Paula Philpott

10/8/2017

PERIODONTAL CARE PLAN

Patient Name__Amber Hudson________________________Age__37_____

Date of initial exam___10/2/17___________________________ 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.

Mrs. Hudson is 37 years old, weighs 232 lbs is 5’2. She is up to date with her yearly physicals. Mrs. Hudson is
under the care of a physician and dentist and has hypothyroidism and depression. My patient takes three
medications once daily. She takes levothyroxine, which is a thyroid hormone for hypothyroidism. Dental
considerations for levothyroxine are nervousness; excitability, sweating or tachycardia may indicate a patient
with uncontrolled hyperthyroidism or a dosage too high. Uncontrolled patients should be referred for medical
treatment. Observe appropriate limitations of vasoconstrictors doses too and monitor vital signs at every
appointment. She also takes Bupropion, which is an antidepressant for her depression. Dental considerations for
Bupropion are to Asses salivary flow at every appointment as a factor in caries, periodontal disease and
candidiasis. Short appointments and stress reduction may be the protocol for anxious patients. The physician
should be informed if significant xerostomia side effects occur so that medication change can be considered.
My patient mentioned after her first appointment that her mouth became dry at times. I advised her to avoid
mouth rinses with high alcohol content due to the drying effects and to use daily home fluoride toothpaste for
anticaries prevention. I also mentioned to drink lots of water throughout the day as well as saliva substitutes. The
third medication she takes is Escitalopram (Lexapro) as an antidepressant selective serotonin reuptake inhibitor
for her depression. I researched Lexapro and Wellbutrin being taken together and these drugs taken together help
balance out a patient with major depressive disorders. Dental considerations are to assess salivary flow as a factor
in caries, periodontal disease, and candidiasis. Consider semi supine chair position for patient comfort if FI side
effects occur. Always question patient about tolerance to the use NSAID’s or Aspirin related to GI disease.
Evaluate respiration characteristics and rate. I mentioned to Mrs. Hudson that I will not use nonalcoholic mouth
rinse for each appointment to avoid dry mouth. I also mentioned for her to let me know is she needs a resting
point during dental treatment. Amber has had a hysterectomy is 2014 and her adenoids and tonsils removed in
1998. She states she doesn’t have any issues with the removal of each. Since there are no current issues with the
previous surgeries, no dental considerations would be advised. The last two appointments Mrs. Hudson’s blood
pressure was pre-hypertensive with readings at 121/84 and 126/86. There have been studies of cardiovascular
disease and periodontitis. I mentioned checking with her medical doctor to make sure there are no cardiovascular
issues if her blood pressure continuous to be pre-hypertensive. She mentioned she had reflux/GERD but not
often. Dental considerations for GERD are to sit the patient semi- supine chair position. She had a heart murmur
when she was younger but no complications now are found nor observed. Amber states that she has no allergies.

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)

Amber’s chief complaint for visit was a “teeth cleaning periodontal- cavity”. Her last dental visit was in 2014 for
periodontal maintenance. Due to infrequent dental visits the patient is unaware of any dental diseases she might
have as well as systemic disease that could contribute to overall oral health. She states she has never had any
problems to previous treatment. She states “idk’ about the appearance of her smile. She hasn’t received x-rays
since 2014 when she had her last dental visit. Patient doesn’t recall taking BWX or FMX during any of her last
dental visits. I took an FMX x-ray during her initial appointment with vertical BWX to check for the rate of bone
loss. I mentioned the importance of going to the dentist for maintenance cleanings and the importance of
brushing twice daily with the use of floss and nonalcoholic mouth rinses. Without the use of dental x-rays the
patient could be unaware of caries that may have developed over the years or other dental issues such as
1
Paula Philpott
10/8/2017
abscesses. A panoramic radiograph was taken in 2014. She states that her gums bleed when she brushes her teeth.
Bleeding is the number one sign of disease state in the mouth and plaque build up. Plaque build up could lead to
gingivitis then sometimes progress to periodontitis, caries, demineralization and the formation of calculus. Her
teeth feel sensitive to cold beverages. She also states she clenches her jaws unconsciously. Clenching could cause
attrition on the occlusal and incisal edges of the teeth. I advised the patient to wear a mouth guard at night to help
with unconscious clenching. She chews sugarless gum. Her diet consists of about 2 sugary drinks daily, which
could increase the risk of caries. I advised my patient to lower the amount of sugary drinks to one daily to help
with future caries. Sugar in the diet is a partial cause of tarter build up on the teeth. My patient doesn’t have
dental insurance and had researched our clinic online. She didn’t seem very excited about dental treatment but
was unaware of the many issues she had with her overall oral health. Patient stated that she doesn’t use floss at all
and rarely brushes her teeth at night. Due to not flossing the patient is leaving plaque interproximally and not
brushing can lead to overall plaque daily build up on the facial, lingual and interproximal areas. Not using proper
oral hygiene methods causes plaque buildup subgingivally and eventually hardens. She uses a medium bristled
toothbrush and uses the Leonard method of brushing vertically. I stated the Bass method of brushing and
mentioned that using a soft bristled toothbrush helps get in between the grooves of her teeth and interproximally.
She uses crest toothpaste, which has fluoride with no other home care aids. Accumulating the patient’s oral
hygiene habits shows that the patient doesn’t have very much knowledge about oral health. I plan on improving
these habits with patient education topics. All habits are contributing factors to the patient’s periodontal health.

