GINGIVAL INDEX

PERIODONTAL CARE PLAN

For Perio Patient
Initial date __9-9-2016__________
Gingival Area
M

13

19

25

28

(tooth number 12 is missing)

TOTAL 1.16 (fair)

Final date___10-28-2016______________
Gingival Area
M

13

19

25

28

(tooth number 12 missing)

TOTAL .29 (good)_

PERIODONTAL CARE PLAN

Patient Name: (removed for privacy)__________________________Age____69____
Date of initial exam: Friday, Sept. 9, 2016
Date completed: Friday, Oct. 28, 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.
My patient has a few medical conditions that should be considered before, during, and after his
treatment. His last physical was in 2015 and he is in overall good health. He is taking several
prescription and non-prescription medications. He is taking Zoloft for depression which has a
dental side effect of xerostomia, dyspepsia, and possible vomiting and altered taste. Xerostomia
can lead to dental caries, and vomiting can lead to acid erosion, although he does not suffer from
this or any of the other side effects mentioned. He takes one baby aspirin per day to prevent
another stroke from occurring. Aspirin should be avoided for 7 days post any surgery to prevent
soft tissue injury, and aspirin should also never be placed directly on the tooth or tissue surface in
order to avoid a chemical burn. Omeprazole is used for acid reflux, and I am mindful of keeping
my patient in a semi supine position for GI comfort. Norvasc is an anti anginal and
antihypertensive drug used to control blood pressure, and vasoconstrictors should be used with
caution. Should he need anesthesia, I will be mindful of communicating this with the dentist. His
blood pressure still tends to run a bit high, at his last appointment he was considered Stage 1
hypertension. I will be sure to monitor my patient closely and accurately take and record blood
pressure at each appointment. He also takes vitamins B3 and B12 for improved circulation. My
patient has had several surgeries, although none are dental related. He had knee surgery in 1980,
eye surgery in 1990, hernia surgery in 2013. As a child, he experienced asthma, but he is no
longer bothered by it. He has occasional sinus congestion due to the weather but currently does
not have any enlarged lymph nodes indicating illness or infection. In 2014, he experienced a
stroke but he has no obvious permanent damage. Following one of his previous surgeries, he
says he was prescribed codeine and experienced hallucinations so he never took it again. He does
not require a pre-medication or a medical clearance before treatment. He does use tobacco, he
says he dips about a can per day and he does drink alcohol, about a 6 pack of beer per day.
Tobacco use and alcohol use can contribute to oral cancer and tooth decay or staining. Tobacco
use could exacerbate his periodontitis status, although his perio case is considered slight, at this
moment. I will explain how to monitor any changes in his oral mucosa that may indicate a
disease, and instruct him to brush and floss often to remove any debris or stain that may be
present on his teeth. During chairside patient education, I will educate my patient to drink
frequent sips of water between alcohol consumption and tobacco use in order to cleanse his teeth
and neutralize the pH.

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)
My patient came to our clinic for a cleaning. He has not had his teeth cleaned since he retired, at
least twelve years ago. He seems a little aware of how important frequent dental visits are, but I
think he feels like he does not need to go unless he is in pain or having an issue. He has several
restorations from previous dental visits, his last one being a filling in 2015. Many of his
restorations are amalgams in the posterior, but he does have some TCRs in the anterior and a
couple in the posterior as well. A root canal and full gold crown is present on tooth number 19,
but he states there is some sensitivity around the margin, occasionally, but nothing was noted on
his x rays. He says his gums do bleed every once in a while when flossing, and he does have a
tendency to clench and grind, which he is aware of. The bleeding indicates infection, and if left
untreated, could worsen his periodontitis. He does not drink very many sodas or sugar containing
drinks, less than 2-3 a week, and he does not chew gum. There is sugar in alcohol, however, so I
will do my best to educate him on this subject. He does have a millimeter or two of recession in
just a few areas which does indicate bone loss. He has several pocket depths that are deeper than
4 millimeters, but some of these readings may be higher due to inflamed tissues. Not all of these
areas bled with probing. There is no family history of periodontal disease and he maintains most
of his natural teeth. He states that he does brush twice per day, flosses with a floss holder at
night, and he does not rinse. He recently began using Sensodyne Pronamel toothpaste and said he
has seen improvement regarding sensitivity. We discussed proper brushing technique, such as
angling his brush at a 45 degree angle to get into the sulcus and remove bacteria, but will
continue to go into more detail at each visit. Due to my patient having recession, he technically
has slight periodontitis. He is willing to come to appointments for proper treatment. Frequent
dental cleanings and adequate home care are imperative in his case, in order to halt disease
progression. Besides his third molars, the only tooth he is missing is his first premolar on the left
side, tooth number 12. I will continue to stress the importance of proper home care and frequent
dental visits in order to halt progression on further bone loss and/or any eventual tooth loss.
Attrition is obvious across the mandibular incisors, which has led to a couple of defective
restorations on #24-M, #25-M and #26-M. Dr. Porter suggested that he return to Dr. Boone for
further evaluation on those areas. There are a couple of suspicious areas, teeth numbers 5 and 6
have areas to be watched on the occlusal and on the disto-occlusal surfaces. After his cleaning, I
will ask about sealing those teeth if logical. Proper brushing and flossing education and diet
counseling will be helpful in avoiding further decay and in stopping the progression of
periodontitis. My patient also tends to grind his teeth and attrition is present on the lower
incisors; I have recommended a night guard to stop further wear. Overall, I think my patient is
willing to do what it takes to maintain his natural teeth for life, he may just lack a little bit of
knowledge. He does a pretty good job with his home care, we just need a little more education
and correction on a few areas. I believe that my patient is eager be treated, and I think we will
both do our part in order to halt the disease process that is periodontitis.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
During the head and neck exam, I noted that my patient has myopia and uses reading glasses. His
TMJ popped on the right side upon opening and he stated that he could hear it, but it was not
tender and he did not have any limitations. I listed the etiology as developmental because he
never had orthodontics. He also presented with bi lateral mandibular tori but was not bothered by
them. None of these issues interfere or are related to his dental condition and none are related to
his periodontal disease. Intraorally, it is apparent that he does grind; his mandibular incisors
present with attrition and a few defective restorations, and he is aware of this. No abnormal
mucosa findings were noted. His occlusion was classed as a tendency to a class II on the right
molar, a class I on the right canine, a class I for the left molar, and a class II for the left canine.
His overbite is about 2 millimeters, overjet is about 2 millimeters, and mid-line shift about 1
millimeters to the left. No open bites were noted, but he is in cross bite on his right side. His
gingiva was scalloped, and had a generalized color of red. This indicates bacteria and
inflammation, but the aspirin every day may contribute to the increased blood flow as well. I
listed the consistency as edematous and spongy in the mandibular anteriors and he also had one
area of fibrotic tissue, in the papilla between #13 and 14 on the facial. The reason for the fibrotic
tissue is unknown, although the facial of #13 does have 2 mm of recession. He did have a few
rolled margins, all on the facials of teeth numbers 7, 14, 22, 27, and 28. No suppuration was
noted. The surface texture was smooth and shiny around the papilla and margin, and the attached
gingiva. Recession was noted on teeth numbers 13, 22, 25, and 29, all on the facial surfaces.
Recession indicates bone loss which equals periodontitis. On radiographs, horizontal bone loss
was noted on tooth numbers 5 and 11-D and 13-M due to #12 missing. Calculus was also
obvious on 2 distal, 7 mesial, 21 mesial, and 30 distal. My patient is a Case 2 periodontal case
due to recession and a Class 5 prophy patient. He has generalized gingival inflammation.

