GINGIVAL INDEX

PERIODONTAL CARE PLAN

Initial date ____9-18-2014_________

Gingival Area
M

12

19

25

28

TOTAL ____.41_-Good________

Final date_________11-14-14___________
Gingival Area
M

12

19

25

28

TOTAL____.13- Good_______

PERIODONTAL CARE PLAN

Patient Name ____Stacey Oubre_______________________________________Age____44_____

Date of initial exam: _____September 2nd, 2014_________ Date completed___________________

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 is a 44 year old male who demonstrates slight to moderate periodontitis. He is currently
under no care when it comes to his medical care. Since the patient does not go to a general physician,
there is no way of knowing whether or not he could have any underlying issues. Mr. Oubres patient
health record indicates that his last physical was February 2014. This patient does not take any
prescribed medications but on occasion does take over-the-counter medication for his acid reflux. At
Mr. Oubres first appointment on September 2nd, 2014 his blood pressure level was at 150/80 which
put him at stage one hypertension. At Mr. Oubres second appointment his blood pressure level was at
150/90 which kept him at stage one hypertension. On Mr. Oubres third appointment his blood pressure
was measured to be 180/90 which put him at stage 2 hypertension. Due to his blood pressure being this
high, I found that I should ask him if there had been any changes recently, or if he was nervous. The
patient stated that he had taken an over the counter anti-acid drug before arriving at his appointment.
This was vital information because anti- acid drug cause fluid retention which in return can cause an
increase in blood pressure. His high blood pressure could be a contributing factor towards his
periodontal disease because there is research that has been done that associates the bacteria that is found
in periodontal disease and heart disease. Because of Mr. Oubres high blood pressure and over the
counter drugs he takes (only when he feels necessary), I will monitor his vital signs closely and make
sure his acid reflux is under control before performing any dental treatment.
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)
Mr. Oubre has not had regular dental visits. His last dental appointment was in 2005 in which he had to
have his tooth pulled. Due to neglecting his dental care, (including routine checkups and cleanings), this
is a contributing factor to his periodontal condition because of the buildup of tartar over the years. His
current home care involves brushing once a day and he does not floss. His lack of flossing can
definitely be a contributing factor as to his periodontitis because of the inadequacy of biofilm removal
during his home care. The patient does state having sensitivity to cold things on his teeth. The patients
chief complaint is for a cleaning. Patient said that he feels great about the appearance of his teeth
besides the staining that reside on them. Patients dental history also mentions a root canal which was
done in 1991. His susceptibility to caries are at a greater risk due to his consumption of 2 sugar
containing drink per day. Patient had an FMX done November 1st, 2013 and a PAN around the same
time of his root canal (1991). His dental IQ is at unaware because he is unacquainted with periodontal
diseases. Patient education on the importance of biofilm removal could motivate the patient to start
brushing his teeth more than one a day and possibly to start flossing periodically. It would also be
enlightening to the patient to mention that the removal of the plaque could help to reduce or prevent the
progression of the disease. The dental hygiene diagnosis is that this patient has slight to moderate
periodontitis. Mr. Oubre does have insurance but does not use it and is able to drive himself to a dental
office and receive proper care and with proper instruction on how to brush and have good home care,
Mr. Oubre has a high chance of reducing/ preventing the progression of the disease.

3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation)
During patients intraoral examination there were no atypical or pathological lesions noted. As for his
oral habits go he does not grind, clench, neither does he mouth breath. His occlusal examination consist
of unclassifiable left and right molar classes due to his maxillary right first molar not being there and
his mandibular left first molar not being there. His canines both left and right are class 1 occlusions.
The patients over-bite and overjet are within normal limits. Mr. Oubre does have a slight midline shift
of 1 mm to the right.