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

 Extraoral Examination:
Face-Atypical prognathic(correction on paperwork) profile
Submental- Atypical Tender lymphadenopathy etio: pathologic
Thyroid- Aytipical – Systemic Disease: Hypothyroidism (controlled) etio: developmental
Oral Habits: Clenching randomly, Mouth breathing when she sleeps

 Intraoral Examination:
Labial/Buccal Mucosa- Scattered white patches on gingiva about 1mm(confirmed by dentist that its
Fordyce Granules etio: developmental
Floor of the mouth- mandibular bilateral tori etio: developmental

Occlusal Examination:
RIGHT: Molar III LEFT: Molar III
RIGHT: Canine III LEFT: Canine Unclassifiable
Other: She also has an under-bite and cross bite which can be a significant contribution to plaque
accumulation such as missing brushing in those hard to get areas as well as overcrowded areas. She is
putting excessive force on her posterior teeth due to the occlusion which can widen the PDL ligament
and cause bone loss along with the under bite and cross bite.

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

a. Case Classification _VII_ Periodontal Case Type__IV____

b. Gingival Description: Generalized Moderate periodontitis with severe bleeding.

The patient’s 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 disease state the
patient should begin practicing prompt oral hygiene methods such as brushing twice daily and the use
of floss daily with mouth rinse to reduce the accumulation of plaque bacteria in the oral cavity. I have
2
Paula Philpott
10/8/2017
mentioned the patient that we want to halt the disease progression.

App't 1:
Architecture: Flat- Generalized, Festoons- #24, 25, 26, 27
Color: Red-Mand. Ant.
Magenta- Max. Ant. Mand. Ant.
Consistency: Edematous/Spongy
Margins: Thickened Gen.
Pappillae: Bulbous: Mand. Ant.
Blunted: Max. Ant. Molar Regions
Suppuration: Upon probing Gen.
Surface texture(marginal &Papillary): Smooth and Shiny Gen.
Surface texture (attached): Stippled- Max. Ant.
Smooth and Shiny- Mand. Ant.

App't 2:
Architecture: Flat- Generalized, Festoons- #24, 25, 26, 27
Color: Red-Mand. Ant.
Magenta- Max. Ant. Mand. Ant.
Consistency: Edematous/Spongy
Margins: Thickened Gen.
Pappillae: Bulbous: Mand. Ant.
Blunted: Max. Ant. Molar Regions
Suppuration: Upon probing Gen.
Surface texture(marginal &Papillary): Smooth and Shiny Gen.
Surface texture (attached): Stippled- Max. Ant.
Smooth and Shiny- Mand. Ant.

App't 3:
Architecture: Flat- Generalized, Festoons- #24
Color: Red-Mand. Ant.
Magenta- Max. Ant. Mand. Ant. Localized #,26,25
Consistency: Edematous
Margins: Thickened Gen.
Pappillae: Bulbous: Mand. Ant.
Blunted: Max. Ant. Molar Regions
Suppuration: Upon probing Gen.
Surface texture(marginal &Papillary): Smooth and Shiny Gen.
Surface texture (attached): Stippled- Max. Ant.
Smooth and Shiny- Mand. Ant.

App't 4:
Architecture: Flat- Generalized
Color: Red-Mand. Ant Facial
Magenta- Max. Ant.

3
Paula Philpott
10/8/2017
Consistency: Edematous
Margins: Thickened Maxillary Facial
Pappillae: Bulbous: Mand. Ant.
Blunted: Max. Ant. Molar Regions
Suppuration: Upon probing maxillary Anterior

Surface texture(marginal &Papillary): Smooth and Shiny Gen.

Surface texture (attached): Stippled- Max. Ant.
Smooth and Shiny- Mand. Ant.

App't 5:
Architecture: Flat- Generalized
Color: Red-Mand. Ant.
Magenta- Max. Ant. Mand. Ant. Localized #27,25,22
Consistency: Edematous
Margins: Thickened Gen.
Pappillae: Bulbous: Mand. Ant.
Blunted: Generalized Max and Mand
Suppuration: None
Surface texture(marginal &Papillary): Smooth and Shiny Gen.
Surface texture (attached): Stippled- Max. Ant.
Smooth and Shiny- Mand. Ant.