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

a. Case Classification V
Periodontal Case Type: II
b. Gingival Description: Generalized gingival inflammation
Appointment 1: Friday, September 9, 2016 (Assessment appointment)
The patients architecture is scalloped and the tissue color is generalized red. Redness
indicates inflammation which is due to the body trying to fight off foreign pathogens. Should
these pathogens remain in the area for too long, his periodontitis could become worse. The
consistency was edematous and spongy on the mandibular anteriors and fibrotic in the papilla
between teeth numbers 13 and 14 on the facial. Rolled margins were obvious on the facials
of teeth numbers 7, 14, 22, 27, and 28. The papilla were pointed, as they should be. This may
not continue to stay the same if the disease process is allowed to progress. The surface
texture on the papilla, margins, and attached gingiva was smooth and shiny, which indicates
inflammation and increased blood flow, likely due to bacteria. Currently, my patient does
have periodontitis since he has recession. We know this cannot be reversed. However, with
proper brushing and flossing, I know my patient can halt the disease process and get back to
healthy gingival tissues without gingivitis. He does brush twice a day and flosses every night

before bed, so we are on the right track. With a little bit of technique correction and thorough
dental treatment, I believe his oral health can be restored.
Appointment 2: Friday, September 23, 2016 (cleaning mandibular left - teeth 17-24)
1st cleaning appointment mandibular left: At todays appointment, I observed the patients
architecture and it is still scalloped like at his previous appointment, and the tissue color
remains red in the mandibular left quadrant. Like previously stated, redness indicates
inflammation. Inflammation is present due to bacteria and if the bacteria is not removed, the
bone and tissues could be destroyed. I used the ultrasonic and fine scaled the mandibular left
quadrant and there was slight bleeding in the posterior around the lingual crown margin of
tooth number 19 and also on the mesial of tooth number 21. Number 19 did have some
suppuration on the facial side upon probing. He stated sometimes it feels a little sensitive
around the gum line on tooth #19. This tooth has been treated with RCT and also has a FGC,
but suppuration indicates infection is present. While perio charting, I got the deepest readings
in the posterior, with several 4-6mm pockets around teeth numbers 18, 19, and 20 on the
facial and the lingual surfaces. Bleeding was also noted upon probing in the posterior. The
margin on tooth number 22 remains rolled, slightly. Bleeding is also a sign of inflammation
and bacteria. The papilla are still pointed, as they should be. The surface texture remains
smooth and shiny, but hopefully in the coming weeks, we will see improvement in this area.
There is 1-2 mm of recession on the facials of teeth numbers 21 and 22; the patient holds his
chewing tobacco in this area of his mouth, which may be causing the recession. Currently,
there is not an oral lesion regarding his tobacco usage in that area. Following todays patient
ed session about plaque removal and brushing, I still remain confident that the patient wants
to improve his oral health and halt the disease process, and together I believe we can and will
achieve this. Next Friday, I will re-evaluate the mandibular left quadrant and begin on the
mandibular right. Our next patient education session is about flossing and periodontitis, and I
will also do a follow up plaque and bleeding score.
Mandibular right quadrant: The mandibular right quadrant remains inflamed due to
calculus and plaque below the gingiva. The margins are still rolled on 27 and 28 and his
anteriors on the mandible remain edematous/spongy. The papilla is slightly bulbous on the
facial between 25 and 26. Since bacteria is still present in this quadrant and we have not yet
had a chance to see improvement in home care, this quadrant as well as the others are the
same as previously listed. My patient is interested and motivated, however, so I am hoping
overall we will continue to see a change in his gingival tissues.
Maxillary left quadrant: The maxillary left quadrant also remains red and inflamed due to
bacteria, calculus, and plaque below the gingiva. The white fibrotic area previously noted is
still present in the papilla between 13 and 14 on the facial, as well as a rolled margin around
tooth number 14. (Later discovered a very deep subgingival calculus deposit in this area
which was likely the cause of the fibrotic papilla.)
Maxillary right quadrant: The maxillary right quadrant has some areas in the anterior
where the gingiva is right at the CEJ. If the tissue were to continue to move apically from the
CEJ, this would be considered recession which indicated periodontal disease. The tissue
follows the bone, so if the tissue recedes, one can assume the bone is resorbing as well. I plan
to educate my patient on proper brushing so he will not cause further recession or abrasion
due to incorrect technique. Also, there is a slight area of abfraction at the gingival margin on
tooth number 6. While this is not necessarily a direct tissue problem, I am sure incorrect

