Periodontology (DHYG 1311)

Fall, 2015
PERIODONTAL CARE PLAN
Student: Sara Scarborough
Patient Name: The patient
Date of initial exam: 9/9/2015

Age: 52
Date completed: 11/18/15

1. Medical History:
The patients last physical was October 2014. It is almost time for him to get another
physical because at his age, some issues and diseases can go unnoticed, affecting his overall
health as well as his oral health. The patient has occasional allergies and sinus problems that
when inflamed might give him sore or inflamed tonsils/ oropharynx making treatments a little
more difficult. He does not usually take any medications when he has an allergy flare up. The
patient does have occasional high blood pressure, which he is not currently taking any
medication for. Taking blood pressure is essential during dental appointments because special
adaption may be needed. There are many factors that can elevate or decrease blood pressure. If
a patient does have abnormally high blood pressure a physician might need to be consulted
before treatment can begin. The patient has a daily intake of alcoholic beverages, which could
irritate his gingiva, and also cause poor eating habits. Since poor eating habits usually lead to
nutritional deficiencies, it might lower his immune system which could impact his
periodontitis.
2. Dental History:
The patients chief complaint or reason for visit is to get x-rays and a cleaning. His last
dental visit was in September 2014, at that appointment they took a periapical of number 14
and also extracted it. Although the patient has never had any serious problems associated with a
previous dental treatment, he said that he does not like going to the dentist. When asked about
his last dental cleaning he said that it had been years and he does not have a current dentist. The
patient is currently a prophy class 4. Infrequent dental cleanings and checkups can be very
damaging to the oral cavity, especially the gingival tissues as a result of inadequate plaque
control. Infrequent dental visits can seriously affect his periodontitis because he is not correctly
removing the detrimental bacteria from his teeth that can cause advancement of his
periodontitis. Also without regular 3 or 6 month appointments we are unable to track his active
and inactive sites. Since the patient was not putting any effort into having good or great oral
hygiene his dental IQ is fair. When asked about how he felt about his appearance of his teeth,
his reply was that they need to be cleaned. The patients most recent dental radiographs taken
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Periodontology (DHYG 1311)

Fall, 2015
was a FMX on 4/8/2015. The patients gums bleed when he flosses generally on every
quadrant. Bleeding is a sign that he has an active site of periodontitis. Having active
periodontitis means that it is very important to have recall cleanings and appointments to
remove the bacteria. He does indeed clench his jaws when he his stressed, mad and also when
he sleeps at night. Clenching can result in headaches and also TMJ problems. If there is pain
the patient might want to avoid using correct oral hygiene habits. If the patient does not use
good oral hygiene, it can cause the periodontitis to progress because of the bacteria. The patient
does not drink many sugar containing drinks, and he also does not chew gum.
3. Oral Examination:
The patient has bilateral lenea alba which is caused from trauma or cheek biting. On the left
side in the buccal mucosa he had a small (less than 1mm) red spot, usually known as macule or
freckle which is usually considered developmental. The patient also has generalized Fordyces
granules on his lips, buccal and labial mucosa. The etiology for Fordyces granules is
considered developmental and a variant of normal.
4. Periodontal Examination:
a. Case Classification: 4
b. Gingival Description:

Periodontal Case Type: 2

App't 1:
Scalloped: Generalized
Color: light pink/ coral
Consistency: Fibrotic Generalized
Margins: Thickened Generalized
Papillae: Bulbous Generalized
Suppuration: None
Surface Texture (papillary and marginal): Stippled Generalized
Surface Texture (attached): Stippled Generalized
I thought it was uncommon that a patient would have normal color, with case 2
periodontitis. The patient also had no gingival inflammation.
App't 2:
On his second appointment we finished paperwork, so his overall gingival description was
still the same as the first appointment. Although we had not started any of the cleaning
treatments yet, on the second appointment, the gingiva looked more irritated and inflamed.
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Periodontology (DHYG 1311)