App't 6:
Architecture: Flat- Generalized
Color: Red-Mand. Ant.
Magenta- Max. Ant. Mand. Ant. Localized #27,25,22
Consistency: Edematous Mand. Ant. Localized #27,25,22
Margins: Thickened Gen.
Pappillae: Blunted generalized
Suppuration: None
Surface texture (marginal &Papillary): Smooth and Shiny Gen.
Surface texture (attached): Stippled- Max. Ant.
Smooth and Shiny- Mand. Ant.

c. Plaque Index: App’t 1__5__ 2__5__ 3__5__ 4___5__ 5__2.3__6__3.3_7__5__

d. Gingival Index: Initial _2.5 GI_POOR Final __1.13 FAIR___

e. Bleeding Index: App’t 1__78%__ 2__100%___ 3__100%__ 4__30%__ 5__52%__6___51% 7__50%__

f. Evaluation of Indices:
1. Initial
The evaluation of the indices are signs that play a role in all contributing factors to the patients periodontal
diagnosis of case type IV with chronic moderate periodontitis with severe horizontal bone loss in the

4
Paula Philpott
10/8/2017
lower anterior. The patient’s plaque score is directly linked to the extreme inflammation on the
periodontal assessment. Patient’s plaque score is a 5 (POOR) and her bleeding score was 78%. The
indices rated as poor reveal that the accumulation of inflammation, and bleeding are all issues that must
be improved to halt the progression of periodontal disease.

2. Final
The final evaluation of the indices are all signs that played a role in contributing factors to periodontal
disease diagnosis. It looks like we have partially halted the progression of periodontitis. Patient’s
inflammation continued to stay inflamed on the maxillary anterior and mandibular anterior but all other
areas have decreased in bleeding to only 50% rather than 78% from the first appointment. Plaque score
is 5 (Poor). Ending periodontal statement: Generalized Severe Diffuse Periodontitis with severe
bleeding. Patient will need to see a periodontist for further evaluation of localized problem sites.

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

1.Baseline
Patient has generalized periodontal pocket depths on every quadrant. Pocket depths were very challenging
to probe due to so much subgingival calculus deposits.(Facial) #3 M-5, #4 D-6, #9 M-4, #12 D-4, #14
M-4, #21 M-7 D-8, #23 M-7, #24 MDF-4, #25 F-4 M-5, #26 M-4, (Lingual) #30 DL-6 , #31 M-6, #3
M-6, #4 D-6. These pockets are most likely going to be deeper once I do periodontal debridement on
each quadrant. I will rechart once each quadrant is scaled. Calculus contributes to loss of attachment.
There will most likely be recession sites but due to so much calculus and plaque build up I am unable to
chart. She had severe bleeding during probing and suppuration, along with gingival sensitivity.

5. Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion,
abfractions)
There was slight attrition on the maxillary incisors due to the prognathic profile on teeth #’s 7, 8, 9, 10,11.
She had caries on #3-O, #4-D, #5-D, #6-M,#7-MFD, #9-D, #10-MD, #11-ML, #12 DO, #13-D, #14-M,
#15- MODL, #19-DOF, #30-O, #31-DO. Missing Teeth: #1,2,16,17,18,32. Bracket from braces left on the
lingual of #30. Metallic Restoration on #30 Facial, # 19 Facial with recurrent decay. Patient had no Overbite.
Overjet- Unclassifiable. Midline shift: Left 4mm. Under bite: 4-5mm. Cross bite: Max.11,12,13, Mand.
18,19,20. Mand. Ant. #24, #25 are mobile.
All contributing factors such as caries, malocclusion, poor plaque score, crowding of teeth are issues than can
contribute to periodontal disease. These problem sites need to be fixed in order for the patient to have proper
oral hygiene
6. Treatment Plan: (Include assessment of patient needs and education plan)
App't 1:
The first appointment with Amber was to do a full and thorough assessment to see if she had chronic or
aggressive periodontitis or if she had chronic or acute gingivitis. I reviewed medical and dental history,
pre-rinsed, FMX radiographs with vertical BWX to see the progression of disease in contrast with bone
loss and caries detection, head and neck, intra/extra oral exam, periodontal assessment, dental charting,
initial plaque and bleeding score, risk assessment, acquired gingival index, informed consent and
intraoral photos to show before and after pictures of her disease. I used an accumulation of all my data
collected to come to the prognosis of Moderate Periodontitis with Chronic Gingivitis. Learning Level:
Unaware; Patient has poor plaque control. This was shown during the plaque score and shown to the
patient right after she brushed her teeth. My patient doesn’t really brush her teeth maybe once daily and
she mentioned she does not floss nor use mouth rinse. I informed her that she should be brushing at
least 2-3 times daily and to keep floss in her car or in her purse for right after she eats a meal. I did chair
side patient education about the use of a soft bristled toothbrush explaining that a soft bristled brush
works better than a medium because the bristles are able to get in between the grooves of the teeth.

5
Paula Philpott
10/8/2017
App't 2:
 Review Medical/ Dental History, pre-rinse, plaque and bleeding score, assess gingiva
 Ultrasonic the upper Right Quadrant then Fine Scale
 Full Periodontal Charting on the Upper Right Quadrant
 Discuss long-term and short-term goals created for the patient and educate her on how it will
correlate a positive outcome of her overall oral health with each topic that is discussed. With
each topic I will remind the patient there will be personal goals to meet and that we are a team.
We will work together and with any questions asked I will be here.
 1.Discuss first long-term goal:
-Patient will reduce Plaque score to 2.0 or lower at the final appointment.