tooth brushing is to blame which can lead to further recession of the gingiva. I did not notice
number 7 to have a rolled margin anymore, however he did mention that sometimes he has a
hard time flossing the anteriors due to several interproximal restorations that may be causing
the floss to break. I have suggested using the Glide floss since it tends to fit between tight
contacts a little better. The overall tissue color does remain red and the consistency remains
edematous and spongy which is due to inflammation caused by bacteria.
Appointment 3: Friday, September 30, 2016 (cleaning mandibular right - teeth 25-32)
Mandibular left quadrant: At todays appointment, I observed the patients architecture
and color of the mandibular left quadrant, following last weeks cleaning of that area. Today,
the tissues are not near as red as they were previously. This indicates that he is producing a
positive tissue response following the removal of soft and hard deposits in the area. His
papilla are pointed and scalloped, and the gingiva is tight around the cervical portions of the
teeth. There is little inflammation remaining in the posterior which leads me to believe he is
responding positively to treatment and healing well. The anteriors are still a little red on the
mandibular anterior facials, but it may be difficult for him to really clean that area well due to
overlapping of the teeth. The margin of tooth number 22 is still slightly rolled, but no
bleeding upon probing was noted. Also, there is still no lesion regarding his tobacco usage.
Very little suppuration is still evident upon probing around tooth number 19. I think since our
previous patient ed session about plaque and brushing, he has applied this knowledge at
home. Adequate home care plus professional deep cleanings will really aid in improving his
tissue analysis.
Mandibular right quadrant: I began cleaning the mandibular right quadrant, which is still
red in color and edematous/spongy in consistency, due to bacteria. The papilla between 25
and 26 is slightly bulbous, possibly due to calculus beneath the gingiva, but the rest are
pointed and scalloped. The margins on 27 and 28 remain rolled, but I am hoping for
improvement at next weeks appointment. The surface texture is still smooth and shiny, but
again, after todays cleaning and his improved home care with correct brushing and flossing,
I am looking for improvement next week. Upon instrumentation, slight bleeding was noted,
indicating inflammation. The deepest pocket depths noted were on teeth numbers 29 and 30,
with 4mm on 30-D and 5mm on 29-D. Upon probing, only 2 bleeding points were noted; on
teeth numbers 27-D and 29-F. There was 1mm of recession on tooth number 29-F and also
on 25-F. There was deep subgingival calculus on 28-D but I was able to get it after a fine
scale check. Hopefully by removing this, next week we will see an improvement!
Maxillary right: The maxillary right quadrant is still slightly inflamed, mostly in the
posterior, probably due to bacteria and subgingival calculus, which has not yet been
removed. His plaque score has come down so I know his brushing and plaque control has
improved. While the tissues remain red with slight inflammation, I am certain with proper
home care and professional cleanings, we should see drastic improvement. The tissue is still
right at the CEJ in some areas (teeth 6-8-F), and while this likely will not change in a positive
manner, we have and will continue to discuss correct brushing and flossing. Tooth number 7
is no longer rolled, the main concern with this tooth is the gingiva being right at the gumline, which may lead to recession and root exposure later on, thus continuing the progression
of periodontitis as well as putting him at risk for root caries.
Maxillary left: The maxillary left quadrant remains red and inflamed due to bacteria, but we
have not cleaned there yet. He states there is some sensitivity along the margin of tooth

number 9. This is likely due to the tissue being slightly receded in that area. The papilla
between 13 and 14 remains fibrotic, likely due to subgingival calculus, but hopefully
following the cleaning, it will respond in a positive manner.
Also, when probing the indicator teeth, he has a bleeding score of 0%! There is a possibility
that his tobacco use may be masking the bleeding, however he is good about flossing at night
before bed and he seems to be absorbing all of the information taught during patient
education. Next Friday will be our third cleaning appointment and final patient education
session. I plan to go back over his brushing and flossing techniques, and discuss caries
prevention along with needed restorations and fluoride use. I will also begin cleaning his
maxillary right quadrant, and evaluate the tissues on the mandible for improvement.
App't 4: Friday, October 7, 2016 (cleaning maxillary right - teeth 1-8)
Mandibular right and left quadrants: At todays appointment, I observed the patients
architecture and color of the mandibular right and left quadrants, following the cleaning of
those areas Today, the tissues are not near as red or inflamed as they were previously, in
either quadrant. His papilla are pointed and the gingiva is tight around the cervical portions
of the teeth and there is very little inflammation remaining in the anterior or posterior. The
mandibular anteriors are still a slightly red on the facial, but it may be difficult for him to
really clean that area well due to overlapping of the teeth. The margins of teeth numbers 27
and 28 are still very slightly rolled, but no bleeding upon probing was noted. I believe they
are in the process of healing. The papilla between teeth numbers 25 and 26 remains slightly
bulbous but it may take a little time to heal.
Maxillary right quadrant: Today I began cleaning the maxillary right which is not near as
inflamed as the mandible was to begin with. The tissue has receded around tooth number 6
and it is right at the CEJ on 7 and 8 but he did not state any pain or sensitivity in these areas.
The pocket depths around tooth numbers 2 and 3 range from 4mm readings to 6mm readings
but with a thorough cleaning and post treatment, hopefully this area will heal as much as
possible. These deep pockets likely indicate some mild bone loss in the area. The patient
stated difficulty flossing between his maxillary incisors, possibly due to interproximal
restorations. I removed a nice sized piece of calculus on 8-M, however, so maybe that will
help him be able to floss better in those areas now. Bleeding was slight in this area, with most
points being in the posterior around teeth numbers 2 and 3, which is where his deeper
pockets are located. He has learned and retained knowledge from previous patient education
sessions about brushing, flossing, gingivitis, and periodontitis and I believe he is applying
this knowledge at home. His tissue status is evident of this.
Maxillary left quadrant: The maxillary left quadrant remains pretty inflamed, but not quite
as bad as our first appointment. I know he has corrected his brushing and flossing techniques
because we are getting lower plaque and bleeding scores. The margin of #9 is still sensitive,
so for next weeks cleaning I will be mindful of this and maybe place topical or something on
the area when scaling as to not make my patient uncomfortable. The papilla between teeth
numbers 13 and 14 still remains fibrotic looking, although maybe once the subgingival
deposits are removed, the tissue will heal correctly.
App't 5: Friday, October 14, 2016 (cleaning maxillary left - teeth 9-16)
Mandibular left and right quadrants: At todays appointment, I evaluated the mandibular
right and left quadrants together and the architecture is scalloped. His tissues are pretty much
back to a healthy pink color on the mandible, with a few slight, localized exceptions, mainly

in the mandibular anterior facials. The rolled margins around tooth numbers 22 and 27 still
remains slight on the facial side, and there is still a little bit of redness on the facial of 27 as
well. The surface texture of the margins and papillae are still slightly smooth and shiny, but I
think we are on the right track as far as healing goes. 19 facial still has very slight
suppuration upon probing, which indicates there may still be a little bit of infection present,
but I do notice improvement since his first appointment. I think my patient is taking the
proper steps needed to halt the status of his periodontitis and I think he is responding very
well to treatment and proper home care.
Maxillary right quadrant: The maxillary right quadrant is healing very well. Very little
inflammation was noted today, the tissues are scalloped, his color is returning to normal, and
the attached gingiva is stippled which is a great sign. While the papilla and margins are still
slightly smooth and shiny, I am confident that we will continue to see improvements overall.
The attached gingiva alone is an improvement since our first appointment, where everything
was smooth and shiny. Tooth number 8 is very slightly rolled on the facial side, but last
week I removed a very large subgingival calculus deposit, so it may also still be in the
process of healing.
Maxillary left quadrant: Today I cleaned the maxillary left which completes all of the
quadrants. He previously told me that the margin of number 9 was sometimes sensitive,
although today we had no issues during the cleaning. The architecture is scalloped and the
color is red in the maxillary left quadrant due to bacteria still being present. The consistency
here is also edematous and spongy, but every other quadrant began this way as well and
healed quickly to a nice pink color once the periodontal pathogens were removed. The
papilla between 13 and 14 remains fibrotic looking, but there was a very large calculus
deposit below the margin and below his amalgam restoration so hopefully after removing
that, we will see the tissue heal correctly. This area also bled a lot upon cleaning. I was able
to remove the deposit during fine scale and it took several tries to fully remove the entire
deposit. This deposit was likely harboring bacteria which causes inflammation and tissue
destruction, which can lead to eventual bone loss if not removed. I also noticed today, that on
the facial of tooth number 14, there is about 3mm of recession and you can slightly feel the
furcation. He states there is not any sensitivity here but I did discuss root caries, the
progression of periodontitis, and the chance of sensitivity occurring in this area due to bone
loss and tissue recession. The papillary and marginal surface texture are still smooth and
shiny, but I did notice the attached to be stippled in this area. I am excited to see his overall
improvement in a couple of weeks! He remains motivated and is doing great with his home
care.
App't 6: Friday, October 28, 2016 (post cal appointment evaluation of all areas +
plaque free and fluoride)
Overall assessment of all quadrants: Today I completed a new perio assessment on my
patient and noticed improvement overall, in most areas of the mouth. There were still a few
areas that may still be in the process of healing, but change has definitely been noted. The
architecture of the whole mouth remains scalloped. His tissue color is returning to normal,
but there was a little bit of redness along the margin of tooth number 28-F. This tells me that
most of the bacteria has been removed and his tissue is responding in the appropriate way.
This is a great sign because it indicates that the progression of the disease process is being
halted. Today he was experiencing xerostomia, which he usually doesnt, so that did make