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

a. Case Classification __4___ Periodontal Case Type___2___
b. Gingival Description:
App't 1:
The patients periodontal examination revealed architecture of generalized scalloped. There were
areas that were erythemous such as the facial of number 8, the facials of numbers 22-28 and the
lingual of the mandibular arch. The margin was rolled on the facial of number 8 and also was quite
bulbous on that same surface. There was no suppuration. The surface texture consisted of Smooth
and shiny on the facial of number 8 and the lingual of the mandibular arch.
________________________________________________________________________________
App't 2:
The patients gingiva remained the same for the second appointment. The architecture was scalloped.
The same areas that were erythemous at the last appointment remained that way. The surface texture
was smooth and shiny.
________________________________________________________________________________
App't 3:

This appointment the patient arrived with the same periodontal description as the last appointment. After the
________________________________________________________________________________
App't 4:
During this appointment I did notice a change in the color of the gingival tissues that had been
cleaned. In the mandibular linguals of his right side there was less redness. Other than that, the rest
of his periodontal assessment remained the same.
________________________________________________________________________________

App't 5:

During this visit I noticed that the mandibular lingual had greatly improved. On the maxillary arch,
the periodontal assessment remained the same.
________________________________________________________________________________
App't 6:
During this visit the periodontal assessment remained the same as the last time.
________________________________________________________________________________
Appt 7:
This appointment demonstrated that with the help of proper oral hygiene instructions and continuing
care that you are able to better your periodontal assessment results. The patients gingiva looked
much healthier that the initial assessment.

c. Plaque Index:
d.

Appt 1: __N/A_ 2)_N/A__ 3)__2.4-Fair___ 4.) 1.4-Good__ 5.) _.6-Good_

Gingival Index: Initial _.41-Good___

Final ___.13-Good__

e. Bleeding Index: Appt 1__N/A___ 2___N/A__ 3___3.7%__ 4__3.3%__ 5. __3.3%__

6.) 0% 7.) 0%
f. Evaluation of Indices:
1. Initial
The patients initial plaque score was 2.4, which is evaluated as fair.
The patients overall gingival index was .41 which is evaluated as good.
The patients bleeding score was 3.7 %.
______________________________________________________________________
2. Final
The patients final plaque score was 0, which is evaluated as excellent.
The patients final overall gingival index was .14, which is evaluated as good.
The patients final bleeding score was 0%.
_______________________________________________________________________
g. Periodontal Chart: (Record Baseline and First Re-evaluation data)
1. Baseline
Mr. Oubre has periodontal pockets that are greater than 3 mm in the posterior regions of his
maxillary arches and the posterior region of the right side of his mandible. These areas with
pockets that are greater than 3 mm contribute to the progress of periodontitis. He did contain a
few bleeding spots while probing. These spots werent localized they were random. This
patient does not have furcation involvement and nor does he have mobility or percussion. His
clinical attachment level was worse in the posterior regions of his mouth, which read some
numbers greater than 3.
2. First evaluation
The patients periodontal pockets have reduced. The areas that were presented with pockets >3

6.) .6-Go

have now decreased anywhere from 1-2 mm. The patient still did not present any furcation
involvement and nor did he have mobility or percussion. His clinical attachment level have
improved in the posterior regions of his mouth.

5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions
Mr. Oubre has carious lesions on the occlusal surfaces of numbers 2 and15, there is also decay on the
mesial of number 31. There is attrition on numbers 23-26 and 8 & 9. He had endodontic therapy on
number 15. His numbers 16 & 17 are impacted. Numbers 3,19, and 32 are missing/ extracted. He
has an amalgam restoration (MO) on number 14. Patient also has another amalgam restoration on
the occlusal surface of number 31.

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

App't 1:
At the first appointment the medical/dental history was reviewed. The patient then pre-rinsed. This
appointment was used to begin his paperwork (head& neck, periodontal assessment, dental charting).
This appointment consisted of only 2 hours so the paperwork was started but was not finished by the
end of his appointment. Chair- side patient education was also shown to the patient (explained gingivitis
due to the patient having a few bleeding spots while probing )
App't 2:
Reviewed medical and dental history. This appointment was then used to finish his paperwork that was
started during the last appointment (head & neck, periodontal assessment, dental charting, informed
consent, risk assessment). After his paperwork was finished I began on his full periodontal charting. By
the end of the appointment I did not finish his full periodontal charting. Chair- side patient education
was done(showed patient the modified bass method and explained gingivitis briefly).
App't 3:
During this appointment the medical and dental history was reviewed. The full periodontal charting was
completed. The plaque score was taken (2.4- Fair). The bleeding score was taken (3.7%) . The
ultrasonic was used on his mandibular right and was checked as well. Chair-side patient education was
done (introduced patient to the modified bass method).