2. Discuss short-term goal

-Patient will define Plaque by next appointment.
-Patient will lower plaque score by 1.0 each appointment.
-Demonstrate proper brushing technique (2min) by next appointment.

3. Discuss third Long-term goal:

-Caries Process and Fluoride & restore caries by Dec 8th (date the patient picked).

4. Discuss short-term goal:

-Understand caries process by next appointment.
-Define fluoride by next appointment.
-Education about demineralization and remineralization.
5. Discuss third long-term goal:
-Halt the progression of periodontitis and final bleeding score to be below 20% at the very
last appointment.

6. Discuss short-term goal:

- Define periodontitis by next appointment.
-Demonstrate proper flossing technique by next appointment (chair side)
-Show improvement of pockets and reduction of bleeding below 20%.

Patient Ed #1: Begin with mentioning to the patient the importance of plaque control and
proper brushing technique. I will ask the patient if she can define plaque and to demonstrate the
way she brushes her teeth on the model. For this session I will demonstrate what plaque is and
how to reduce their plaque score for each appointment and demonstrate the correct brushing
technique by using the bass method using the mouth model and mention that bad breath comes
from the tongue so brushing the tongue is just as important as brushing the teeth. At the end of
the session I go over briefly what we will discuss for the next appointment: What is
Periodontitis and proper Flossing technique.
App't 3:
 Review Medical and Dental History, Pre-Rinse, Plaque Score and Bleeding score
 Ultrasonic Lower Right Quadrant and then Fine scale
 Full Periodontal chart on Lower Right
 Patient Ed #2: First mention that in this session we will be going over demineralization and the
use of fluoride. I will then ask if she can remember what is periodontitis and the proper way to
floss. If incorrect we will review. I will educate the patient on what is fluoride and that it
remineralizes demineralized tooth areas. I will explain how it remineralizes the tooth. I will

6
Paula Philpott
10/8/2017
educate the patient on preventive measures of fluoride against cavities. Fluoride remineralizes
tooth areas where there are deeper grooves to help seal of these areas from harmful bacteria that
we miss with daily brushing habits. This will be our final patient education appointment. We
will review the goals and mention to the patient once again we are a team and that if she has any
questions to please ask. I hope that I have made an impact on her overall oral health and I hope
she continues to practice these measures outside of the appointments.

App't 4:
 Review Medical and Dental History, Plaque score and bleeding score
 Ultrasonic Upper Left Quadrant then fine scale
 Full Periodontal Charting on the upper Left quadrant
 Patient Ed #3: Halting the progression of periodontitis with the proper flossing technique. Ask
my patient if she can define Plaque and to demonstrate the proper brushing technique using the
Bass method by using the mouth model. If she can’t remember we will review. I will then ask
the patient if she knows what Periodontitis is. We will then discuss what periodontitis is and the
contributing factors of periodontitis. I’ll ask the patient how do they normally use floss. I will
demonstrate the proper ‘C’ shape around the gingival margin of the tooth and the importance of
removing plaque from the interproximal surfaces of the tooth to reduce plaque score. The end of
the session I will give a brief mention of what we will talk about during her next appointment.
 What is demineralization and remineralization with the use of fluoride
App't 5:
 Review Medical and Dental history, pre-rinse, plaque and bleeding score, review gingival
condition, ask about previous goals and follow up with daily oral habits.
 Ultrasonic Lower Left quadrant and fine Scale
 Full Quadrant Periodontal Charting

App't 6:
 Medical Dental History, Pre-Rinse, Final Plaque and Bleeding Score, New Gingival
IndexAssess Gingival condition, follow up on previous patient Ed. Goals. Final Periodontal
Charting, Arestin (pocket
Reattachment antibiotics placed), Plaque free, Fluoride and 3 month recall.

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

Patient has moderate horizontal bone loss between every tooth besides on the mandibular anterior
region with severe horizontal bone loss. There is generalized loss of the crestal lamina dura.
Radiographs show periapical pathology on the Upper Right and Upper Left quadrant. There is
calculus between every interproximal space on the radiographs. Caries on the Upper Right, Upper
Anterior, Upper Left and Lower Left. She has adverse crown to room ratio on the lower Anterior.
While examining the radiographs I noticed my patient had braces for 10 years and there is root
resorbtion on all teeth shown and hypercementosis. Her having braces for such a long period of time
can effect PDL ligament on each tooth which can accumulate to her perio prognosis.

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.