his tongue and palate appear more red than normal. For the most part, his gingival tissue was
pink or very light red, with the exception of 28, which was more of a darker red around the
margin. This area may still be healing from previous treatment, because after fine scaling
today, there are no deposits left around the area. The consistency however remains
edematous and spongy in the mandibular and maxillary anterior facial area. This also
indicates remaining pathogens, but again he may take a little longer to fully heal in some
areas. Rolled margins are present on 7 and 11 facial but all other areas were normal. The
margins that were rolled at his last appointment 8, 22, and 27, are no longer rolled. Im not
quite sure what exactly is causing the rolled margins to come and go but hopefully after his
fine scale today, he will have nice healthy gingival tissues that will return to their normal
state soon. I checked number 19 for suppuration and did not note any today upon probing or
palpation. Hopefully this means that the infection is no longer present in the area. This will
aid in the halting of his periodontitis. The surface texture of the papilla and margins are
considered smooth and shiny, but healing, and the attached gingiva was overall stippled,
which indicates that the tissues are attached tightly to the bone.

c.

Plaque Index: Appt 1 1.16 (good) 2 1.6 (good) 3 0.6 (good) 4. 0.6 (good) 5 0.33
(good) 6. 0.33 (good)

d.

Gingival Index: Initial

e.

Bleeding Index: Appt 1. 6.7% (whole mouth) 2. 0% 3. 0% 4. 0% 5. 0%

6. 4.3% (whole mouth)

1.16 (fair)

Final .29 (good)

f. Evaluation of Indices:
1. Initial: He does a good job cleaning most of his teeth. While he did have generalized
inflammation, he does not have generalized bleeding. His highest numbers on the
gingival index were a two, which noted on the distal and the lingual of tooth number 28.
His brushing technique does need some work, as he tends to scrub, but I think that can
be easily corrected. The most work is needed cleaning the distal and lingual on posterior
teeth. This can be achieved with correct brushing, and flossing of interproximal spaces.
His gingival index score is currently 1.16, which is fair, but with the correct treatment
and home care, he should improve by our final appointment.
2. Final: We have seen major improvement since the initial gingival index in early
September! My patient was very motivated during all patient ed sessions, and he was
able to easily retain, repeat, and apply the skills he was taught. I believe the improved
homecare as well as being treated in our clinic has helped to improve his overall oral
health and halt the progression of his disease. His bleeding score and plaque scores both
have declined significantly since we began treatment. One area that was commonly
coming up on the plaque score was the lingual of his mandibular anteriors; we corrected
his brushing and saw a change on the following week. I sent him home with some Glide
floss, as he stated the floss he was using had a tendency to shred in some areas.
Hopefully he will see results and stay motivated after trying the product. We have
changed his brushing technique to rolling at a 45 degree angle and he says he still flosses

at night. I explained that by doing this 2 times a day, he can help halt the progression of
periodontitis, which he is motivated to do. There were several areas with deep
subgingival calculus so since that has been removed, the tissue is returning to a healthier
state. Overall, my patient responded well to suggestions and treatment, and I think we
will continue to see his oral health improve.
g.

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

1. Baseline: My patient did have a few periodontal pockets that were 4mm or deeper pocket
depths at his first appointment. His deeper pockets are localized in the posterior, with
6mm being the deepest, on 2-M (F&L), and also 20-D. 5mm depths were noted on 2-D
(lingual), 3-D (facial), 14-M (lingual), and 19-M and D (facial and lingual). 4mm depths
were found on 2-L, 3-L, 15-M (facial), 18-M (facial and lingual), 20-M (lingual), 30-M
(lingual) and 30-D (facial and lingual). 4mm was also present on 31-M and D (lingual).
Several areas of recession are noted. Number 13 has 2mm of recession on the facial,
number 22 has 1mm of recession on the facial, number 25 has 1 mm of recession on the
facial, and number 29 has 1mm of recession on the facial. Bleeding was slight but noted
upon probing on 2-M, 3-D and 3-L, 11-M, 15-M and 15-F, 19-M, 20-D, 26-D, and 29-F.
His recession may be due to incorrect brushing, his clenching habit, and/or incorrect
flossing, as well as bacteria causing the gingival tissues to recede away from the
pathogens.
2. First Evaluation: Today, my patient still has a few 4mm or deeper pockets, all localized
in the posterior. This indicates that periodontal disease is still present, either active or
inactive. A normal pocket depth is within 1-3mm, and since he has pockets deeper than
what is considered normal, we know that periodontal pathogens can get down into the area
and cause more destruction. Deeper pockets are harder to clean and can increase the risk
and severity of periodontitis. The 4mm pockets were found on the following maxillary
teeth, 3-ML, 5-ML, 14-M (distal and lingual), 15-MF. The mandibular teeth with 4mm
pockets include 22-DF, 30-MF-DF-ML-L, and tooth 31 on the MF-ML, and DL.
5mm pockets were noted on 2-L, 3-DL, 14-DL, and 15ML. On the mandibular teeth 5mm
pockets were found on numbers 18-M (F&L), 19-DL and MF, and 20-DL and also on 30DL. 6mm pockets were noted on tooth 2-MF, and also on 19-DF and 20-DF. The 6mm
pocket on 2-MF remains unchanged from his baseline reading.
There was only one 7mm pocket and that was found on tooth 3-DF. This area has increased
by 2mm since the baseline reading so this indicates active periodontal disease progression.
There were several areas on the maxillary and mandibular where the tissue was right at the
CEJ so he had a 0 for tissue height; this was also the case at baseline. Areas of recession
were noted on 25F (1mm) and also on 18 and 20 facial, also 1mm. What is interesting and
quite possibly a mistake from last time, is that last time more recession was charted than
this time. Neither I nor my instructor noted recession that was previously listed in the areas
before. I know the tissue does not grow back, because gingival recession indicates bone
loss. Next time I will check these areas again for another assessment. Overall my patient
does still have periodontal disease, and while some of his pocket depths have increased,
hopefully now that he has had a thorough dental cleaning, he will be able to maintain good
home care and keep up with regular dental check-ups and we can see an improvement in
his overall oral health. I placed 5 Arestin capsules in areas 5mm or deeper. One was place

