Amanda Stout

September 16, 2018

Finished: November 9, 2018
Perio Care Plan

PERIODONTAL CARE PLAN

Patient Name: Amanda Smith Age: 38

Date of initial exam:9/14/2018. Date completed: 11/9/2018

1. Medical History: (systemic conditions altering treatment, pre-medication, medical clearance) explain
steps to be taken to minimize or avoid occurrence, effect on dental hygiene diagnosis and/or care.

The patient’s medical history does not indicate any potential medical problems that may
complicate her treatments. Overall, her health is good. All her vitals (pulse, respirations, and
temp.) are within the normal limits. The only thing that was of concern was her BP was
slightly elevated but that could be due to the patient rushing in traffic to get to her
appointment both times. She does not receive annual physicals to check up on her health, her
last physical was in 2015, which could be an issue for early detection of any diseases that
could occur. She is not currently under the care of a physician and has not been hospitalized
within her last visit. As for her medical health, she appears to never have or have been treated
for any of the health problems or conditions listed on the medical/history form. The patient
had gastric bypass surgery back in feb/march 2007 and a tummy tuck in June 2014 with no
complications. The patient does not have any systemic conditions that can alter her care,
therefore she will not need any pre-medications or medical clearance to get started. She does
not take any prescribed or OTC medications, so there are no possible drug interactions to
consider if anesthesia is provided. She also has no allergens. As for substance use, the patient
has never used any form of tobacco but has occasional consumption of alcoholic beverages
around once a week. Although no alcoholic beverages would be ideal her low consumption
and lack of using any form of nicotine or tobacco is a good thing because both tobacco and
alcohol are high risk factors of periodontitis, oral cancer, xerostomia, leukoplakia, and
carious lesions.

Overall, the patient is a good candidate medically and is less likely to have complications
form this treatment plan. Also, due to her medical health being good, her debridement
treatment should have a successful outcome. Once treatment is finalized, the patient should
be able to heal appropriately to halt the progression of her periodontal disease.

2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief complaint,
present oral hygiene habits, effect on dental hygiene diagnosis and/or care)

The patient chief concern for visit is a cleaning. According to her dental history, she lacks
frequent dental visits. Her last actual dentist visit was in May of 2014, where she only had a
cleaning.Her x-rays were also updated on Septemeber 14, 2018 with vertical BWX to check
for any bone loss and carious lesions.
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

The patient’s gums bleed throughout the mouth when brushing, patient states not all the time
but predicts probably around 90%. She states that she is not sensitive to hot, cold or
pressure. Patient states that she does clench her jaws when concentrating and also grinds her
teeth while sleeping. Patient does not wear a night guard. Patient states that when she goes to
the dentist she does not have many cavities but while dental charting I noticed a full array of
restorations and crowns so I would conclude that perhaps the patient does have frequent
caries when visiting the dentist .Dental complications include: not flossing frequently and not
brushing at least two times a day. The numerous restorations and plaque could be due to her
consumption of sugar such as her vast consumption of 3 or more sugar containing drinks per
week. Patient does chew gum, but states that it is sugar free. No other positive findings on
her dental history such as decreased saliva flow.
The patient is self aware about the importance of brushing 2X daily but not the importance of
flossing. She then realized how important flossing is once having shown her on the
radiographs and explaining to her what plaque is and how it forms. I then took intraoral
pictures to give her a better visual. She was shocked to see all the interproximal calculus by
me pointing the spots out to her on her X rays as well as showing her how much that
accumulated behind her anterior teeth where her tongue presses against her mouth. She
couldn’t believe how “bad” of a cleaning she needs. Her attitude toward treatment is positive
and is she is really looking forward to having “clean” teeth and learning skills and good oral
hygiene habits to help her maintain her smile.
Present oral habits: brushes with an electric toothbrush with medium bristles only 1X a day,
the patient also does not floss at all. The patient also admitted that she does not brush for at
least 2 minutes because she says her TB is electric and does the work faster. I told her that
she should still make sure to at least brush for 2 minutes to make sure she’s removing all the
biofilm effectively so it doesn’t harden into calculus. I also stated that she needs to be sure
shes moving the toothbrush around to all areas of her mouth, especially those posterior teeth
and behind her front teeth, where she has crowding since that’s where I’ve noticed most of
her plaque accumulates.