App't 4:
This appointment will consist of reviewing medical/dental history, pre-rinse, and more data collection

(plaque and bleeding score). I also plan on conducting my first patient education session (plaque and
brushing). Afterwards I hope to complete fine scaling on his mandibular right and start and finish the
ultrasonic/fine scaling treatment on his mandibular left.

App't 5:
This appointment will start off with reviewing medical/dental history and data collection (plaque and
bleeding score). I also plan on conducting my second patient education session (periodontal disease:
periodontitis & flossing). Another goal for this appointment is to continue onto the maxillary right
quadrant and start and finish the ultrasonic and fine scaling treatment on that area of the mouth.
App't 6:
For this appointment, the medical and dental history will be reviewed first, the patient will pre-rinse and
there will be more data collection (plaque and bleeding score). This appointment will consist of the
third and final patient education session (Caries & prevention/ sealants). Afterwards, I plan on using the
ultrasonic and fine scaling the final quadrant (maxillary left).
App't 7:
On this final appointment, medical and dental history will be updated, patient will pre-rinse, and more
data collection will be done (plaque and bleeding score). I will also conduct a full periodontal charting
to evaluate the patients periodontal health and also conduct the gingival index. Also, I will conduct
chair side patient education (review brushing technique and flossing). This is also the appoint where
any referrals for the patient will be addressed.

7. Radiographic Findings: (crown root ratio, root form, condition of interproximal bony crests,
thickened lamina dura, calculus, and root resorption)
The patient presents mild/slight horizontal bone loss in the upper right region of the mouth. Mr. Oubre
also shows calculus in his radiographs in the upper left and lower right regions in the mouth (between
#12& 13 and 30& 31). This can contribute towards his periodontitis by increasing the pathogenicity in
that area which then causes gum & bone recession. Tooth numbers 14 & 2 are supererupted. Patient
does not show widened PDL space, loss of crestal lamina dura, close root proximity, root anomalies,
furcation involvement, periapical pathology, caries, defective restoration, or adverse crown to root ratio.

8. Journal Notes: (Record in detail the treatment provided, oral hygiene education, patient response,
complications, improvements, diet recommendations, learning level, short and long term goals,

expectations, etc.) The progress notes should be written by appointment date.

9-2-14
On this day, I was able to begin my patients paperwork. First we reviewed his medical and dental
history and then pre-rinsed. The paperwork consisted of periodontal assessment, Intra & Extra oral
exam, and dental charting. My patient was very cooperative and let me know about any health and
dental details that I questioned him about (which was the list of things that the medical and dental
history). His learning level was unaware. For chair-side patient education I explained to him why
his mouth would bleed in certain areas (gingivitis).
9-18-14
This appointment we began by reviewing his medical and dental history and then pre-rinsing. We
finished the head & neck exam, periodontal assessment, dental charting and began his full
periodontal charting. I went over the informed consent with him and made sure he understood the
treatment that was about to take place. His learning level at this point was still unaware. For
chairside patient education, I quickly showed him the modified bass method and explained to him
why I chose this method of brushing for him (marginal plaque build-up).
9-26-14
This appointment we began by reviewing his medical and dental history and then pre-rinsing. We
then finished off his periodontal charting. We then proceeded to taking his plaque score which was
2.4 (Fair) and bleeding score 3.7%. His learning level at this point is aware due to him asking
questions about gingivitis and learning a new method of brushing his teeth. During this appointment
I explained to him what the ultrasonic was and how it worked (Its a type of instrument that uses
very quick vibrations along with irrigation in order to remove difficult deposits that I cant
mechanically remove with my traditional instruments). Then with his consent I began using the
ultrasonic and made sure that it did not bring him any discomfort. He actually stated that he enjoyed
the ultrasonic more than the traditional method of scaling because it helped him fall asleep. At this
appointment is where I learned that I would have to use a bite block in order to keep this patients
mouth open while he drifted off into is naps.
10-10-14
This appointment began by reviewing his medical and dental history and then pre-rinsing. At this
appointment we did the first patient education session which consisted of the topics brushing and
plaque. I then told him his long term and short term goals but for this patient education session this
were the goals
Long Term Goal: Patient will lower his plaque score by .3 at every appointment.
Short Term Goal: Patient will describe plaque and how it forms by the 2nd Appointment.
Short Term Goal: Patient will correctly use brushing technique shown to him by the 3rd
appointment.
Short Term Goal: Patient will choose to floss 1-2x/week by the 4th appointment.
These goals were accomplished.
I described why brushing was important and how plaque plays an important role in the health of
your periodontium. I then took his plaque score which was (1.4 - Good) and bleeding score: 3.3%. I
fine scaled his mandibular right and ultrasonic mandibular left. His learning level at this point was
self-interest.
10-22-14
On this appointment we reviewed his medical and dental history and then pre-rinsed. I fine-scaled