around tooth 2-3, one on the lingual interproximal area of 14-15, one between 18-19, and
19-20, and also on the lingual of 30. This should aid in his healing and shrink the pocket
depths and hopefully by his recall in the spring, there will be obvious improvement.
Initially, his greatest pocket depths were located around 2-M, and 19 and 20-D. all of these
pockets were originally 6mm. They remain at 6mm but the greatest change was on 3-D
where it was previously 5mm and now it is 7mm. This may be due to technique error or
maybe a piece of calculus was still present and led to an incorrect reading.
5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth,
occlusion, abfractions). My patient is missing all third molars and tooth number 12. He says
he has not ever had any teeth pulled and he has never had orthodontics. There are several
metallic restorations present and also a few TCRs. An occlusal and lingual metallic
restoration is present on tooth number 2, an occlusal-distal-lingual metallic restoration on
tooth number 3, and an occlusal metallic restoration on tooth number 4. Also, suspicious
areas are noted on the occlusal of tooth number 5 and on the distal of tooth number 6. TCRs
are present on the maxillary anteriors. Number 7 has a mesial-incisal-facial TCR, 8 and 9
have mesial and distal facial and lingual TCRs, and tooth number 10 has a mesial TCR and
also a small one on the facial near the gum line. Tooth number 13 has a D-O metallic, and
number 14 has a M-O and a lingual pit metallic restoration. On the mandible, tooth number
18 has a M-O-B metallic, 19 has RCT and a FGC but he does state that occasionally the
marginal area of this tooth has a bit of sensitivity. No pathology was noted on the x ray.
Number 20 has a D-O metallic. Attrition is noted all along the mandibular anteriors and also
there have been a few failed restorations along the mandibular incisors. Numbers 24, 25, and
26 all previously had TCRs on the MI surfaces but they are no longer present. He was
instructed to see Dr. Boone regarding this issue. Number 28 has a M-O-D TCR and 29 has a
M-O TCR. 30 has a M-O-D metallic restoration and number 31 has an occlusal metallic
restoration.

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

All appointments will include:
- Reviewing medical and dental history
- Pre-Rinse
- New plaque and bleeding scores
- Gingival assessments and notes
- Ultrasonic scaling and fine scaling 1 quad / wk
- Full perio charting per quad
- Chair side patient education
LTG 1: Bring plaque score down to .1 or less. (Reduce plaque score by .5 per each
appointment)
STG: Define plaque
STG: Define and demonstrate proper brushing
STG: Evaluate (and correct if needed) patients brushing method with typodont and also
on self.

LTG 2: Halt disease progression of periodontitis

STG: Define periodontitis
STG: Define and demonstrate correct flossing technique. Continue flossing each night, just
work on technique.
STG: Reduce bleeding score by 1% at each appointment.
LTG 3: See dentist for suspicious areas and failed restorations on mandible, following
prophylaxis at LIT Dental Hygiene Clinic (by end of year)
STG: Define caries and explain process
STG: Discuss diet counseling and how a lower pH effects enamel and caries process
STG: Discuss and educate on benefits of fluoride use
LTG4: Tobacco cessation
STG: Discuss effects of tobacco products on oral cavity as well as systemically
STG: Teach self-monitoring for any changes that may be related to oral cancer
STG: Reduce tobacco use to can every 2 days
Appt 1: At my patients first perio appointment I will take a new plaque and bleeding score and
also do a gingival assessment and make thorough notes. I plan to use the intraoral camera to add
pictures to my patients file. Then, I will ultrasonic and periodontal chart the mandibular left
quadrant, with 6 pocket depths, tissue heights, and clinical attachment levels, per tooth. I will
have all of this checked by an instructor before moving on. After the quadrant is checked, I will
thoroughly fine scale the quadrant and have that checked twice. If time allows, I would like to
get through our first patient ed session about plaque. I will define plaque which is a white sticky
film that is made up of bacteria and food debris. I will educate him on how plaque demineralizes
the tooth surface and leads to eventual decay, gingivitis, and possible periodontitis and tooth
loss. I will demonstrate proper brushing which includes angling a soft toothbrush 45 degrees
towards the gingiva and removing plaque from all surfaces. Last, I will evaluate my patients
knowledge of brushing by watching him at the sink. Our long term goal is to reduce the plaque
score to .1 or less; by .5 at each appointment.
Appt 2: At my patients second perio appointment I will take a new plaque and bleeding score
and also do a new gingival assessment and make thorough notes. I will ultrasonic and
periodontal chart the mandibular right quadrant, with 6 pocket depths, tissue heights, and clinical
attachment levels, per tooth. I will have all of this checked by an instructor before moving on.
After the quadrant is checked, I will thoroughly fine scale the quadrant and have that checked as
well. If time allows, I would like to get through our second patient ed session about periodontitis.
I will define periodontitis which is bone loss and tissue destruction due to bacteria being present
for a period of time. I plan to use his intraoral pictures to show areas of recession, and also his x
rays, which will be helpful in showing his current bone level. I will educate him on how
periodontitis progresses over time and cannot be reversed, but it can be stopped. I will
demonstrate proper flossing which includes making a C shaped loop around each interproximal
tooth surface and getting down into the sulcus (space between tissue and tooth) in order to
effectively remove as much bacteria as possible. Last, I will evaluate my patients knowledge of
flossing by watching him on the typodont and at the sink. Our short term goals are to continue
flossing each night before bed, but to correct the technique in order to remove as much bacteria