Effects on dental hygiene diagnosis/care: Gingival bleeding, gingival sensitivity, nausea

(fluoride), root exposure, root sensitivity, and possible side effects of anesthesia when
undergoing treatment.

These factors have all contributed to her current state of periodontitis, if she continues on this
path the disease can progress and eventually lead up to loss of teeth. With patient education
and a change in oral hygiene habits, she can halt the progression of the disease after calculus
removal. Her excessive bleeding is due to the inflammation of her gums tissues from lack of
good oral hygiene, this is also an indicator that there is something happening below the
surface which we cannot see, usually an active disease is present and this is NOT GOOD. I
explained to the patient that with effective oral hygiene, she can tremendously change the
excessive bleeding to halting the progression of this disease with a flossing routine. I told her
we will come up with a plan together and she will learn how use the floss properly in our
future patient education sessions. I also went ahead and let her know that she isn’t alone in
this journey and we are a team to halt the periodontal disease.
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

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

Extraoral examination: atypical findings include: (1).TM joint: slight deviation to the
patient’s left, no pain, but slight sound and popping, etiology: clenching while
concentrating/grinding at night. All other normal findings for posture, physical limitations,
skin/nails, face, eyes, salivary glands, thyroid and lymph nodes (auricular, occipital, cervical
chain, supraclavicular, and submental) are normal.

Intraoral examination: atypical findings include: (1) Buccal mucosa: bilateral linea alba.
Etiology: trauma.
Oral Habits: patient grinds while sleeping, patient clenches when concentrating or anxious,
no mouth breathing, but slight tongue thrusting when patient swallows.

Clenching overtime can lead to attrition and breakdown of enamel. It can cause a tremendous
amount of pressure on the teeth as well as the gingiva and alveolar bone. With continuous
force, this can lead to exposed dentin and making the patient’s teeth more sensitive and prone
to caries, gingival tissues to recede exposing root surfaces, damage to the periodontium, and
even TMJ problems. These factors could affect the progression of her periodontal disease.
Occlusal Examination: Right Side – Molar unclassifiable, Canine Class: class 1
Left Side - Molar unclassifiable, Canine Class 1

Overbite is 1 mm and Overjet is 1 mm; midline shift is 1mm to the right; cross bites#10/#21-
#22 and #2 and #31 no open bites.

Other: she also has crowding on her upper anterior teeth, her central incisors on both the
mandible and maxillary show extreme crowding and are lingoverted, which can be a
significant contribution to plaque accumulation. The patient’s tooth location makes it
difficult to brush those hard to reach areas where bacteria can harbor aiding in the
progression and rate of her current periodontal disease.

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

a. Case Classification IV. Periodontal Case Type II

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

App't 1:Septemeber 14, 2018 (Baseline)

Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

Soft tissue examination: generalized scalloped architecture, Generalized red with

localized magenta between the facial of 24&25 and 23&22 as well as the lingual anterior
teeth. Consistency: generalized edematous/spongy. Margins: generalized thickened; Papillae:
generalized bulbous. Surface texture (papillary and marginal): generalized smooth; Surface
texture (attached): stippled. No suppuration found.
Periodontal Condition: Generalized gingival inflammation and affects of the marginal and
papillary gingival tissues. The patients’ periodontal assessment shows that infection is
occurring within the tissues and plaque accumulation is causing the tissue to migrate apically.
To prevent progression of the diseased state the patient should begin practicing prompt oral
hygiene methods such as brushing twice daily and the use of floss daily with alcohol free
mouth rinse to reduce the accumulation of plaque and bacteria in the oral cavity. I have
mentioned to the patient that our goal is to halt the disease progression and to help instill
some good oral habits she can begin to incorporate into her hygiene routine. Papillary and
marginal areas was generalized smooth and surface texture of attached was stippled.