his mandibular left. Then I used the ultrasonic on the maxillary right followed by starting finescaling on that same quadrant. After that we went ahead and did patient education session #2 which
were about flossing and periodontitis. His long and short term goals for this were:
2. Periodontal Disease:
Long Term Goal: Patient will halt the progression of periodontitis.
Short Term Goal: Patient will define periodontal disease and causes of it by 2nd appointment.
Short Term Goal: Patient will complete scheduled treatment in clinic.
Short Term Goal: Patient needs to schedule regular cleanings.
These goals were accomplished by the patient.
His learning level at this point is involvement. His plaque score was .6 (Good) and his bleeding
score was 3.3%.
10-28-14
On this appointment we reviewed his medical and dental history and then pre-rinsed. I finished fine
scaling the maxillary right, finished ultrasonicing the maxillary left, finished fine scaling maxillary
left. We did patient education session #3 which we went over caries and fluoride and the long and
short term goals were:
3. Caries:
Long Term Goal: Patient will get the help of a dentist in order to restore decayed teeth.
Short Term Goal: Patient will define caries and how it is formed by the 2nd Appointment.
Short Term Goal: Patient will have caries restored.
Short Term Goal: Patient will choose a fluoride containing dental product to use (other than
varnish) by the 4th appointment. (Maybe a fluoride containing rinse).
Patient has not yet had his caries restored.
I mentioned to him how the caries process takes place and how fluoride can help prevent that by
remineralizing the enamel. His plaque score was .6-good and his bleeding score was 0%. I then did
plaque free and gave him the fluoride treatment. I went over the referrals that the dentist recommend
that he get fixed. His learning level at this point was action.
11-14-14
On this appointment we reviewed his medical and dental history and then pre-rinsed. I then took the
plaque score (0) and bleeding score (0%). Then I did his 2nd full periodontal charting (post perio). I
then applied arrestin to the one spot where he had a fairly deep pocket (Lingual of 31M & 30D). His
learning level is action.
9. Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth
morphology, periodontal examination, recare availability)
The prognosis for this patient seems to be a promising one. The reason why I believe this is because his
attitude towards his oral care has changed. For example, he is now educated on the diseases that he has
in his mouth and he is will to continue the oral hygiene care that I taught him. The number of teeth that
he has also indicates that he may be keeping is teeth for a while. The teeth that he already has are in
pretty good condition to begin with, he only had a moderate amount of stained calculus build-up. He
has agreed to continue treatment at the clinic for his routine dental cleanings/ check-ups. His
background isnt great when it comes to visiting the dentist/ dental hygienist but he is able
10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule.
(Note: Include date of recall appointment below.)

The patients recall date was set to be every 4-5 months (February or March 2015). The patient was told
about a few a few decayed spots that needed restorative care (#2-O, #15-O, and #30-M). I suggested to
the patient that he continue his modified oral hygiene care and to visit a general dentist for those
decayed spots before they progressed to a worse condition.
11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing
depths)
This patient clearly made some habitual changes during the month and a half time that I was seeing
him. His plaque index and gingival bleeding score evidently indicate a change in his oral hygiene for
the better. At the beginning he did present with a higher plaque score and a higher bleeding score and as
the appointments passed he presented with a lower plaque and bleeding score. On another note, his
probing depths had also significantly improved.