as possible; and to reduce the bleeding score by 1% at each appointment. Our long term goal is
to halt the progression of the disease process. I believe all of our goals are achievable.
Appt 3: At my patients third perio appointment I will take a new plaque and bleeding score
and also do a new gingival assessment and make thorough notes. I will ultrasonic and
periodontal chart the maxillary right quadrant, with 6 pocket depths, tissue heights, and clinical
attachment levels, per tooth. I will have all of this checked by an instructor before moving on.
After the quadrant is checked, I will thoroughly fine scale the quadrant and have that checked as
wellIf time allows, I would like to get through our third and final patient ed session about caries.
I will define caries (cavities), which are areas of decay due to plaque being left on the tooth
surface for too long. Diet and effective plaque removal are imperative in avoiding decay and
eventual tooth loss. I will educate him on how caries progress over time and can cause other
issues such as broken teeth, or painful abscesses. Also, sugar or fermentable carbs being left on
the tooth or in the mouth for too long, lower the pH which causes demineralization and/or caries.
In this patients case, I dont think he is fully aware that drinking alcohol frequently and using
tobacco products can lead to decay. Proper brushing and flossing are critical but I will also
educate on the importance of fluoride to remineralize the tooth structure before decay occurs.
Our short term goals are to make sure my patient has enough knowledge to understand effective
plaque removal and caries prevention. Our long term goal is for him to see a dentist regarding the
failed restorations on the mandibular incisors and also for evaluation of two suspicious areas.
App't 4: At my patients fourth perio appointment I will take a final new plaque and bleeding
score and also do a final gingival assessment and make thorough notes. I will ultrasonic and
periodontal chart the maxillary left quadrant, with 6 pocket depths, tissue heights, and clinical
attachment levels, per tooth. I will have all of this checked by an instructor before moving on.
After the quadrant is checked, I will thoroughly fine scale the quadrant and have that checked as
well. I will re enforce all of the previous patient ed sessions, answer any questions my patient
may have, and commend him for areas of improvement that are clinically obvious. I will discuss
tobacco cessation chair side and teach him how to check his oral tissues for any changes that
may indicate oral cancer. I will also encourage him to try cutting down to a can every two
days in the hopes that our long term goal of quitting completely, can be achieved.
Appt 5: This is our final appointment, two weeks post scaling last quadrant. I will take a new
gingival assessment, evaluate all gingival tissues, and I will re check and fine scale all areas to
remove any new or residual calculus. I will also probe the entire mouth, 6 pocket depths and
tissue heights per tooth, and calculate the CAL accordingly. This will be checked by an
instructor before proceeding. I will compare todays charting to the numbers from his previous
appointments to note improvement. Any pockets that remain over 5mm will be treated with
Arestin to aid in healing. I will answer any questions from my patient and place him on a 3
month recall. We will also do plaque free and fluoride at this appointment.
7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony
crests, thickened lamina dura, calculus, and root resorption)
No 3rd molars are present and neither is tooth number 12. Mild horizontal bone loss was noted on
the distal of tooth number 11 and mesial of 13 due to number 12 missing. Calculus was noted on
2-D, 7-M, 21-M, 30-D. Suspicious areas are also noted on 27-D and 28-M.

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.
9-9-16 Today was my patients first time visiting the Dental Hygiene Clinic. We began and
completed all paper work, took an FMX with phosphor plates and I also took vertical bitewings
to evaluate his bone level. He qualified as my perio patient and since it is my grandpa and he is
retired, I am going to use him as my primary perio patient. We discussed the number of
appointments and he said it was fine, that he would continue to come. I am going to see him
every Friday for 4 hours until treatment and patient education is complete. This should be just
enough time to get everything done before the deadline. The intraoral camera was not working
on this day, so we will get our pictures at his next appointment. He is willing to be treated and I
think he is eager to change his habits that need correction because when I watched him brush at
my sink I taught him the correct brushing method and he accepted my recommendations. He is
currently flossing each night before bed, but he is using a floss holder so I dont think it is as
effective at cleaning the posterior teeth interproximally, as manual floss would be. We will find a
solution to help him get rid of bacteria. At our next appointment, we will discuss diet
recommendations, note any complications he may have been having, and I will commend him on
any improvements. I will also go over our short and long term goals and I will always try my
best to motivate and encourage my patient. His learning level right now is involvement, because
he is trying his best and taking action on all suggestions. He does not want to lose his teeth and
he has a good amount of knowledge about periodontitis.
9-23-16 Today was our first cleaning appointment. We began with updating his medical and
dental history which had no changes. Following pre-rinse, I took a new plaque (1.6) and bleeding
score (0%) and then we took a few photos with the intraoral camera. I took a front picture, a
picture of his recession in the mandibular left quadrant, and one of the incisal edges of both the
maxillary and mandibular centrals. He has attrition on his incisors, and some missing restorations
on his mandibular incisors. I will use these photographs for patient education next week, when
we discuss periodontitis, and the following week when we discuss seeing a dentist about caries
and having his restorations restored. They will also be helpful in discussing tobacco cessation, so
I can show him what the tobacco is doing to his teeth and gingival tissues. After we used the
intraoral camera, I began using the ultrasonic to clean his mandibular left quadrant. During
ultrasonic, Mrs. Harrell came to get me for patient education. We spent about 10-15 minutes
teaching about brushing and plaque. I defined plaque, demonstrated brushing, and had the patient
show me how he brushes on the typodont and at the sink. After he brushed, I disclosed him to
show any areas that had been missed. I asked him some review questions and he was able to
answer them correctly and he seems interested in changing his brushing habits. (He uses the
scrub technique). We then went back to my chair to continue cleaning. Following the
ultrasonic, I had an assistant help me to perio chart his quadrant. After having the periodontal
charting checked, I moved on to fine scale. I was/am slightly disappointed in myself for not
doing a better job, as I missed a few spots. My final fine scale will be checked at our next
appointment. My patient did state that he could feel a difference on his teeth, and that they felt
smoother than before. Hopefully this in itself will be motivating enough for him to return for