App't 2:
Architecture: Generalized scalloped
Color: Redness on lingual side of UR
Consistency: Redness on maxillary bilateral lingual
Margins: generalized rolled
Papillae: Localized bulbous mandible and maxillary anterior
Suppuration: None
Surface Texture: Generalized smooth (papillary and marginal); Generalized stippled
(attached)

App't 3:
Architecture: Generalized scalloped
Color: Magenta on lingual side of UR due gingival abscess
Consistency: Edematous/spongy on mandible and maxillary anterior lingual
Margins: blunted on maxillary lingual posterior and generalized rolled
Papillae: Localized bulbous mandible and maxillary anterior
Suppuration: None
Surface Texture: Generalized smooth (papillary and marginal); Generalized stippled
(attached)

App't 4:
Architecture: Generalized scalloped
Color: redness on mandibular and maxillary anterior
Consistency: Edematous/spongy on mandible and maxillary anterior lingual
Margins: generalized rolled
Papillae: Localized bulbous mandible and maxillary anterior
Suppuration: None
Surface Texture: Generalized smooth (papillary and marginal); Generalized stippled
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

(attached)

App't 5:
Architecture: Generalized scalloped
Color: slight redness on anterior mandibular and maxillary anterior
Consistency: Edematous/spongy on mandible and maxillary anterior lingual
Margins: generalized rolled
Papillae: Localized bulbous mandible and maxillary anterior
Suppuration: None
Surface Texture: Generalized smooth (papillary and marginal); Generalized stippled
(attached)

c. Plaque Index: App’t 1: 6.8%. (poor) 2: 5.2% (poor) 3: 4.7% (poor) 4: 3.2% (fair) 5: 1.5% (good)

d. Gingival Index: Initial: 2.625% Final 1.3%

e. Bleeding Index: App’t : 12.3% (poor) 2: 9.8% (poor) 3: 8.3% (poor) 4:7.2% (poor) 5: 2.8% (good)

f. Evaluation of Indices:
1. Initial: The patients initial assessment identified her as having slight periodontitis with
generalized severe bleeding. She has mild horizontal bone loss in the UR, LL, LA. Her
plaque score is 6.8% which is considered poor. According to the disclosing solution the
patient needs to focus on pretty much all of her teeth because on the mesial, distal,
lingual aspects the solution stuck. We will be able to correct this with proper brushing,
flossing and routine dental visits. The gingival index is to assess the patients severity of
gingivitis based on the collection of color, consistency and BOP. Her initial GI score is
2.625% which is considered poor, our goal is to eventually get her down to 0 which will
indicate healthy tissues. Her score was highest on the mesial of #3, #9 #28 the facial of
#9, #12, #19 the distal of # 3, #12, #19, #25, #28 and the lingual of #3, #19, #25, #28.
The patients bleeding score was 12.3% (I only took it on the indicative teeth on the
plaque index sheet but as I was measuring pocket depths I noticed numerous BOP points
so I am sure the actual bleeding score will fluctuate. Bleeding was generalized pretty
much throughout the patients entire mouth. This information shows the severity of her
periodontal disease and indicated the patient’s lack of flossing and routine dental
cleanings. The patient needs to practice good oral hygiene to lower her plaque and
bleeding indices. All of these are associated with periodontitis. If she can apply all the
things she will be taught throughout her patient education sessions: the correct way to
brush and floss, and the fact that they both need to be done routinely I have no doubt
that she will ultimately lower these initial scores greatly in turn improving her overall
health, and halting the progression of periodontitis.

2. Final: November 9, 2018

The patients plaque score is 1.5 (good) therefore, the patient is doing really well on her oral
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

care at home. I did notice a little bit of biofilm in the posterior lingual regions, so I
refreshed the patient on being sure to focus on those back areas as well as taking the
adequate amount of time needed to properly remove plaque accumulation. Despite being
in a hurry and her busy schedule, those two minutes are necessary in order to properly
disturb the biofilm. I also reminded the patient about the importance of flossing and
even recommend that she bump her flossing from 1x a day to 2x a day once after lunch
and once before bed in order to be proactive and prevent any bacteria from disrupting
the healing of her gingival tissues. The patients bleeding score decreased consistently
throughout our appointments, ending with 2.8. The patient showed no 5mm pockets post
perio, therefore no Arestin was necessary at this time. The patients gingival index went
down as well from 2.6 to 1.3 which shows that her gingival tissues are healing and the
inflammation is receding back down to a normal state. Although she still showed some
inflammation on the facial anteriors, you can visibly see a huge improvement in
comparison to appointment #1.