7
Paula Philpott
10/8/2017
Appt. #1 Oct. 2 2017 Medical/Dental History, Pre-Rinse, FMX survey with Vertical BWX to check
for bone loss. Intra/Extra oral examination, periodontal assessment, dental charting, plaque score,
bleeding score and gingival index. Gave patient chair side education: mentioned to patient to brush
3 times daily to lower her plaque score using the bass method. I advised her to floss twice daily by
keeping it in common places like her car and purse. The use of Biotene rinse, due to dry mouth
effects from medication. I mentioned she had cavities, which was confirmed by doctor Armstrong.
She was surprised at how many and stated “That’s what happens when you don’t go to the dentist
regularly.” She was surprised about her oral health status and was willing to come in whenever I
needed her and stated she would be at every appointment to get her oral health where it needed to
be. I showed my patient her x-rays on the screen and showed her the dark areas on each tooth where
there were suspicious areas of decay. I mentioned to my patient that we will have patient education
topics to review 3 out of the 5 other appointments that I will see her. I typed up a schedule for her to
be easily reminded to put on her refrigerator. Patient LL: in unaware and involvement. She was
unaware of her condition but wants to get involved in her daily oral habits. She texted me and
mentioned she had bought floss picks and non-alcoholic mouth rinse. I told her I was impressed and
am very happy she’s making a change in her daily oral habits. I did intraoral photos to show her
before and after pictures for a great comparison to help show her what good oral hygiene care can
do.

Appt. #2 Oct 6, 2017 Medical and Dental history, pre-rinse. Plaque Score and Bleeding score.
Finished doing her Dental charting and Gingival Index and took intraoral photos. This appointment was
used to have all the proper paperwork and data to help with the prognosis of her dental treatment. I will
use these in her patient education topics for each patient education.

Appt. #3 Oct. 9, 2017 Medical/Dental History, pre-Rinse, asked patient how their oral health is
and if she has been brushing twice daily and flossing at least once a day. Recorded plaque and bleeding
score. She stated that she has been trying to remember but she bought floss and a soft bristled
toothbrush. I complimented her on her trying and taking a big step in her oral health. We did patient
education session #1. We went over her long-term goal and how she can reduce her final plaque score
by 1.0 the last appointment. We went over three short term goals on defining plaque the next
appointment, lowering her plaque score by 1.0 each appointment, demonstrate proper brushing
technique(2 min) by next appointment. In the patient ed session we discussed: Begin with mentioning to
the patient the importance of plaque control and proper brushing technique. I asked the patient if she
can define plaque and to demonstrate the way she brushes her teeth on the model. For this session I will
demonstrate what plaque is and how to reduce their plaque score for each appointment and demonstrate
the correct brushing technique by using the bass method using the mouth model and mention that bad
breath comes from the tongue so brushing the tongue is just as important as brushing the teeth. At the
end of the session I went over briefly what we will discuss for the next appointment, which is caries
process & fluoride and when to restore caries. Patients LL: involvement. Patient has bought toothbrush
and floss and mouth rinse. I recommended that the patient possibly change diet habits and drink more
water and less sodas or fruit drinks. Ultrasonic, fine scale and perio charted mand right.

Appointment #4 Oct. 16 2017. Medical Dental History. Plaque score and bleeding score. Pre-Rinse
Perio charted max Rt. Ultrasonic max right and fine scale. Pt Ed. Chair side. Reminded patient to floss
daily and brush 2x daily using the bass method. Remember to use mouth rinse. LL; Action Patient is
taking action in her oral habits and is willing to see a DDS for proper treatment of cavities. Ultrasonic
max RIGHT and fine scale and perio chart.

8
Paula Philpott
10/8/2017

Appt. #4 Oct. 30th 2017 Medical/Dental History, pre-rinse, asked how the patient is doing with her oral
hygiene. She stated she’s trying to remember to brush once daily but she has been busy. I reminded her
to try to continue her oral hygiene once daily by setting a timer on her cell phone. Recorded Plaque
score and bleeding score. Patient education #2 we went over her long term goal of caries process and
fluoride and when to restore caries by Dec 8th (patients personal goal). Then went over the understand
caries process by next appointment; define fluoride by next appointment and Education about
demineralization and remineralization. Patient Ed. Session #2 was about: First mention that in this
session we will be going over demineralization and the use of fluoride. I will then ask if she can
remember what is plaque and how to remove it. If incorrect we will review. I will educate the patient on
what is plaque and how to remove it. I will explain how to remove it with daily oral hygiene such as
brushing. We will review the goals and mention to the patient once again we are a team and that if she
has any questions to please ask she needs to do her part at home and Ill do mine here. I hope that I have
made an impact on her overall oral health and I hope she continues to practice these measures outside of
the appointments. Ultrasonic, fine scale, perio chart mandibular left. LL: Action. Patient is starting to
take action in her oral health care and I am seeing less plaque accumulation. Some areas on the
mandibular lower anterior are still very red and swollen even after cleaning. Patient may need to see a
periodontitis.

Appointment #5 Nov 6, 2017 Medical and Dental History. Ask how my patient was doing she said
well and stated she started taking a new medication that helped her sleep. I told to watch the medication
to make sure that if it does cause dry mouth even worse to drink frequent sips of water and use biotene
mouth rinse. We went over her last long term goal, which is Halt the progression of periodontitis and
final bleeding score to be below 20% at the very last appointment. Short-term goals were to define
periodontitis by next appointment, demonstrate proper flossing technique by next appointment (chair
side) and show improvement of pockets and reduction of bleeding below 20%. In patient education #3
we went over: Halting the progression of periodontitis with the proper flossing technique. Ask my
patient if she can define Plaque and to demonstrate the proper brushing technique using the Bass
method by using the mouth model. If she can’t remember we will review. I will then ask the patient if
she knows what Periodontitis is. We will then discuss what periodontitis is and the contributing factors
of periodontitis. I’ll ask the patient how do they normally use floss. I will demonstrate the proper ‘C’
shape around the gingival margin of the tooth and the importance of removing plaque from the
interproximal surfaces of the tooth to reduce plaque score. Ask patient to review what is fluoride and
caries process. The end of the session I will give a brief mention of what we will talk about during her
next appointment and this will be chair side. I mentioned we are a team and she must do her part at
home and I will do my part here in the chair. Ultrasonic, fine scale, perio chart Max Left Will see
patient for post calc in two weeks.