treatment and to continue frequent dental visits in the future. Currently, I would describe his
learning level as involvement. Next Friday, I will evaluate the mandibular left quadrant and
have 18-DL and 19-L checked. I will also begin on the mandibular right. Our next patient
education session is about flossing and periodontitis, and I will also do a follow up plaque and
bleeding score.
9-30-16 Today was our second cleaning appointment. We began with updating his medical and
dental history, which had no changes. Following pre-rinse, I took a plaque and bleeding score (.6
and 0%) and went back to check the mandibular left for any residual calculus and began on the
mandibular right. I used the ultrasonic to clean his mandibular right quadrant and began
periodontal charting for that quadrant. After I recorded all pocket depths, we did his second
patient education session. Mrs. DeMoss sat in on this session and it was about flossing and
periodontitis. I used his x rays and intraoral pictures to show bone loss and recession and taught
him about making a C shape when flossing to get in between the teeth and clean the adjacent
tooth surfaces. He uses a floss holder and was aware of the technique needed. I first defined what
periodontal disease is, specifically periodontitis, and demonstrated the flossing C-shape
technique on the typodont and then my patient demonstrated flossing at the sink. Our last short
term goal related to this session would be to reduce the bleeding score by 1% at each
appointment. His indicator teeth produce a bleeding score of 0% at each appointment. He is
really motivated to learn and he is good about his homecare. He flosses each night and
understands the basic information. We reviewed tooth brushing and plaque and he retained the
information that I had taught him. I gave my patient a gum disease brochure that was in the
patient ed room, and he seemed interested in learning more. Following patient education, I
recorded all tissue heights and calculated the CAL for each tooth. I had last weeks two spots,
my ultrasonic from today, and the periodontal charting checked by Mrs. Harrell and proceeded to
fine scaling. Today I ran out of time to go back and complete the fine scale, however, next week
I can go back and remove the four deposits that were noted today. My patient stated again today
that he noticed a difference on the entire mandible now. He says his teeth feel smooth and I think
this will continue to motivate him to return for additional treatment. Next Friday, I will go back
to fine scale the mandibular right quadrant and move on to the maxillary right with the
ultrasonic. We will complete our third and final patient ed session which is over caries and
restorations and hopefully his plaque score will be even lower this time. I am anxious and
excited to see my patient improve his oral health. I think by now his learning level is considered
action, because he is taking the information home and applying it, in order to make positive
changes. He remains motivated and I am confident in him.
10-7-2016 Today was our third cleaning appointment. We began by updating medical and dental
history, pre-rinse, and taking a new plaque and bleeding score (.6 and 0%). I also did a gingival
assessment of all of the tissues and noted any changes. I had a few fine scale spots left to get on
the mandibular right quadrant so I did that first and then began cleaning the maxillary right
quadrant with the ultrasonic. I feel like usually, the maxillary teeth are easier to clean than the
mandibular teeth. That remained the case today. There just isnt near as much build up on the
maxillary teeth as there typically is on the mandible. I got my ultrasonic checked and missed one
spot, 2-D. I also did perio charting and found the deepest pockets to be around the posterior,
specifically teeth numbers 2 and 3, with readings ranging from 4-6mm. There was also slight
bleeding noted in the posterior. Following perio charting, I began patient education session 3

with Mrs. Dinh. We discussed the caries process and definitions, and the benefits and sources of
fluoride, as well as restorations needed on the mandibular incisors. We also talked about how
frequent alcohol consumption keeps the mouth at a lowered pH, which can increase his caries
risk. I advised him to drink water often between beverages, in order to cleanse the teeth. The
restorations on the mandibular incisors failed previously, so he needs to have them repaired. My
patient does clench and grind however, and he is in cross bite, so this may be the cause for the
failed restorations. He has been advised to see Dr. Boone as soon as possible for the evaluation
of the restorations as well as a couple of suspicious areas on teeth numbers 5 and 6. I did a quick
follow up of previous sessions, asked if he had any questions, and told him we would likely
place him on a 3-4 month recall following the end of these appointments already scheduled.
Following our final patient ed session, we went back to my chair to fine scale. I had my fine
scale checked by Mrs. Sandusky and Mrs. Dinh, and the only spot left was 8-M which I removed
promptly while Mrs. Dinh was still there and could check. She checked that spot and it was
cleaned, so I was able to dismiss my patient early. He is returning next week for our final
cleaning appointment. We will work on the maxillary left quadrant and hopefully see a further
reduction in his plaque score, being as our long term goal is to be at .1 or plaque free! His
bleeding score on the indicator teeth remains at 0%, however, generalized slight bleeding is
noted upon instrumentation and in some areas for probing. I am confident that my patient will
continue and improve on good home care and that by his 2 week follow up, we should see
improvement in all quadrants. The learning level at this appointment remains action.
10-14-2016 Today was our final cleaning appointment and we did not have any formal patient ed
sessions to do. We began by updating medical and dental history, pre-rinse, and taking a new
plaque and bleeding score (.33 and 0%). I also did a gingival assessment of the mandible and the
maxillary right quadrants and noted the changes (improvements!!). I also went back to feel for
any new build-up in the previously cleaned areas and removed what I found which was very
light. I began using the ultrasonic on the maxillary left quadrant. After I felt like I had completed
this area with my universal and slim-line, I completed the final quadrant of periodontal charting.
Once this was checked, I missed a couple spots with ultrasonic but still passed the quadrant. My
perio charting was good, the deepest pockets were located in the posterior with several 4mm+
pocket depths. There was a significant amount of bleeding between teeth 13 and 14 on the facial,
where the fibrotic papilla is present. I then proceeded to fine scale. Here I was able to remove the
spots missed from ultrasonic. The deepest deposit was noted between 13 and 14, but there was
also a large deposit between 11 and 13, 12 is missing. We reviewed our previous patient
education sessions and he also told me he is going to receive the fluoride treatment. He was
previously hesitant but I am happy to say that after our last patient ed session, he has made the
decision to receive fluoride. Todays patient ed was all done chair side, and it consisted of all
previous topics such as brushing and flossing, plus some information about tobacco cessation.
He doesnt seem quite ready to quit dipping, but may try to cut down. I will complete plaque free
and fluoride at our post care appointment on October 28. I will also fine scale all areas, complete
a full periodontal charting, and place Arestin in all 5mm+ pockets. I am anxious to see the final
improvements and I am so glad that he is motivated to do his part! Learning level is still action.
10-28-2016 Today was our post cal appointment. We began by updating his medical and dental
history which had no changes. After he pre-rinsed, I took a new gingival index and did a new
perio assessment to help me keep track of his gingival tissues. I then took a plaque score which

has stayed the same in the past few weeks, .33. We have not met our goal of .1 or less, but we
have seen significant improvement since his first appointment, so I am satisfied. I did a brand
new bleeding score based on the whole mouth, because I wanted it to be very accurate and
comparable to the first bleeding score. There was improvement!! His original bleeding score was
6.7 and today it was 4.3 for the entire mouth. On the weeks that I only checked the 6 indicator
teeth, his bleeding score was 0%. Our long term goal was to halt the progression of periodontal
disease, and I think we are on the right track. While his bleeding score didnt calculate to -1%
per appointment I fine scaled the entire mouth and then perio charted every tooth in each
quadrant. 6 probing depths and tissue heights, and I calculated the CAL accordingly. Mrs.
Rogers checked my scaling and my perio charting. Following the perio charting, I highlighted
the 5mm+ pockets and placed Arestin to aid in healing. This was my first time to use the product
but I found it easy to use. The Arestin was placed in several locations in the posterior,
interproximally. I used 5 cartridge tips at todays appointment. I am anxious to see him again in
the spring, so I can see if it worked and how well. I completed plaque free and a fluoride
treatment at todays appointment and we discussed previous patient ed topics such as brushing,
flossing, and having those restorations restored. We talked a little about tobacco cessation, but
again I still dont think he is quite ready just yet. Also, regarding caries prevention, I informed
him that it would be wise to drink water following beer or any other sugar/acidic beverage. This
will cleanse the teeth and reduce his caries risk. Today he was experiencing a little bit of
xerostomia, but he hasnt dealt with this in the past. This could be due to the medications he is
on. I explained frequent sips of water, sugar free gum, and reducing alcohol intake should be
helpful. He didnt seem too bothered by it but I could tell that his tongue and palate both were
looking a little more red than normal. I noted his learning level as action because he has stayed
motivated and remains interested in learning new things about halting the progression of
periodontitis.
9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion,
tooth morphology, periodontal examination, recare availability)
My patient has a good attitude about halting the disease process. He is 69 years old and has all of
his natural teeth minus his wisdom teeth and tooth number 12, all of which were congenitally
missing. He is brushing twice per day and flossing at night so I know he has some knowledge of
maintaining oral health. I think he will strive to change his current habits to avoid any
progression of periodontitis, tooth loss, and any chance of systemic disease once he is fully
aware of how environmental factors and their oral manifestations and disease can affect you
systemically. If he is willing to correct his brushing and flossing techniques and visit the dentist
frequently for thorough cleanings, his gingivitis can be reversed and periodontitis can be
stopped. His tobacco use should be reduced, however, currently there is no oral lesions noted
regarding tobacco use leading to possible oral cancer. He does have malocclusion in a few areas,
as well as a cross bite on the left side. The malpositioned teeth in the anterior may make effective
plaque removal difficult, but he seems to be doing a pretty good job. He will likely be placed on
a 3 month recall for thorough cleanings and fluoride treatments, however, continued adequate
home care is essential for successful treatment. With further education, I think my patient and I
can achieve optimal oral health.