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

1.Baseline: During her periodontal assessment we found out that the patient has several
pocket depths over 3mm. By quadrant the depths read: Maxillary Right and left Facial-
#1- missing #3M(4mm), #4D(4mm)#12D(4mm)#14D(4mm)#15MD(7mm) Maxillary
R/L lingual aspect: #2MFD(3,3,4mm)#3MD(4mm)#4MD(4mm,4mm) pretty much
generalized 4,and 5mm pockets throughout both quads) The same pattern exists on the
mandibular lower right/left from both the lingual and facial aspects. With a 7mm pocket
on the distal of #15 being the only 5mm or above that I found. I was unable to calculate
the attachment loss at this time and plan to do it by individual quad after ultrasonicing,
but I did note some areas of recession while probing. Her next appointment I will be
able to get an accurate reading from the UR (because I will be documenting and charting
quad by quad) and eventually have readings from all quads as her treatment continues.

2.Firstevaluation: On the maxillary there were still a few 4mm pockets starting from the facial of
tooth #3M #4M #14D and from the lingual aspect of tooth #3M. With 1mm. of recession on #3
#13 #14. On the mandible starting with the facial aspect the 4mm pocket depths were as follows
#26M #20D and #18D and from the lingual aspect #30M #29MD with 2mm recession on tooth
#18 and 1mm recession on tooth #22 and #31. These are the only areas of concern I noticed
during her post perio appointment. In comparison to her initial appointment her pocket depths
have made a huge improvement. Especially on #15MD now reading as 3mm instead of 7mm and
the mandibular anterior where she had 5mm pocket on #27M and 4mm pockets on #26D #25D
#24D. Once the calculus was removed from those lower anteriors upon reevaluation the pockets
are now 2-3mm which is considered WNLs. The patient has no furcation classes nor shows any
mobility or sensitivity with any of her teeth. She continues to show localized mild bone loss on
the lower anterior teeth. Upon the removal of calculus, #18 and #14 show around 1-2mm area of
recession.
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

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

occlusion, abfractions)
The patient shows a SA area on both the mesial occlusal of #3, as well as a fractured tooth on the
facial aspect. The patients dental charting also showed a watch on tooth #20 MO and a
fracture on the incisal edge of tooth # 24. This patient also shows a missing crown on the
tooth #19 along with numerous restorations and composites. This is an indicator for increased
bacteria and plaque accumulation which can exacerbate the patients periodontal disease and
speed up the process of clinical attachment loss and bone resorption. Good oral hygiene
practices are key, and making sure to brush/ floss in between those tight contact areas to
avoid plaque and biofilm accumulation.

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

Treatment Plan-Patient Education Sessions for future appointments:

Lesson 1 will cover plaque and brushing (App’t 2)

 Teach topic (what it is) use flipbook/other visual aids
 Teach skill (brushing) use demonstration/typodont
 Allow patient to demonstrate skill learned at the sink/correct when needed
 Show where improvement is needed (disclosing solution – visual aid)/compare
plaque scores
 Ask follow up question to assess learning level
 Encourage patient
 Summarize and brief statement of next session
 Let her know that we are a TEAM
___ Lesson 2 will cover periodontal disease and flossing (App’t 3)
 Discuss goal attainment from last session (compare plaque score/bleeding scores)
 Ask about and discuss gingivitis – “Did you know had gingivitis?” Explain the
inflammation/periodontitis connection
 Visual aids (flip chart/paperwork/xrays)
 Teach Periodontitis (What it is)
 Teach Skill (Flossing) use typodont to demonstrate
 Let patient demonstrate skill learned/correct as needed
 Show patient where she needs improvement (disclosing solution – visual aid)
 Ask to assess learning level
 Encourage patient
 Summarize and brief statement of next session
 Establish TEAM membership
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