Fall, 2015
App't 3:
Scalloped: Generalized
Color: normal light pink/ coral
Consistency: Fibrotic Generalized
Margins: Thickened Generalized
Papillae: Bulbous Generalized
Suppuration: None
Surface Texture (papillary and marginal): Stippled Generalized
Surface Texture (attached): Stippled Generalized
App't 4:
Scalloped: Generalized
Color: normal light pink/ coral
Consistency: Fibrotic on Maxillary left and mandibular
Margins: Thickened on Maxillary left and mandibular
Papillae: Bulbous on maxillary left and mandibular
Suppuration: None
Surface Texture (papillary and marginal): Stippled Generalized
Surface Texture (attached): Stippled Generalized
App't 5:
Scalloped: Generalized
Color: normal light pink/ coral
Consistency: Fibrotic just on Mandibular; Edematous on Maxillary
Margins: Thickened on Mandibular; Normal on Maxillary
Papillae: Bulbous on Mandibular; Normal on Maxillary
Suppuration: None
Surface Texture (papillary and marginal): Stippled on Mandibular; Smooth on Maxillary
Surface Texture (attached): Stippled on mandibular; Smooth on Maxillary
App't 6:
Scalloped: Generalized
Color: Normal light pink
Consistency: Edematus on Mandibular right and on the Maxillary. Fibrotic on Mandibular
left
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Periodontology (DHYG 1311)

Fall, 2015
Margins: The Mandibular left was Thickened
Papillae: The Mandibular left was Bulbous
Suppuration: None
Surface Texture (papillary and marginal): Stippled on Mandibular left; Smooth on
Maxillary
Surface Texture (attached): Stippled on mandibular left; Smooth on Maxillary
App't 7:
Scalloped: Generalized
Color: Normal light pink/ coral
Consistency: Edematous Generalized
Margins: Normal
Papillae: Normal
Suppuration: None
Surface Texture (papillary and marginal): Smooth Generalized
Surface Texture (attached): Smooth Generalized
c.Plaque Index:
d.

Appt 1: 1.8 (Fair) 2: 1.6 (Good) 3: 1.3 (Good) 4: .66 (Good)

5: .5 (Good) 6: .33 (Good) 7. .33 (Good)

Gingival Index: Initial: 1.08 (Fair)

Final: 1.00 (Fair)

e.Bleeding Index: Appt 1: 5.12% 2: 3.8% 3: 5.56% 4: 2.56% 5: 1.92% 6:1.92%

7: 0%
f. Evaluation of Indices:
1. Initial:
On 9/9/15 the patients plaque index was 1.8 which is a rating of a fair. His gingival
index was also a rating of a fair from scoring a 1.08. At the first appointment his bleeding
score was 5.12%. I believe with the ratings and score his chance of the progression of his
periodontal disease is at a great risk. But with the proper patient education session and
treatment I believe the patient will see a dramatic change in his overall oral health. On 3
there was inflammation mesial, distally, and facial with slight bleeding on probing
lingually. On 9 mesial, distal, facial, and lingual was mildly inflamed with no bleeding.
On 12 there was slight bleeding on probing mesially and lingually, with just slight
inflammation on the facial and distal surfaces. On 19 there was slight inflammation on the
mesial, facial and distal surface with slight bleeding on probing on the lingual surface. On
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Fall, 2015
25, and 28 all surfaces were slightly inflamed with no bleeding.
2. Final:
The patient has done an overall excellent job at working and trying to increase he oral
health. His plaque score, bleeding index and also his gingival index have all reduced. I
believe that if the patient keeps up his good work, and keeps brushing and flossing, his
very periodontal disease will halt in progression. The patients bleeding index scores were
5.12%, 3.8%, 5.56%, 2.56%, 1.92%,1.92%, and 0%. Every appointment his bleeding
score decreased which shows and tells that there is major changes in the oral cavity and
that the periodontitis is halting, and healing is taking place. The patients bleeding scores
were 1.8 (Fair), 1.6 (Good), 1.3 (Good), .66 (Good), .5 (Good), .33 (Good), .33 (Good).
The patient took his plaque score from fair and changed it to good, with it decreasing at
every appointment. Since plaque is a contributor to disease and infection, it is a major
improvement to have his plaque score decrease. Before the start of our treatment, the
patient had never been taught to brush or floss properly. He went from having no
instructions on oral hygiene to doing a great job at removing the bacterial and plaque. We
had no problems with learning methods from the patient education sessions and he picked
up the Stillmans brushing method so fast and easy. The patients gingival index also
reduced from 1.08 to 1.00, which also shows the halt of progression of the periodontitis
since there was no bleeding.
g.