10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall
schedule. (Note: Include date of recall appointment below.)
My patient has been informed and has agreed that he will return two weeks after his last scaling
appointment, on October 28, 2016, to reassess his gingival tissues and overall healing. At this
appointment, all quadrants will be fine scaled and evaluated. He will receive polishing, a fluoride
treatment, and Arestin placed in deeper pockets to aid in total healing. I will place this patient on
a 3-4 month recall visit for dental cleanings to help stop any disease progression from occurring.
If my patient does not comply, the risk of periodontal disease progressing, is inevitable. He was
referred to Dr. Boone by Dr. Porter for evaluation of suspicious areas and for repair of
restorations on the mandibular anteriors. I have set up my patients next appointment for
February 2017; about 3-4 months from end of current treatment.
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health,
probing depths)
We have seen a lot of change in the past month! While we did not reach our overall plaque score
goal of .1 or less, he has continued the downward trend or stayed the same by week, and his
plaque score now of .33 is considered good. The most common areas that he had issues with
plaque control were the mandibular anteriors and then sometimes in the posterior interproximal
areas. I discussed and demonstrated different brushing techniques to help get those specific areas
a little better, and he was accepting of the information. His bleeding score also decreased. His
initial bleeding score was 6.7% and today it was 4.3%. While this isnt exactly meeting our goal
of -1% per appointment, I am still proud because every week his 6 indicator teeth were 0%
bleeding; most of the bleeding was noted in the posterior and upon instrumentation and even
then it was considered slight. The only significant area of bleeding was on 14-M, and there
was a large, subgingival deposit located there. I removed it on October 14 and today, October 28,
you can see major improvement in the area. The papilla looks better and it did not bleed near as
bad as before. Probing depths of 4-7mm are still localized in the posterior, but some
improvements have been noted. Five cartridges of Arestin were placed in several spots today,
October 28, 2016, to aid in the overall pocket healing. His overall gingival health is not perfect,
but he is improving with each appointment. His probing depths are localized 4-6mm pockets and
one 7mm pocket, all located in the posterior. These probing depths as previously listed do make
home care a bit of a challenge, so he has been encouraged to return for recall appointments. Deep
pockets are difficult to clean at home and leaving bacteria behind can lead to an increase in the
periodontal disease process and probability of progression. The deepest areas were noted as 6
and 7mm between teeth 2 and 3, and also between 18, 19, and 20, with ranges from 5-6mm
interproximally. 5mm pockets were also noted on the lingual surfaces of 3-M, 14-D and 15-M,
and also on 30-D; and again between 18, 19, and 20. Most areas have stayed the same or
changed by 1-2mm which is within the margin of error. The most significant change was on 3-D,
where it was previously a 5mm pocket and it is now a 7mm pocket. However, some areas of
healing are present, because 29-D was previously a 5mm and now it is 3mm. He may not be able
to reverse his bone loss, but he can restore his gingival tissue to a healthy state and I believe he is
motivated enough to make that happen. A new evaluation will be conducted at his recall
appointment in February 2017.
12. Patient Attitudes and Cooperation:
I could not have asked for a better perio patient. He is extremely eager to learn new information,

applies that information and skill as best he can at home, and he cooperates very well during all
areas of treatment. He was interested and accepting of new brushing and flossing techniques and
also about caries prevention. Probably our least accepted topic was tobacco use, which is going
to have to be a decision he truly wants to make. He changed his brushing technique and we saw a
decrease in his plaque score each week. He has taken home some Glide floss to aid him in
flossing difficult areas more thorough, and he understands he needs to drink water following
alcoholic or sugar containing beverages. He seemed excited about trying out the new floss,
especially in the maxillary anteriors. He understands he needs to return to Dr. Boone to have the
restorations on the mandibular anteriors restored, and he is knowledgeable and motivated in
halting the progression of periodontal disease. Overall I am very pleased with his treatment and
his home care. We may not have met our long term goals in time, but I know he is doing his best
to improve where he needs to. Maybe our long term goals were a bit out of reach for this time
frame, but I am pleased with his response and acceptance of treatment, and I believe he will stay
on the right track.
13. Personal Evaluation/Reaction to Experience:
I enjoyed seeing my perio patient each week. He is my grandpa so it was nice to have the time
with him. Overall I think he spent a combined total of 24 hours in my chair, so seeing that
definitely makes me realize how much time goes into quality treatment and total patient care.
While this is not always practical in private practice, I think this project has helped me to better
understand the sequence of events for thorough treatment and overtime I will be able to improve
my own system of cleaning. I think during his appointments, I became more confident in myself
and gained skill and knowledge of different areas of treatment, such as ultrasonic use and perio
charting. Also, he had several deep deposits so working on him helped me to understand what all
is necessary for removing those deposits, and being comfortable doing so. I was afraid to hurt
him since he chose not to receive anesthesia, but I think it went very well regardless. I made a
point to check on him often, and he would give me appropriate feedback. The entire process was
a long experience, but I am glad we made it through. I learned a lot in the past six weeks and that
gives me more confidence going forward into next semester and even into my personal career
after graduation. Also, it is exciting to see little changes week by week, which turn into big
changes by the end. I enjoyed getting feedback from my patient, from what is comfortable for
him, what could improve the appointment, teaching him new skills and information, and also
him mentioning feeling a change in his teeth each week. It is a good feeling to know that you are
helping someone out, by giving them a quality service while in the chair and teaching them
information and skills that they can take home and apply for the rest of their life. Hopefully he
will remain motivated and keep up with regular cleanings in the future, to avoid any progression
of the disease process.