__ Lesson 3 will cover caries (this is appropriate because patient has clean medical
history with no factors effecting periodontal state) (App’t 4)
 Discuss goal attainment from last session (compare plaque/bleeding scores)
 Discuss new goals
 Teach lesion – caries process and fluoride/discuss how areas of recession are
more susceptible to decay.
 Use flipbook
 Review brushing/flossing at sink
 Disclose and evaluate/modify
 Assess learning level
 Discuss recall schedule
 Establish TEAM partnership
 Thank her for her time and effort

Short/Long term goals

LTG 1: Reach a plaque score of 1 or less by last visit
STG: Define Plaque
STG: Discuss the importance of brushing 2X daily for 2min. and flossing
STG: Correct patients brushing technique (teach bass method) to reduce plaque score
by 0.5 each visit

LTG 2: Halt Periodontitis progression by 3rd appointment & try to obtain no bleeding
points by last visit
STG: Define Periodontal disease (loss of bone and gum)
STG: Teach the importance of flossing and correct technique (“c” shape)
STG: reduce patient’s bleeding score by 1.0 each appoint.

LTG 3: Prevention of future caries

STG: Define cavities (caries)
STG: Discuss carbs/acidic diet and the pH level
STG: Preventative fluoride treatment/benefit-find/benefits of possible sealants

Treatment plan: Debridement for future appointments

Appointment 2
 Medical/Dental Hx
 Pre-rinse
 Vitals (signature)
 Plaque/bleeding score
 Take initial Gingival index score
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

 Take gingival description of quad and document findings

 Patient Education session 1- see above
 Ultrasonic maxillary-UR with anesthesia (get checked)
 Full periodontal charting with CAL (get checked)
 Fine Scale maxillary-UR (get checked)
 Progress notes and confirm appointment 3

Appointment 3
 Medical/Dental Hx
 Pre-rinse
 Vitals (signature)
 Plaque/bleeding score
 Take gingival description of quad and document findings
 Patient Education session 2- see above
 Ultrasonic maxillary-UL with anesthesia (get checked)
 Full periodontal charting with CAL (get checked)
 Fine scale maxillary-UL (get checked)
 Progress notes and confirm appointment 4

Appointment 4
 Medical/Dental Hx
 Pre-rinse
 Vitals (signature)
 Plaque/bleeding score
 Take gingival description of quad and document the findings
 Patient Education last session-see above
 Ultrasonic mandibular-LR with anesthesia (get checked)
 Full periodontal charting with CAL (get checked)
 Fine Scale mandibular-LR (get checked)
 Progress notes and confirm appointment 5

Appointment 5
 Medical/dental Hx
 Pre-rinse
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

 Vitals (signature)
 Plaque/bleeding score
 Take gingival description of quad and document the findings
 Chairside patient education (review) and post care instructions
 Ultrasonic mandibular-LL with anesthesia (get checked)
 Full periodontal charting with CAL (get checked)
 Fine scale mandibular-LL (get checked)
 Plaque free and fluoride if there is time
 Progress Notes and schedule 2-week check

Appointment 6-FINAL
 Medical/dental Hx
 Pre-rinse
 Vitals (signature)
 Take gingival description of all quads and document the findings
 Post- calculus (get checked)
 Post-periodontal charting with CAL (get checked)
 Arestin
 Plaque free and fluoride (get checked)
 Progress Notes
Remember 3-month recall for my patient, ending gingival statement, and patient learning
level within my progress notes.

** encourage good oral hygiene habits and thank my patient for their time with possible
note or goody basket full of oral hygiene items such as toothbrush, floss and toothpaste.

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

The patient has horizontal bone loss mild on UR, LL and LA. The patient also has widen PDLs
on D23, 3M, 4MD, 18-21MD. The patient has generalized visible calculus throughout the
radiographs and also has a defective restoration tooth #19 is missing the crown. All of these
radiographic findings show an effect on the progression of the patients periodontal disease
which is why good oral hygiene habits are key to prevent continuing widening of the PDL.
These findings also indicate the patient’s current state of periodontitis (which is bone loss).
Calculus findings indicate high class, and the need for adequate debridement to help assist
and halt the progression of the disease.