12. Patient Attitudes and Cooperation:

The patient at first was very uncomfortable in the dental chair. He mentioned to me that he does not like
anyone being in his mouth. Though he was drawn back by that he was still very cooperative and willing
to listen to all of the patient education sessions and chair-side patient education that I told him. He
actually started becoming more involved in his own habits of brush/flossing/rinsing and was interested
in the types dental products that would best suite his needs.
13. Personal Evaluation/Reaction to Experience:
In my opinion, if you take into account that this man has not been to a dentist in over 10 years, I would
say that his oral health was not that bad. Over the years he must have been taking pretty good care of
his teeth on his own. I think this was a great experience due to the fact that I got to see, first hand, how
effective good oral hygiene along with dental care can be. I witnessed how his periodontal assessment
showed signs of healthier gingiva and how his full periodontal charting demonstrated reduce in pocket
depths. He was extremely cooperative and I enjoyed having him as my periodontal patient.

Goals
1. Plaque:

 Long Term Goal: Patient will lower his plaque score by .3 at every appointment.
Short Term Goal: Patient will describe plaque and how it forms by the 2nd
Appointment.
Short Term Goal: Patient will correctly use brushing technique shown to him by
the 3rd appointment.
Short Term Goal: Patient will choose to floss 1-2x/week by the 4th appointment.
2. Periodontal Disease:
Long Term Goal: Patient will halt the progression of periodontitis.
Short Term Goal: Patient will define periodontal disease and causes of it by 2nd
appointment.
Short Term Goal: Patient will complete scheduled treatment in clinic.
Short Term Goal: Patient needs to schedule regular cleanings.
3. Caries:
Long Term Goal: Patient will get the help of a dentist in order to restore decayed teeth.
Short Term Goal: Patient will define caries and how it is formed by the 2nd
Appointment.
Short Term Goal: Patient will have caries restored.
Short Term Goal: Patient will choose a fluoride containing dental product to use
(other than varnish) by the 4th appointment. (Maybe a fluoride containing rinse)

DATE________________________

NAME_________________________________________
PERIODONTAL CARE PLAN EVALUATION
PART 1
PC.9
LIT Dental Hygiene
Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
PC.10
Competency
Use critical decision making skills to reach conclusion about the patients dental hygiene needs based on all available
assessment data.
PC.12
Provide specialized treatment that includes preventive and therapeutic services designed to achieve and maintain oral health.
PC.13
Evaluate the effectiveness of the implemented clinical, preventive, and educational services and modify as needed.
All information should evaluated and correlated to periodontal disease; the progression of, the healing of, and the prevention of. Failure to evaluate and
correlate to periodontal disease on this write-up will constitute loss of points.
Topic area
Points
Excellent
Good
Fair
Unacceptable
5
4
3
2
Identifies many systemic conditions
Identifies several systemic
Identifies at least one relevant systemic
Fails to identify any relevant systemic
Medical
altering treatment, steps taken to avoid
conditions altering treatment, steps
condition altering treatment, steps taken to
conditions altering treatment, steps taken
History
medical problem, effect on dental hygiene
taken to avoid medical problem,
avoid medical problem, effect on dental
to avoid medical problem, effect on
diagnosis and/or care. Relates many
medical history findings to periodontal
disease: its progression, healing, and
prevention

effect on dental hygiene diagnosis

and/or care. Relates several
medical history findings to
periodontal disease: its progression,
healing, and prevention
Identifies several elements of the
dental history, its effect on dental
hygiene diagnosis and/or care.
Relates several dental history
findings to periodontal disease: its
progression, healing, and
prevention
Identifies several findings of the
oral exam, steps taken to avoid a
medical problem, effect on dental
hygiene diagnosis and/or care.
Relates several oral exam findings
to periodontal disease: its
progression, healing, and
prevention

hygiene diagnosis and/or care. Relates at

least one relevant medical history finding to
periodontal disease: its progression, healing,
and prevention

dental hygiene diagnosis and/or care.

Fails to relate any medical history
finding to periodontal disease: its
progression, healing, and prevention

Identifies at least one relevant element of the

dental history, its effect on dental hygiene
diagnosis and/or care. Relates at least one
relevant dental history finding to periodontal
disease: its progression, healing, and
prevention

Fails to identify any elements of the

dental history, its effect on dental
hygiene diagnosis and/or care. Fails to
relate any medical history finding to
periodontal disease: its progression,
healing, and prevention

Identifies at least one relevant finding of the

oral exam, steps taken to avoid a medical
problem, effect on dental hygiene diagnosis
and/or care. Relates at least one oral exam
finding to periodontal disease: its
progression, healing, and prevention