Appointment #6 Nov 11 2017 Medical Dental History, Pre-Rinse, plaque score and bleeding score
gingival index, Post calculation, Fine scale Max Right & Left, Mand Right & Left. Post Periodontal
chart. Max Right & Left, Mand, Right & Left. Plaque Free, Applied sodium Flouride %5 Varnish.
Instructed her to not eat or drink anything hot, sticky, crunchy, or alcohol for 4-6 hours. It helps
remineralize your teeth with cavity prevention. Ending Periodontal statement: Generalized diffuse
periodontitis with severe bleeding. Recall Feb.2018 3-4 months Referalls: Carries on #3 OD, 4D, 5D,
6D, 7MFD, 9D, 10MD, 11 MLD, 12 OD, 13D, 14 M, 15 OLD, 19 OD, 30 O, 31 OD.LL:
INVOLVEMENT Patient is taking slight involvement in her oral health and care. Pt. ED. Remember to
brush 2X daily and try to floss once daily. Make sure to get all tooth surfaces and not just the bottom
reminded patient that some of her medication will cause her to have dry mouth and so sipping frequent

9
Paula Philpott
10/8/2017
sips of water is advisable. Applied Arestin on 14 D 1mg of minocycline HCL subgingivally.

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

Overall Prognosis: Fair

I’m stating fair because her attitude seemed very compliant and is willing to take care of her oral care
but with her age being only 37 years old with hypothyroidism, an under bite, root resorbtion, and a
poor periodontal examination, she lacks oral hygiene education. With the patient education topics I
plan to improve her oral hygiene education to a well-known status. She is very willing to commit to
every appointment and shows interest in improving her oral health. There’s only been one
appointment but to have a better prognosis I will need to see her more than once to have a better
understanding on how compliant she will be with education topics and overall appointments.

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

Amber is well aware of her gingival status and caries and results to expect with her re-evaluation. If she
continuous to use proper oral hygiene care, she will have a better recall appointment. She has referrals for
cavities on tooth numbers # 3,4,6,7,9,10,11,12,13,14,15,19,30,31. She is recalled for January 2018. I mentioned
for her to see a Dentist about fillings on each of these teeth and for 19,15 and 31 to see urgently due to so much
decay.

11. Assessment of Changes: (including plaque control, bleeding tendency, gingival health, probing depths)
The assessment changes of her plaque control were pretty consistent. Only at two appointments did
her plaque score drop down to 2.2 and 3.3. At each appointment she stated she had forgot to brush
this morning because I seen her only on Monday nights. Overall her plaque control was very poor
but also the amount of cavities and her malocclusion affected some of her plaque score changes.
Her bleeding tendency each appointment reduced towards the end. Bleeding Index: App’t 1__78%__
2__100%___ 3__100%__ 4__30%__ 5__52%__6___51% 7__50%__. Every quadrant I cleaned each
appointment could have been a huge contribution to her lowered plaque score. Patient still failed to maintain
plaque control each appointment, which is a contributing factor to her periodontal disease. Her gingiva
became extremely healthy in the posterior portions of her quadrants and healed very well but her mandibular
anterior and maxillary anteriors didn’t heal with still some very red areas. For these problem areas she will
need to see a periodontist to fix the redness and pocket depths. For post periodontal charting her pocket
depths receded 1-2 mm, which is very good. She had one area where Arestin was needed. Overall clinically
I feel that if my patient would have contributed more she would have had a better outcome in her oral health
and pocket depths would have reduced way more to halt her perio diease.

12. Patient Attitudes and Cooperation:

I had the absolute best patient when it came to attitude and cooperation. She went and bought mouth
rinse, floss and her own toothbrush. Even though she still had poor plaque control and oral hygiene she
showed total interest in her oral health and the patient education topics at each appointment. She was
very honest with me about when she brushed and when she had not. Her frequent times of brushing

10
Paula Philpott
10/8/2017
were at night time, before bed. Her flossing was not very good and I demonstrated on using a placker
instead of actual floss. She liked the placker instead. She was on time at every appointment and
remembered every patient education topic we talked about. The main thing that impressed me about her
cooperation was that she contacted a local dentist on getting her cavities fixed a little at a time. She told
me the start date was Dec. 8th 2017.