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.
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

9/14/18 journal #1 (this was done during care plan part 1)

Today was my patients initial appointment with me. She had previously been screened and
classed back in spring 2018 during my freshman Spring clinic when I had free clinic time left
over, so the appointment on this day was to double check and see if she would be a good
candidate for periodontal education and treatment. The patient needed an FMX, so I took one
on digital sensors and included vertical bitewings as to have an accurate reading of both her
bone levels and progression of the disease as well as any suspicious areas that could be visual
in the radiographs. I then completed a perio assessment, intra oral, head and neck exam. I
also completed dental charting with X-rays. I took an initial bleeding score mouth as well as
pocket depths of her whole mouth but was unable to configure the CAL and TH readings. I
plan to do that per individual quadrant throughout her appointment treatments. I took an
initial plaque score of her indicative teeth in order to establish a baseline to compare
throughout her treatment. I gave a chairside interview and inquired on her brushing and
flossing methods while correcting and adding some tid bits of information as to which ways
would be more beneficial for achieving the healthy oral environment that’s ideal for the
halting the progression of her periodontal disease. I also began her patient education session
over brushing and plaque because I had already finished one session with my backup perio
patient and was graded on it, for her appointment number 2 I will begin lesson #2 over
flossing and periodontitis. While I probed I also took a gingival index on the indicative teeth
as well as intraoral pictures so I could show her what her plaque and hardened biofilm looked
like while going over chairside patient education with her.

(Journal entries for Care plan part 2 are listed below)

Apt #1 (September 14, 2018): Assessment to baseline findings: medical dental history, vital
signs, pre-rinse, head/neck intra/extra oral examination, periodontal assessment, and
informed consent. Plaque score, bleeding score, Gingival index score, and intraoral pictures
were also taken. A FMX radiograph was taken on digital sensors, including a set of
vertical bitewings. These were needed to check for bone loss and carious lesions. These
findings allowed me to assess my patients needs and formulate a treatment plan and
education sessions that are tailored to the patient’s care. I performed the patients first patient
education session chairside and we discussed the correlation between plaque and brushing.
What is plaque, what causes it, how can it be removed. I also showed on the typodont proper
ways of brushing and gave advice on using the electric toothbrush, that although it does some
of the work for you, that it is still advised to brush for at least 2 minutes in order to
successfully remove all the biofilm before it hardens into calculus.

Appt #2 (October 5, 2018): Medical/Dental history, pre-rinse. Second patient education

session was completed on Flossing and Periodontitis. Discussed all LTG and STG. Long
term goals: Patient will halt the progression of periodontitis. Short-Term goals: Patient will
define Periodontitis, patient will reduce gingival bleeding score to 4% or lower by each
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

appointment and shows improvement of reduction of periodontal pockets, and patient will
demonstrate flossing techniques. Before I discuss periodontitis and flossing, I refer back to
our last patient education if the patient has remembered and learned about plaque and
brushing. I define periodontitis and it can lead to bone loss, which makes it irreversible. I
showed the patient her intraoral picture of her harden calculus on her lower anteriors and
showed her the radiographs and bone levels on her teeth where she shows mild bone loss. I
explained that although we are UNABLE to grow the bone back that she lost, we can help
prevent any FURTHER bone loss from occurring. Our main goal is to stop the progression of
the disease. I explained the patient the importance of flossing it can help prevent the
progression the disease. While the patient brushes, there is some remaining plaque left
between the teeth; therefore, flossing helps removes it. I demonstrated using some homemade
slime I had acquired in order to present a visualization of what the bacteria looks like when it
gets trapped on the teeth and in between the contacts of the teeth. I then demonstrated how it
gets left behind if all you do is brush and don’t floss. I demonstrate a flossing technique to
the patient. Placing the floss between the teeth and making a “C” shape. Also, I said
changing the floss between teeth to prevent from bacteria back into the teeth. I asked the
patient to demonstrate the flossing technique on the typodont. Then, have the patient floss at
the sink. She had difficulties reaching her posterior teeth while successfully applying it into a
“C” shape. So, I referred her to start with a floss pick first for those hard to reach areas and
that it just takes practice. I refresh the patient knowledge on today patient education. Next
patient education session will be Caries process and fluoride. LL: self interest Bleeding
score: 9.8% (poor) plaque score 5.2 (poor) Ultrasonic and scaling completed on Mand Rt,
full periodontal charting on Mandibular Rt.