Periodontal Chart:
1.Baseline:
The patient had generalized 4mm pocket depths in every quadrant. He also had two
5mm pocket depths, on the distal-facial of 4 and on the mesial-lingual of 18. The patient
has 1mm of recession on the facial 2, 15, and 30 and on the lingual of 22-27. He also has
2mm of recession on the lingual of 15. The patient has a high CAL on the distal-lingual of
2, the distal-facial of 3, and also the mesial-lingual of 15. The patient has no suppuration.
He had 1, 14, 16, 17, 31, and 32 extracted. He has a caries on the facial of 30. He has
generalized horizontal bone loss in all four quadrants. The patient also has RCT on 19.
There was no furcation involvement, mobility or percussion on any of the patients teeth.
2. Firstevaulation:
The patient has generalized 1-3 mm pocket depths since completing ultrasonic and
scaling on all 4 quadrants. He has 4mm pockets on the Distal of 3, and the Mesial of 13,
30, 19, and 18. The patient has 5 mm pockets on the Distal of 15 and 18. The patient has
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Periodontology (DHYG 1311)

Fall, 2015
no suppuration. There is 1mm of recession on 2. The patient now has no high CAL
numbers. He had 1, 14, 16, 17, 31, and 32 extracted. He has a caries on the facial of 30.
He has generalized horizontal bone loss in all four quadrants. The patient also has RCT on
19. There was no furcation involvement, mobility or percussion on any of the patients
teeth. There is an open contact between 13 and 15 where 14 was extracted.
5. Dental Examination:
On the facial of 30 the patient has a caries that is increasing in size and this tooth also
happens to be broken on the distal side. Since caries are plaque biofilm retentive, they are a
contributing factor to periodontitis. He has attrition on teeth 7-11, and also 22-27. The patient
has had 1, 14, 16, 17, 31 and also 32 extracted leaving him with 26 remaining teeth. On teeth 2,
3, 12, 15, 18, 19, and 30 he has occlusal amalgam restorations. Also on 3 and 15 he has small
lingual amalgam restorations. On 19 additional to the occlusal restoration, there is also a small
facial amalgam restoration, and root canal therapy. On tooth 26 there is lingoversion. On teeth
24 and 25 there is labioverision. The patients right molar occlusal classification is a 1. The left
molar occlusal classification is unclassifiable due to the extraction of tooth 14. The occlusal
classification of the right and left canines are both a class 1. The patient has a 5mm overbite,
and also a 2mm mid-line shift to the right. There is open contact between 13 and 15 since 14
was extracted. Since the patient has an open contact, malocclusion, old restorations, caries, and
broken teeth it increases his risks for periodontitis and bone loss.
6. Treatment Plan:
App't 1: (9/9/15)
Health History/ Vitals
Pre-Rinse
Head and Neck/ Intra Oral Exam
Periodontal Assessment
Dental Charting With X-Rays
Plaque Score
Bleeding Score
Risk Assessment
Informed Consent
Intraoral Camera
Started Full Periodontal Charting
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Periodontology (DHYG 1311)

Fall, 2015
App't 2: (9/16/15)
Health History/ Vitals
Pre-Rinse
Plaque Score
Bleeding Score
Completed Full Periodontal Charting
Gingival Index
Patient Education: X-rays, Showed Caries, Explained that they are a diagnostic tool
App't 3: (10/7/15
Health History/ Vitals
Pre-Rinse
Plaque Score
Bleeding Score
1st Patient Education Session-Brushing/ Plaque
Long Term Goal: Patient will Reduce Plaque Score
Short Term Goal: Patient will define plaque
Short Term Goal: Patient will brush twice a day using the correct technique
Short Term Goal: Patient will lower plaque score by end of the treatment
Ultrasonic Maxillary Right
Fine Scale Maxillary Right
App't 4: (10/14/15)
Health History/ Vitals
Pre-Rinse
Plaque Score
Bleeding Score
2nd Patient Education Session- Flossing/ Periodontitis
Long Term Goal: Patient will halt the advancement of his periodontitis
Short Term Goal: Patient will define periodontitis
Short Term Goal: Patient will floss twice a week
Short Term Goal: Patient will maintain a 3 month recall after treatment is over
Short Term Goal: Decrease plaque score and bleeding score
Review Brushing
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Periodontology (DHYG 1311)

Fall, 2015
Ultrasonic Maxillary Left
Fine Scale Maxillary Left
Appt 5: (10/28/15)
Health History/ Vitals
Pre-Rinse
Plaque Score
Bleeding Score
3rd Patient Education Session- Caries/ Fluoride
Long Term Goal: Patient will have Caries restored
Short Term Goal: Patient will define the process of caries
Short Term Goal: Patient will make an appointment to have a consult about his caries
Review Brushing and Flossing
Ultrasonic Mandibular Right
Fine Scale Mandibular Right
Appt 6: (11/4/15)
Health History/ Vitals
Pre-Rinse
Plaque Score
Bleeding Score
Patient Education: Replacement of missing teeth, and why it should be done
Ultrasonic Mandibular Left
Fine Scale Mandibular Left
Plaque Free
Fluoride Varnish
Appt 7: (11/18/15)
Health History/ Vitals
Pre-Rinse
Plaque Score
Bleeding Score
Gingival Index
Post-Periodontal Evaluation
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Periodontology (DHYG 1311)