13. Personal Evaluation/Reaction to Experience:

My personal experience was very interesting. I loved the fact that we got to see the results throughout
the weeks of the tissue healing and the ones that didn’t heal. I do believe it was a lot of data that had to
be collected to get the best treatment out come. I feel like the patient education topics helped her so
much and will in the long run with her kids and family. She demonstrated amazing interest that I have
never honestly met a patient that didn’t have some sort of good oral hygiene. I really think this was a
great learning experience. I do feel like she took a lot from this project and so did I. I feel as if she was
wasn’t doing much of her part at home which effected majority of her results but I continued to keep
her educated and reminded her every appointment to try to keep up the consistency with her oral health.
I feel as if we halted periodontal disease every where in the oral cavity except the maxillary anterior and
mandibular anterior. Those localized areas continued to be inflamed.

GINGIVAL INDEX
PERIODONTAL CARE PLAN

Initial date ___10/6/2017______________

Gingival Area

M F D L

3 3 2 3 3

9 3 3 3 2

12 3 1 3 2

19 2 1 3 2

25 3 2 3 1

28 3 3 3 3

TOTAL ______2.5 POOR _______

11
Paula Philpott
10/8/2017
Final date______11/20/17________________

Gingival Area

M F D L

3 1 2 0 2

9 1 1 1 1

12 1 1 1 1

19 1 1 0 1

25 2 1 2 2

28 1 1 1 1

TOTAL__________1.13 FAIR_____

12
Paula Philpott
10/8/2017
DATE___11/25/17_____________________ NAME___Paula Philpott____________
PERIODONTAL CARE PLAN EVALUATION
PART 1
LIT Dental Hygiene PC.9  Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
Competency PC.10  Use critical decision making skills to reach conclusion about the patient’s 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
Medical Identifies many systemic conditions Identifies several systemic Identifies at least one relevant systemic Fails to identify any relevant systemic
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 effect on dental hygiene diagnosis hygiene diagnosis and/or care. Relates at dental hygiene diagnosis and/or care.
medical history findings to periodontal and/or care. Relates several least one relevant medical history finding to Fails to relate any medical history
disease: its progression, healing, and medical history findings to periodontal disease: its progression, healing, finding to periodontal disease: its
prevention periodontal disease: its progression, and prevention progression, healing, and prevention
healing, and prevention
Dental History Identifies many elements of the dental Identifies several elements of the Identifies at least one relevant element of the Fails to identify any elements of the
history, its effect on dental hygiene dental history, its effect on dental dental history, its effect on dental hygiene dental history, its effect on dental
diagnosis and/or care. Relates many hygiene diagnosis and/or care. diagnosis and/or care. Relates at least one hygiene diagnosis and/or care. Fails to
dental history findings to periodontal Relates several dental history relevant dental history finding to periodontal relate any medical history finding to
disease: its progression, healing, and findings to periodontal disease: its disease: its progression, healing, and periodontal disease: its progression,
prevention progression, healing, and prevention healing, and prevention
prevention
Oral Exam Identifies many findings of the oral exam, Identifies several findings of the Identifies at least one relevant finding of the Fails to identify any finding on the oral
steps taken to avoid a medical problem, oral exam, steps taken to avoid a oral exam, steps taken to avoid a medical exam, steps taken to avoid a medical
effect on dental hygiene diagnosis and/or medical problem, effect on dental problem, effect on dental hygiene diagnosis problem, effect on dental hygiene
care. Relates many oral exam findings to hygiene diagnosis and/or care. and/or care. Relates at least one oral exam diagnosis and/or care. Fails to relate any
periodontal disease: its progression, Relates several oral exam findings finding to periodontal disease: its oral exam finding to periodontal disease:
healing, and prevention to periodontal disease: its progression, healing, and prevention its progression, healing, and prevention
progression, healing, and
prevention
Periodontal
Exam
Gingival Describes many characteristics of the Describes several characteristics of Describes at least one characteristic of the Fails to describe any characteristics of
gingival exam by quadrant. Evaluates the gingival exam by quadrant. gingival exam by quadrant. Evaluates one the gingival exam by quadrant. Fails to
Exam & many of the indices and relates to Evaluates several of the indices and index and relates to periodontal disease evaluate any index and relate to
Dental periodontal disease relates to periodontal disease periodontal disease
Indices
Periodontal Describes many of the findings of the Describes several of the findings of Describes at least one of the findings of the Fails to describe any of the findings of
periodontal examination and relates many the periodontal examination and periodontal examination and relates any to the periodontal examination. Fails to
Chart findings to periodontal disease. relates several to periodontal periodontal disease. relate any to periodontal disease.
disease.