Apt #3 (October 19, 2018): Medical/Dental history, pre-rinse. Patient Education #3 Caries
process and fluoride. Long-term goals: Restore defective restoration by recall visit in Spring of
2019. Short-Term goals: patient will seek a dentist, patient will define caries process, and patient
will cut back on the amount of diet cokes she consumes throughout the day. I refresh the patient
knowledge on our previous discussion about plaque, brushing, periodontitis, and flossing. I
started educating the patient about cavities and they are caused by the bacteria and remaining
food debris, which is demineralizing the tooth overtime. The reasoned I explained to the patient
is because she has a defective restoration on tooth #19 as well as suspicious areas on tooth #3.
Defective restorations can cause an increase in plaque biofilm and cause her to retain the bacteria
that adheres to that restoration, therefore, the remaining bacteria is eating the tooth. I also
discussed with the patient one way to prevent this by using fluoride. I explained what fluoride is
and they are present in tap water, toothpaste, and mouthwash. This is our last patient education,
so I have ended it by giving her printed referrals and a list of dental offices close to her home and
reviewed all the STG and LTG. LL: Self-interest. Plaque score: 4.7% (poor) but it went down
since the previous appointment so its progress in the right direction. Bleeding score: 8.3%. (poor)
but in comparison to previous appointment its consistent with progress. Ultrasonic Mandibular
left. Fine scale Mandibular left. Periodontal chart Mandibular left. Performed gracey curet skill
evaluation on LL. Ultrasonic Maxillary Left. Fine scaled Maxillary Left. Full Periodontal
charting on Maxillary Left.
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

Apt #4: (October 26,2018): Medical/Dental history, Pre-rinse, Plaque score 3.2% (fair)
Bleeding score 7.2% (poor) but it shows improvement since the patients previous appointment
which is an indication that the patient is doing their part at home. Ultrasonic Maxillary Right.
Fine Scaled Maxillary Right. Full Periodontal charting on Maxillary Right. I explained to the
patient if she had any questions regarding brushing or flossing, I would be happy to make any
adjustments. I also inquired how she was doing on cutting back on her diet coke consumption
and she stated that although the quantity of diet coke consumed hasn’t gone down, she no longer
drinks them before bed. I also told the patient that the next appointment would be the last, and if
she had any 5mm pockets I would be placing Arestin to assist in the pocket healing.

Apt #5 (November 9, 2018): Review medical and dental history, pre-rinse, polishing and
fluoride varnish. I obtained a gingival index, which improved immensely from 2.6 to 1.3. Full
periodontal charting on all quadrants. Upon comparing the charting with the previous
appointments her pocket depths had decreased which is one of our overall goals for her. Arestin
was not necessary due to her no longer showing any 5mm or above pockets. I gave instructions
on the fluoride varnish, not to brush or floss for at least 4-6 hours and to avoid super crunchy
foods such as ice chips or granola in order to allow the varnish to adhere to her teeth and help to
re-mineralize those susceptible areas within her mouth. Plaque score 1.5% (good) and Bleeding
score 2.8% (good) I was VERY pleased with the plaque and bleeding score at her final
appointment because it showed consistent progress and that although there is still signs of
infection and disease within her body she is on the path to a good overall healthy oral
environment. Next appointment will be placed on 4- month recall, March 2019.

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

9/14/18
My patient shows a positive and upbeat attitude about completing her periodontal care plan, and
is hopeful on achieving that clean mouth she desires, free of excess plaque and calculus buildup.