Fall, 2015
Patient Education: Review all sessions, Arestin-what it is and why it helps
Chemical Irrigation on 15 and 18
Recall 3 months (February 18, 2016)
Referrals: 30 Broken and Caries
7. Radiographic Findings:
According to the patients radiographs he has moderate horizontal bone loss in the left and
right maxillary posterior regions, and also the left and right mandibular posterior regions.
Caries can be seen on the facial of 30. On number 19 the patient has had Root Canal Therapy.
8. Journal 1: (9/9/15)
Today, I updated the patients medical history and then took his vitals. I then proceeded to
start his paperwork. I completed the head and neck/ intra oral examination, and also the dental
charting. I started the periodontal assessment, not knowing that the patient was going to be my
periodontal care plan patient, so I just probed and noted the pocket depths that were not in the
normal limits. Later, after completing the assessment, we discovered that he could and would
be my periodontal patient. I took the patients plaque score which was 1.8 (fair) I also took his
bleeding score which was 5.12%. I completed the risk assessment form and also the informed
consent form. During this appointment I also took several intraoral pictures. The intraoral
pictures included a smiling picture, and also several in the oral cavity. I started full periodontal
charting, but was unable to complete it during this appointment. Today, for patient education, I
gave a little introduction about plaque. I showed him what it looked like, and told him it was a
bacteria that needs to be brushed and flossed off. The patients learning level for today was
aware. He did not say much about what I told him about plaque, just sat and listened.
Journal 2: (9/16/15)
Today, I reviewed and updated the patients medical history, and also took his vitals. I
acquired his plaque score which was 1.6 (good). I also took the patients bleeding score which
was 3.8%. During this appointment, I completed full periodontal charting which took more
time than I thought it would to complete. I also completed the gingival index score which was
1.08 (fair). Today, for patient education we looked at bone loss on his x-rays, I showed him
where his caries was and explained that x-rays are a great diagnostic tool. The patients learning
level for today was aware. Again, he did not say anything just listened and had no questions.
Journal 3: (10/7/15)
Today, I reviewed and updated the patients medical history. His blood pressure was a little
high registering at 145/90 on the right arm which is stage 1 hypertensive. His pulse was 100,
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Periodontology (DHYG 1311)

Fall, 2015
his respiration was 17 and his temperature was 98.3, which are all in normal ranges. His plaque
score was 1.3 (Good) and his bleeding score was 2.56% which has decreased a little. I
completed the first patient education session which went great. For the patient education
session we discussed all the long and short term goals. I also taught the patient about plaque,
that it is a bad bacteria that needs to be mechanically removed by brushing and flossing. I made
sure that the patient knew that we are working as a team. I taught the patient the Stillmans
method, so he can now do a great job a brushing to reduce his plaque score. He did great at
showing me and demonstrating that he could accomplish the Stillmans method. I think that the
patient will do great with this brushing method and will do great and bring his oral cavity to a
healthier state. The patients learning level for today is action. I also ultrasoniced and fine
scaled the maxillary right quadrant. While scaling the maxillary right, the distal of 2 bleed quit
moderately. The gingiva in the entire oral cavity still looked scalloped, the color was still a little
pink and inflamed. There was no suppuration. The margins were generalized thickened and the
papilla was generalized bulbous. The surface texture was stippled and the patient still had
generalized Fordyces Granules on his lips, buccal mucosa, and labial mucosa.
Journal 4: (10/14/15)
Today, I updated and review the patients medical history and took his vitals. All his vitals
were normal except his blood pressure which was 140/90 on the right arm which is stage 1
hypertensive. There is a slight decrease in his blood pressure from his last appointment to this
one, which is a positive note. Today, the patients plaque score was .66 (Good) and his bleeding
score was 2.56%. The bleeding score was the same as the last appointment, but his plaque score
was reduced. For the patient education session today we went over his brushing technique to
make sure that he had no problems and I also taught him how to correctly floss. We went over
what periodontitis is, and that it is a bacteria that destroys the gums and bones resulting in tooth
loss. The patient did great with both the brushing and the flossing techniques. At the second
patient education session, we also went over all of the long and short term goals. Again, the
patient was great with learning and had no problems with the brushing and flossing. His
learning level for today is action. As I scaled the maxillary left there was not much bleeding,
but the gingiva did look increasingly red.
Journal 5: (10/28/15)
Today, I updated and review the patients medical history and took his vitals. His blood
pressure is slightly lower today again, which an improvement to his overall health. His blood
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Periodontology (DHYG 1311)

