 and
bleeding score of 1%. Mr.. did not think it was necessary to receive local anesthesia. I then
ultrasonic the mandibular right quadrant, periodontal charted, and then fine scaled during that
appointment. I then ultrasonic the maxillary right quadrant, periodontal charted and then fine
scaled during that appointment. I then did a chair side patient education on flossing again to
make sure he was understanding the concept. My patient told me that he was trying to floss more
often but it was hard because he could not reach the back of his mouth. He then demonstrated
how and I suggested to position the floss in a C-shape and to make sure to get the floss beneath
the sulcus to remove plaque debris. He then asked me about floss picks and floss threads. I told
him he does not have to use a floss threaders since he does not have any areas that would require
it to be used. I told him if he were to use floss picks, to make sure to wipe off or rinse off the
plaque throughout flossing to not transfer the plaque. Again, I asked him about how was the new
brushing method and he said it was much easier. The learning level is involvement. No major
complications were present other than the patient being sensitive in a few areas beneath the
gumline.

11-11-16:
During the fifth appointment, Mr.. came into the clinic for a 2-hour post periodontal
appointment. I reviewed the medical and dental history and he reveled he had no changes in his
medical history and took vitals. I then gave my patient pre-rinse. I took a plaque score
.33, bleeding score 2.4% and gingival index 1.5. Unfortantely, Mr.. did not reach his plaque score
of .1 or less by the final appointment and did not reach his bleeding score of 1% or less. I then
did a post calculus evaluation and began exploring and removed any fine scaled any excessive
remaining calculus. A few areas that needed rescaling was his molars and mandibular anterior

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Periodontal Care Plan
lingual. I then did post periodontal charting. I was then able to plaque free my patient. I then
placed Arestin in 5 of my patients pockets, #14 distal, # 15 mesial and distal, # 18 distal and
buccal. I then gave my patient a topical fluoride treatment and gave him instructions, not to eat
or drink anything for 30 minutes. I stressed the importance of his 3 month recall and for him to
find a local dentist to replace his defective restoration. Throughout the appointment, I did chair
side patient education on my patient and discussed how teeth can demineralize and form caries,
and that fluoride will help to remineralize the enamel. He asked me when he could start
whitening his teeth. I told him that he could use the white strips to improve the appearance of his
smile now that all the calculus and stain was removed. The learning level for this appointment
was involvement because he has the information and is taking action.

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

tooth morphology, periodontal examination, recare availability)
Based on my patients attitude and cooperation towards treatment, I believe Mr prognosis
would be fair because he seems to be determined to push himself to maintain good oral hygiene.
I stressed to him the importance of maintaining good oral health because the bacteria he leaves in
his mouth can progress to a more severe periodontal disease. With the education I taught him
about periodontal disease he is now aware that if he does not halt the progression it will only
continue to get worse. He seemed very concerned of the potential of destruction that periodontal
disease can have. Mr.. is 52 years old and has 27 teeth. He has no systemic conditions that would
affect his oral health. His malocclusion is a class 1 on the right canine and molars and a class 1
on the left canine and molars. He has an over bite of 3 mm , over jet of 4 mm and no midline
shift. There was a class 1 furcation involvement on number 18. The periodontal exam showed
significant improvements in the reduction of pocket depths and clinical attachment levels. Mr.
West said he will maintain his recare availably and return every 3 months, I hope he will make an
effort to be committed and does not cancel on his future appointment times.
10. Supportive Therapy: Suggestions to the patient regarding re-evaluation, referral, and recall
schedule (Note: Include date of recall appointment below)
My patient will return two weeks after treatment, I will then reassess his gingival tissues and
how well his tissues have healed. I will also fine scale and plaque free at this appointment. Due
to the patients moderate bone loss and furcation, I will place him on a 3-month recall, Feburary
11, 2017. There were no referrals from the dentist.
11. Assessment of changes: (include plaque control, bleeding tendency, gingival health, probing
depths)
During the treatment, my patient maintained a good plaque control. From the first appointment,
my patient had a low plaque score and continued to maintain and his score. His plaque score
went from .33, only decreasing one time to .50 and ending with a .33 by keeping this low plaque
score it will help to halt the progression of periodontal disease in addition to good oral hygiene.
Mr also had a low bleeding score of 2.4% to 2.4%. I was also surprised that his bleeding score
had not reduced, I am anxious to see what his score will be in three months. Based on the

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Periodontal Care Plan
examination at the final evaluation appointment, my patients gingival health has improved. His
tissues were less inflamed and overall pocket depths and clinical attachment levels were reduced
since the bacteria had decreased.
12. Patient Attitudes and cooperation:
My patients attitude and cooperation towards treatment was mixed. His cooperation with
maintaining his appointments were an issue because he canceled on three appointments.
Although confirming the day before he called ten minutes after the appointment had started to
reschedule. I stressed to him the importance of being dedicated to his appointments because I
would not finish on time and he would not receive the best comprehensive care possible.
However, when Mr. West showed for his appointment, he seemed to have a good attitude and
seemed interested in learning ways to improve his oral health.

13. Personal evaluation/ reaction to experience:

Evaluating myself on a personal level, I would say that I have learned a lot about periodontitis
throughout my periodontal patient. Being that my patient was a class 6, I was nervous that it
would be too difficult and that I would not be able to provide him with comprehensive care by
not finishing his treatment on time. However, I am very proud and gained confidence within
myself in treating harder patients. This project has also made me realize the importance of
writing progress notes and that I need to improve and be more thorough. By completing this
project I will use it in the future while I am in private practice. I now feel confident in educating
patients about halting the progression of periodontitis. My reaction to this experience is that I
have notice improvement in myself and I am progressing towards being a great dental hygienist!
Although, it was quite stressful with an unreliable patient I still tried to remain positive
throughout the process. It was a great feeling when my patient thanked me for the hard work Ive
done. Being able to educate and help to improve the oral health of my patient is truly a
wonderful feeling.