Fails to identify any finding on the oral

exam, steps taken to avoid a medical
problem, effect on dental hygiene
diagnosis and/or care. Fails to relate any
oral exam finding to periodontal disease:
its progression, healing, and prevention

Describes many characteristics of the

gingival exam by quadrant. Evaluates
many of the indices and relates to
periodontal disease

Describes several characteristics of

the gingival exam by quadrant.
Evaluates several of the indices and
relates to periodontal disease

Describes at least one characteristic of the

gingival exam by quadrant. Evaluates one
index and relates to periodontal disease

Fails to describe any characteristics of

the gingival exam by quadrant. Fails to
evaluate any index and relate to
periodontal disease

Describes many of the findings of the

periodontal examination and relates many
findings to periodontal disease.

Describes several of the findings of

the periodontal examination and
relates several to periodontal
disease.

Describes at least one of the findings of the

periodontal examination and relates any to
periodontal disease.

Fails to describe any of the findings of

the periodontal examination. Fails to
relate any to periodontal disease.

Dental History

Identifies many elements of the dental

history, its effect on dental hygiene
diagnosis and/or care. Relates many
dental history findings to periodontal
disease: its progression, healing, and
prevention

Oral Exam

Identifies many findings of the oral exam,

steps taken to avoid a medical problem,
effect on dental hygiene diagnosis and/or
care. Relates many oral exam findings to
periodontal disease: its progression,
healing, and prevention

Periodontal
Exam
Gingival
Exam &
Dental
Indices
Periodontal
Chart

Topic area
Dental Exam

Treatment
Plan
Plans
Treatment
& Patient
Education

Points

Excellent
5

Good
4

Fair
3

Describes many of findings of the dental

examination and relates many to
periodontal disease and the disease
process.

Describes several of findings of the

dental examination and relates
several to periodontal disease and
the disease process. .

Describes at least one of the findings of the

dental examination and relates any to
periodontal disease and the disease process..

Fails to describe any of the findings of

the dental examination. Fails to relate
any to periodontal disease and the
disease process.

Assesses many of the patient education

needs. Accurately plans many of the
treatment and patient education sessions.
Many of the patient education topics are
appropriate.

Assesses several of the patient

education needs. Accurately plans
several of the treatment and patient
education sessions. Several of the
patient education topics are
appropriate.
Several of the long and short term
goals are developed with the
patient. Goals are provided to the
patient.
Describes several findings of the
radiographic examination and
relates many findings to
periodontal disease.
Thoughts are generally organized
and logically presented; word usage
is adequate and sets a professional
tone; several errors in spelling,
grammar, punctuation,
capitalization, and sentence
structure.
Plan is submitted within 96 hours
with grading sheet. Many records
are updated and properly identified.

Assesses at least one of the patient education

needs. Plans at least one of the treatment and
patient education sessions. At least one of the
patient education topics are appropriate.

Fails to assess any of the patient

education needs. Fails to plan any of the
treatment and patient education sessions.
Patient education topics are not
appropriate.

At least one of the long and short term goals

are developed for the patient. At least one
goal is provided to the patient.

Fails to develop any of the long and short

term goals. Goals are not provided to the
patient.

Describes at least one finding of the

radiographic examination and relates any
finding to periodontal disease.

Fails to describe any finding of the

radiographic examination and relates any
finding to periodontal disease.

Thoughts are somewhat disorganized, vague

and difficult to follow; word usage is
sometimes inappropriate and detracts from
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, and sentence structure.
Plan is submitted within 120 hours with
grading sheet. Not all records are updated
and properly identified.

Thoughts are very disorganized,

extremely vague, and difficult to follow;
word usage is often inappropriate and
detracts significantly from the
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, sentence structure. Plan is
submitted after 120 hours. Many records
are not updated or properly identified

Long and
Short Term
Goals
Radiographic
Findings

Many of the long and short term goals are

developed with the patient. Goals are
provided to the patient.

Writing &
Basic
requirements

Thoughts are highly organized and

logically presented; easy to follow; word
usage is correct and sets a very
professional tone; correct spelling,
grammar, punctuation, capitalization, and
sentence structure.
Plan is submitted within 72 hours with
grading sheet. All records are updated and
properly identified.

TOTAL
POINTS
(50 points possible)

Comments:

Describes many findings of the

radiographic examination and relates
many findings to periodontal disease.