Fall, 2015
pressure is 125/85 on the right arm, which is pre-hypertensive. Today, the patients plaque score
was .5 (Good) and his bleeding score was 1.92%. For this appointment both the plaque score
and bleeding score was reduced, which is great. For the patient education session today, we
talked about caries and fluoride. I taught the patient about the process of caries and how
fluoride helps to prevent them. I also told him that there is fluoride in toothpaste, water, soil and
food. We reviewed his brushing and flossing techniques which he is still doing great at, and I
was very proud that his plaque score has reduced. His learning level for today is involvement.
As I scaled the mandibular right, I noticed that the gingiva on the facial and lingual was
swollen. The maxillary gingiva on both the left and right sides looked improved, healthier and
pinker. Also while assessing the gingiva, the mandibular right showed a slight purplish color.
Journal 6: (11/4/15)
Today, I reviewed and updated the patients medical history and took his vitals. His blood
pressure was at a slight increase from last time registering at 135/89 on the right arm which is a
little pre-hypertensive. Today, both maxillary quadrants looked pinker and even healthier than
the last appointment. The patients plaque score decreased to .33 (Good) and his bleeding score
was the same as the last appointment which was1.92%. I know that he is working very hard at
his trying to achieve good oral health. The patient education for today was the replacement of
his missing teeth. It would be good if the patient would have 14 and maybe even 31 replaced.
Today, the patients learning level was aware. He didnt not really seem interested in getting his
teeth replaced.
Journal 7: (11/18/15)
Today, I reviewed and updated the patientss medical history and took his vitals. He prerinsed with mouthwash. His blood pressure was better again today registering at 130/85 on the
right arm. His plaque is again .33 which is great and his bleeding score is 0%, which is
amazing! Today, I completed post-periodontal charting and also administered Arestin to 15 and
18. For patient education today, I taught him all about Arestin, and what it is and why it helps.
Today, the patients learning level was aware. He was glad that I administered Arestin, but did
not really seem interested while telling him about it.
9. Prognosis:
Based on the attitude of the patient, I believe that the prognosis of the patients teeth are
very good. If he keeps up a good job, and maintains his good oral health, and keeps
practicing and perfecting the Stillmans method and flossing, The patient will halt the
progression of his periodontitis. Based on the patients systemic background and tooth
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Periodontology (DHYG 1311)

Fall, 2015
morphology, I think that his chances of further progression is good, but with the
brushing and flossing that he does now, it will be halted. Even though the patient does
have a little malocclusion of his mandibular anterior teeth, I believe that if he keeps his
flossing up, he should have no problems with it. Also, based on the age of the patient
which is 55 and that he has 26 teeth left, leave him with a pretty good prognosis of that
he can stop the progression.
10. Supportive Therapy:
The only suggestion I have to the patient regarding his re-evaluation is to keep up the
great work. Keep brushing using the Stillmans Method and keep flossing and using a
mouth rinse. If you keep us the good work, the progression will continue to be stopped
and will not progress any further. Your gum, and oral cavity overall looks better and
healthier. One thing that is of importance to get taken care of is tooth number 30- the
one that has caries and that is broken. That tooth really need to be taken care of and
fixed. Your next appointment will be on February 18th, 2016 at 8am.
11. Assessment of Changes:
I think that the changes that occurred in that patients oral cavity were amazing. I have
never personally seen the changes of the gingiva and overall periodontium go from
infection and disease to normal. The plaque scores, bleeding score, and gingival index
all decreased which is so great for the patient. His periodontium is showing great
improvement and health.
12. Patient Attitudes and Cooperation:
The patient was a very enthusiastic and cooperative patient to do this project with. He
never once complained about coming or called to cancel his appointment. He followed
all the directions he was giving and did not have and complaints or bad attitudes. I am
very grateful to have found the perfect patient to help and treat.
13. Personal Evaluation/ Reaction to Experience:
I believe that this project has helped me tremendously to learn and understand more
about being more personal with my patients. It has also helped me with my record
keeping skills, writing down everything and taking journals and notes. I really enjoyed
working with my patient, and loved the connection that we had. I think that this project
has helped my skills, and also knowledge grow.

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