Overall Prognosis: Fair

The Patient is 38 years old. She seems very compliant and eager and has shown up for all
scheduled appointments eager to learn and get her mouth back to a state of health. She doesn’t
have any systemic factors (which is good) because systemic factors can increase her risk for
exacerbating her current periodontal disease. The Patient has malocclusion which makes it
difficult to keep the area free of plaque and biofilm, and the patient still shows difficulty trying to
reach those posterior teeth when flossing so that could cause an issue for patient compliance
when flossing at least 1x a day. The patient is aware of the increase of biofilm accumulation on
those crowded lower anteriors, which happens to be where she also shows mild bone loss, so
being meticulous and practicing the skills I have shown her will be key for a positive long-term
prognosis. The patient also has a defective restoration on tooth #19 and a SA on tooth #3 which
both can cause biofilm retention. The patient seemed eager to get those restorations taken care of
before the Spring, but she also teaches 8 classes and with her busy school schedule I’m not sure
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

if she will make it a priority if they are not causing her any pain or discomfort.

10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall
schedule. (Note: Include date of recall appointment below.)

The patient is aware of results of the re-evaluation appointment with the proper home care to
reduce the plaque and gingival conditions, bleeding and periodontal pockets. The patient is
aware the dentist made some referrals for tooth #19 to fix her broken crown and tooth #3 for a
SA. At the end of treatment the patient will be notified for a recall appointment March 2019.

11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health,
probing depths)

Plaque control: The patients plaque control was consistent throughout every appointment. It
gradually decreased over the course of treatment which was a good indicator that the knowledge
and material I was teaching her was being retained and used at home.
Bleeding Tendency: Bleeding decreased at every appointment in relation to the indicator teeth,
but some areas showed a fluctuation of increased bleeding. Overall the patient had slight
bleeding at her final appointment, showing a decrease of infection and a good sign that her oral
health was becoming healthy again.
Gingival Health: Her gingival health has improved immensely since her initial appointment,
especially around her lower anteriors. Once the calculus was removed the loose gingival tissues
began to tighten around her teeth again. Removing the cause of that initial inflammation allowed
for that tissue to begin healing.
Probing Depths: The patient continues to have 4mm pockets on several of her teeth but the
areas in which I was most concerned, the areas where she showed mild bone loss her pocket
depth decreased, which I was extremely pleased about. I am hoping for more improvements
when I see her back for her 4 month recall in March 2019.

12. Patient Attitudes and Cooperation:

The patient was truly a pleasure and was always so positive and upbeat when it came to topics
about her oral health. She seemed eager to learn the techniques and skills that would better equip
her when she was at her home during her oral care regime. The patient wasn’t too thrilled about
the idea of flossing at least 1x a day, but once I explained and discussed the importance of
flossing and how removing that bacteria from the contacts of her teeth will assist in helping to
HALT her periodontal disease and bone loss, she became more compliant. Her plaque score and
bleeding score consistently lowered at every appointment, which was an amazing indicator that
she was indeed putting the work and time and effort in to maintain a healthy mouth. I appreciated
Amanda Stout
September 16, 2018
Finished: November 9, 2018
Perio Care Plan

my patient so much for taking the time out of her busy schedule to come to every one of her
appointments. She was always on time, and just such a wonderful patient to do this treatment
plan on.

13. Personal Evaluation/Reaction to Experience:

This was such a wonderful learning experience, to be able to contribute so much time and be able
to piece together all of this information that we learn throughout clinic was really amazing. It
was like parts to a puzzle and getting to see the end result of the treatment and be able to
compare and contrast the results to see plausible, definitive change in the right direction was so
inspiring. When you have a patient that truly is interested in their oral health and changes and
modifications they can make that helps them become more knowledgeable is something that
makes me excited about the profession I’ve chose. I think the big WOW factor for me was those
lower anteriors, once all that calculus was removed, how loose the tissue was originally with like
4mm pockets generalized throughout to the ideal 2-3mm pockets was amazing to see in such a
short period of time. I hope I have provided enough information that she needed in order to
become motivated about keeping her oral health a priority in the now, and not just when
something is causing her pain or discomfort. Overall, this was such an amazing learning
experience and I hope to bring this amount of care and thorough knowledge to all my patients in
the future so that they can achieve the proper home care they need in order to have a healthy
smile.