13
Paula Philpott
10/8/2017
Topic area Points Excellent Good Fair Unacceptable
5 4 3 2
Dental Exam Describes many of findings of the dental Describes several of findings of the Describes at least one of the findings of the Fails to describe any of the findings of
examination and relates many to dental examination and relates dental examination and relates any to the dental examination. Fails to relate
periodontal disease and the disease several to periodontal disease and periodontal disease and the disease process.. any to periodontal disease and the
process. the disease process. . disease process.
Treatment
Plan
Plans Assesses many of the patient education Assesses several of the patient Assesses at least one of the patient education Fails to assess any of the patient
needs. Accurately plans many of the education needs. Accurately plans needs. Plans at least one of the treatment and education needs. Fails to plan any of the
Treatment treatment and patient education sessions. several of the treatment and patient patient education sessions. At least one of the treatment and patient education sessions.
& Patient Many of the patient education topics are education sessions. Several of the patient education topics are appropriate. Patient education topics are not
Education appropriate. patient education topics are appropriate.
appropriate.
Long and Many of the long and short term goals are Several of the long and short term At least one of the long and short term goals Fails to develop any of the long and short
developed with the patient. Goals are goals are developed with the are developed for the patient. At least one term goals. Goals are not provided to the
Short Term provided to the patient. patient. Goals are provided to the goal is provided to the patient. patient.
Goals patient.
Radiographic Describes many findings of the Describes several findings of the Describes at least one finding of the Fails to describe any finding of the
radiographic examination and relates radiographic examination and radiographic examination and relates any radiographic examination and relates any
Findings many findings to periodontal disease. relates many findings to finding to periodontal disease. finding to periodontal disease.
periodontal disease.
Writing & Thoughts are highly organized and Thoughts are generally organized Thoughts are somewhat disorganized, vague Thoughts are very disorganized,
logically presented; easy to follow; word and logically presented; word usage and difficult to follow; word usage is extremely vague, and difficult to follow;
Basic usage is correct and sets a very is adequate and sets a professional sometimes inappropriate and detracts from word usage is often inappropriate and
requirements professional tone; correct spelling, tone; several errors in spelling, professional tone; numerous errors in detracts significantly from the
grammar, punctuation, capitalization, and grammar, punctuation, spelling, grammar, punctuation, professional tone; numerous errors in
sentence structure. capitalization, and sentence capitalization, and sentence structure. spelling, grammar, punctuation,
Plan is submitted within 72 hours with structure. Plan is submitted within 120 hours with capitalization, sentence structure. Plan is
grading sheet. All records are updated and Plan is submitted within 96 hours grading sheet. Not all records are updated submitted after 120 hours. Many records
properly identified. with grading sheet. Many records and properly identified. are not updated or properly identified
are updated and properly identified.
TOTAL
POINTS
(50 points possible)

Comments:

14
Paula Philpott
10/8/2017

DATE____________11/25/17____________ NAME___Paula Philpott______________________________________

PERIODONTAL CARE PLAN EVALUATION
PART 2
LIT Dental Hygiene PC.9  Systematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.
Competency PC.10  Use critical decision making skills to reach conclusion about the patient’s 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 Describes many characteristics of
the gingival exam by quadrant.
& Dental Indices Evaluates many of the indices
and relates to periodontal disease
Periodontal Describes many of the findings of
the periodontal examination and
Chart relates many findings to
periodontal disease. Compares
many of the findings to the initial
periodontal examination.
Journal Notes – kept
by appt. date
Treatment provided, Describes many of the treatment
OH education, pt. procedures provided, OH
response, education, pt. response, and
complications complications by appt date.
Improvements, Diet Describes many of the pt.
recommendations, improvements, diet
learning level recommendations, and learning
level. Descriptions are kept by
appt date.
STG & LTG Describes many of the STG &
attained, LTG attained, and expectations.
Expectations Descriptions are kept by appt
date.
Prognosis Describes many prognosis
characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability,
and 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 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 several prognosis
characteristics by attitude, age,
number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
periodontal examination.
Describes any characteristics of the gingival
exam by quadrant. Evaluates an indices and
relates that indices to periodontal disease
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.
Describes any of the treatment procedures
provided, OH education, pt. response, and
complications by appt date.
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.
Describes any prognosis characteristic by
attitude, age, number of teeth, systemic
background, malocclusion, tooth
morphology, recall availability, and
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.
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.

15
Paula Philpott
10/8/2017
Topic area Points Excellent
5 4
Supportive therapy Describes many of the
suggestions made to patient
regarding re-evaluation, referral,
and recall schedule. Includes date
of recall appt.
Assessment of Describes many of the changes
occurring from trt including
changes plaque control, bleeding, gingival
health, probing depths.
Pt. Attitudes and Evaluates comprehensively
patient’s attitude and cooperation
cooperation including patient’s mental and
Personal emotional status, temperament
evaluation/reaction and attitude. Comments on
to experience personal evaluation/reaction to
experience.
Writing & Basic Thoughts are highly organized
and logically presented; easy to
requirements 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:
Good
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 patient’s attitude and
cooperation including patient’s
mental and emotional status,
temperament and attitude.
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.
16
Fair
3 2
Describes 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 patient’s attitude and
cooperation including patient’s mental and
emotional status, temperament and attitude.
Comments on personal evaluation/reaction to
experience
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.
Unacceptable
Fails to describe 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 changes
occurring from trt including plaque
control, bleeding, gingival health,
probing depths.
Fails to evaluate patient’s attitude and
cooperation including patient’s mental
and emotional status, temperament and
attitude. No comments on personal
evaluation/reaction to experience
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
Paula Philpott
10/8/2017

17