Unacceptable
2

DATE________________________

NAME_________________________________________
PERIODONTAL CARE PLAN EVALUATION
PART 2
PC.9
LIT Dental Hygiene
Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
PC.10
Competency
Use critical decision making skills to reach conclusion about the patients dental hygiene needs based on all available
assessment data.
PC.12
Provide specialized treatment that includes preventive and therapeutic services designed to achieve and maintain oral health.
PC.13
Evaluate the effectiveness of the implemented clinical, preventive, and educational services and modify as needed.
All information should evaluated and correlated to periodontal disease; the progression of, the healing of, and the prevention of. Failure to evaluate and
correlate to periodontal disease on this write-up will constitute loss of points.
Topic area
Points
Excellent
Good
Fair
Unacceptable
5
4
3
2
Periodontal Exam
Gingival Exam
& Dental Indices
Periodontal
Chart

Describes many characteristics of

the gingival exam by quadrant.
Evaluates many of the indices
and relates to periodontal disease
Describes many of the findings of
the periodontal examination and
relates many findings to
periodontal disease. Compares
many of the findings to the initial
periodontal examination.

Describes several characteristics of

the gingival exam by quadrant.
Evaluates several of the indices and
relates to periodontal disease
Describes several of the findings of
the periodontal examination and
relates several to periodontal
disease. Compares several of the
findings to the initial periodontal
examination.

Describes any characteristics of the gingival

exam by quadrant. Evaluates an indices and
relates that indices to periodontal disease

Describes many of the treatment

procedures provided, OH
education, pt. response, and
complications by appt date.
Describes many of the pt.
improvements, diet
recommendations, and learning
level. Descriptions are kept by
appt date.
Describes many of the STG &
LTG attained, and expectations.
Descriptions are kept by appt
date.
Describes many prognosis
characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability,
and periodontal examination.

Describes several of the treatment

procedures provided, OH
education, pt. response, and
complications by appt date.
Describes several of the pt.
improvements, diet
recommendations, and learning
level. Descriptions are kept by appt
date.
Describes several of the STG &
LTG attained, and expectations.
Descriptions are kept by appt date.

Describes any of the treatment procedures

provided, OH education, pt. response, and
complications by appt date.

Describes several prognosis

characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
periodontal examination.

Describes any prognosis characteristic by

attitude, age, number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
periodontal examination.

Describes any of the findings of the

periodontal examination and relates any to
periodontal disease. Compares any of the
findings to the initial periodontal
examination.

Fails to describe any characteristics of

the gingival exam by quadrant. Fails to
evaluate any indices and relate to
periodontal disease
Fails to describe any of the findings of
the periodontal examination. Fails to
relate any to periodontal disease. Fails to
compare any of the findings to the initial
periodontal examination.

Journal Notes kept

by appt. date
Treatment provided,
OH education, pt.
response,
complications
Improvements, Diet
recommendations,
learning level

STG & LTG

attained,
Expectations

Prognosis

Describes any of the pt. improvements, diet

recommendations, learning level, STG &
LTG attained, and expectations. Descriptions
are kept by appt. date.
Describes any of the STG & LTG attained,
and expectations. Descriptions are kept by
appt date.

Fails to describe any of the treatment

procedures provided, OH education, pt.
response, and complications by appt
date.
Fails to describe any of the pt.
improvements, diet recommendations,
learning level, STG & LTG attained, and
expectations. Descriptions are not kept
by appt. date
Fails to describe the STG & LTG
attained, and expectations. Descriptions
are not kept by appt date.
Fails to describe any prognosis
characteristics by attitude, age, number
of teeth, systemic background,
malocclusion, tooth morphology, recall
availability, and periodontal
examination.

Topic area

Supportive therapy

Assessment of
changes
Pt. Attitudes and
cooperation
Personal
evaluation/reaction
to experience
Writing & Basic
requirements

TOTAL POINTS
(50 points possible)

Comments:

Points

Excellent
5

Good
4

Fair
3

Unacceptable
2

Describes many of the

suggestions made to patient
regarding re-evaluation, referral,
and recall schedule. Includes date
of recall appt.
Describes many of the changes
occurring from trt including
plaque control, bleeding, gingival
health, probing depths.
Evaluates comprehensively
patients attitude and cooperation
including patients mental and
emotional status, temperament
and attitude. Comments on
personal evaluation/reaction to
experience.
Thoughts are highly organized
and logically presented; easy to
follow; word usage is correct and
sets a very professional tone;
correct spelling, grammar,
punctuation, capitalization, and
sentence structure.
Plan is submitted within 72 hours
with grading sheet. All records
are updated and properly
identified.

Describes several of the

suggestions made to patient
regarding re-evaluation, referral,
and recall schedule. Includes date
of recall appt.
Describes several of the changes
occurring from trt including plaque
control, bleeding, gingival health,
probing depths.
Evaluates patients attitude and
cooperation including patients
mental and emotional status,
temperament and attitude.
Comments on personal
evaluation/reaction to experience

Describes any of the suggestions made to

patient regarding re-evaluation, referral, and
recall schedule. Date of recall not included.

Fails to describe any of the suggestions

made to patient regarding re-evaluation,
referral, and recall schedule. Date of
recall not included

Describes any of the changes occurring from

trt including plaque control, bleeding,
gingival health, probing depths.
Fails to evaluate patients attitude and
cooperation including patients mental and
emotional status, temperament and attitude.
Comments on personal evaluation/reaction to
experience

Fails to describe any of the changes

occurring from trt including plaque
control, bleeding, gingival health,
probing depths.
Fails to evaluate patients attitude and
cooperation including patients mental
and emotional status, temperament and
attitude. No comments on personal
evaluation/reaction to experience

Thoughts are generally organized

and logically presented; word usage
is adequate and sets a professional
tone; several errors in spelling,
grammar, punctuation,
capitalization, and sentence
structure.
Plan is submitted within 96 hours
with grading sheet. Many records
are updated and properly identified.

Thoughts are somewhat disorganized, vague

and difficult to follow; word usage is
sometimes inappropriate and detracts from
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, and sentence structure.
Plan is submitted within 120 hours with
grading sheet. Not all records are updated
and properly identified.

Thoughts are very disorganized,

extremely vague, and difficult to follow;
word usage is often inappropriate and
detracts significantly from the
professional tone; numerous errors in
spelling, grammar, punctuation,
capitalization, sentence structure. Plan is
submitted after 120 hours. Many records
are not updated or properly identified

GINGIVAL INDEX
Loe and Silness
The purpose of the Gingival Index (GI) is to assess the severity of gingivitis based on color, consistency,
and bleeding on probing. The GI will be determined for our purposes using tooth #'s 3, 9, 12, 19, 25, 28.
Four gingival areas (distal, facial, mesial, and lingual) should be examined systematically for each tooth.
Procedure
The teeth and gingiva are dried, and under adequate light, a mouth mirror and probe are used. The probe
is used to press on the gingiva to determine the degree of firmness. The probe is also used to run along
the soft tissue wall near the entrance to the gingival sulcus (not at the base of the sulcus) to evaluate
bleeding. (If you do not understand this explanation, see the figure in Wilkins p. 338-339.
Criteria for Scoring
0 = Normal gingiva
1 = Mild inflammation - slight color changes, slight edema. No Bleeding on probing.
2 = Moderate inflammation - redness, edema, and glazing. Bleeding on probing.
3 = Severe inflammation - marked redness and edema. Ulceration. Tendency to
spontaneous bleeding.
Scoring
Each of the 4 gingival surfaces (distal, facial, mesial, lingual) is given a score of 0 to 3. Each tooth used
will have 4 scores. By totaling the scores and dividing by the number of teeth examined, the Gingival
Index is determined. Indices range from 0 to 3.
Calculating Example for an Individual.
Gingival Area
M

12

19

25

28

TOTAL 12 + 5 + 12 + 6 = 35
Gingival Index = Total Score 35 divided by Number of Surfaces 24 = 1.45 GI
Interpretation: According to the suggested nominal scale, the score for this individual (1:45) indicates
only fair gingival health (moderate inflammation). The ratings for each gingival area or surface can be
used to help the patient compare gingival changes toward health at each appointment.

SUGGESTED NOMINAL SCALE FOR PATIENT REFERENCE

Rating
Excellent (healthy tissue)
Good
Fair
Poor

Scores
0
0.1-0.9
1.0-1.9
2.0-3.0

Periodontal Care Plan

Written By: Carrie Oubre