Perio Patient Journal

First Appt. 8/20/15

I went over Georges M/D history with him, and I found that hes taking Trazadone, and the dental implications
are xerostomia, light-headedness, dizziness, headache, blurred vision, and nausea. He also suffers from GERD,
which lets me know to pay attention to the position of the dental chair- supine may be uncomfortable for him.
Looking over his dental history, I found that he has problems with bruxism, and he has not been very interested in
his oral health in the past. Before coming to our clinic, he has not had his teeth cleaned in about 18 years. After
this I took his vitals, and whenever I got his M/D history checked by an instructor I began his H/N exam. My
findings were that he has a slight deviation of his TMJ to the left on closing, he grinds his teeth in his sleep and
clenches his jaw when stressed. After examining his occlusion, I found that his right molar is a tendency toward
class II, left molar is unclassifiable, right canine tendency toward class II, and left canine tendency toward class
III. He also has a midline shift 1 mm to the left. I found nothing atypical in his intraoral exam. When I performed
the perio assessment, I found generalized scalloped architecture, localized red, spongy, rolled, and bulbous
margins and papillae on maxillary and mandibular molar regions. I found surface texture to be localized smooth
and shiny on maxillary and mandibular molar regions. I concluded that he is a perio case II. Mrs. Brown and Mrs.
Tornwall both agreed that he qualifies to be my perio patient, because he is a prophy class IV and a perio case II.
On full periodontal charting I found generalized recession in both anterior and posterior regions, and localized 4
mm pocket depths on posterior teeth. For dental charting (using full mouth radiographs I took on him last
semester) I found attrition on all maxillary and mandibular anterior teeth. Hes missing #14, #15 is unerupted, and
#16 is mesially drifted and partially erupted. #17 and #32 are impacted. He has generalized amalgam fillings on
posterior teeth. I educated him on bruxism and the harm it is causing to his teeth, and when Dr. Wiggins checked
my dental charting he recommended that the patient look into getting a night guard. After I got H/N, intraoral,
perio assessment, and dental charting checked, I took his gingival index- which was 1.4 (fair). Then I took his
plaque score- which was 1.5 (good), and bleeding score- which was 1.2%. Teeth #18 and #20 bled. After that, I
filled out risk assessment, and informed consent. I explained to him the treatment plan and I told him that he has
slight periodontitis. His learning level is interested. He seems willing to come to the clinic many times this
semester for treatment and he understands how important it is to complete the treatment. Lastly, I discussed with
him some of the long term and short term goals, and came up with these:
LTG: The patient will lower plaque score
STG: The patient will define plaque by second appointment
STG: The patient will floss twice a week
STG: The patient will use antimicrobial rinse twice a week
LTG: The patient will halt the progression of periodontitis
STG: The patient will complete treatment
STG: The patient will reduce bleeding score
STG: The patient will come back for re-evaluation
LTG: The patient will improve bruxism habit
STG: The patient will reduce stress
STG: The patient will save money
STG: The patient will go to the dentist and get a nightguard
Second Appt. 9/1/15
I had a last-minute cancellation, so I called my perio patient to see if he could come in for about an hour so I could
take his intraoral pictures and do his first formal patient education session. I reviewed his M/D history- no
changes. We had complications with the intraoral camera and decided to put that off until another day. I took his
plaque score, it was 1.2 (good), which was an improvement from the first appointment. His oral health methods
hadnt changed- still brushes using the scrubbing method, brushes twice a day, doesnt floss or rinse. He DID
switch to a soft-bristled toothbrush though. His bleeding score was 0.6%, which is also an improvement! His
gingival tissue looked slightly less inflamed on the facial surfaces of maxillary and mandibular molar regions, but
all other regions havent improved and remain the same. After that, we went into the patient education room and I
went over his long and short term goals. Whenever I got to the goals about improving bruxism, to my surprise he

said he had invested in a night guard! This shows that he is already putting forth effort to improve his oral health. I
then taught him about plaque (he didnt know anything about it), and then I showed him the bass tooth brushing
method on the typodont. I let him practice on the typodont, then we went to the sink so that he could practice the
skill. I had to correct him a couple of times because he brushes hard and fast in a horizontal direction. He seemed
to get the hang of it by the end of the session. His learning level is action, and I expect him to continue making an
effort to change his habits as treatment continues.
Third Appt. 9/3/15
I reviewed his M/D history- no changes. Then I took his intraoral pictures at a different cubicle that we knew for
sure would work. Then I watched him brush his teeth at the sink and his technique was correct (circular strokes),
but he was still brushing very hard and fast. I reviewed with him the brushing method we had learned last
appointment, and he seemed willing to continue working to change the habits. His plaque score was 0.8 (good),
which is another improvement toward one of his long term goals! His bleeding score was 1.2%, which is not an
improvement from the last appointment. His gingival tissues hadnt really changed since the last appointment,
which was only two days earlier. After this, I educated him chair side about calculus, how it forms, and the
importance of removing it. I also educated him about the ultrasonic scalar and how it aids in effectively removing
heavy calculus deposits. I also explained to him how the ultrasonic would sound and feel. He did not seem
anxious at all. I then began ultrasonic scaling quadrant 4 (mandibular right). I realized shortly into scaling that my
high-speed suction was barely working and that the low-speed was working way better, so I switched to the lowspeed. The water was a bit overwhelming at times and I had to take frequent breaks to make sure I removed all the
water from his mouth, but other than that it went smoothly. I got Mrs. Tornwall to check my ultrasonic scaling,
then I went back and hand-scaled a few grainy areas. I finished that quadrant, scheduled him to come back in two
weeks (hes going to be out of town the next week). I expect his gingival tissues to be greatly improved in
quadrant 4 the next time he comes in. His learning level for this appointment is action.
Fourth Appt. 9/16/15
Today George came in as my second patient of the day. I was already running a bit behind because my first patient
left later than I had planned, so I was rushing to get my cubicle clean and I got him in the chair later than I had
planned. First I reviewed his M/D history- no changes. I then watched him brush his teeth (method has not
changed since third appointment, except for he now uses mouthwash every day!) and took his plaque score, which
was 0.6 (good). His plaque score was less than last appointment which is great! His bleeding score was 0.6%,
which was less than last appointment also! I evaluated the appearance of his gingiva in the quadrant I had scaled
last appointment- quadrant 4. The tissue surrounding the teeth looked much less inflamed, especially the lingual
surfaces of the gingiva which had been the most inflamed before. I did not find any bleeding on probing in
quadrant 4. I then brought him to the patient education room to do his second formal patient education session.
The teachers were really busy with other students, so we had to wait a little bit before I could begin. First I went
over his long and short term goals, and was happy to point out that he has satisfied yet another one of his short
term goals- using mouth rinse! I then taught the patient about periodontitis (he did not know what it is), and the
importance of flossing. I demonstrated flossing on the typodont and then let him practice before moving to the
sink. He really seemed to catch on quickly! When we went back to the table to review, he seemed to really
understand what I had taught him about periodontitis and the importance of flossing. After our session ended, we
went back to my cubicle so I could begin ultrasonic scaling quadrant 3 (mandibular left). I only had about an hour
left of clinic, so I had to be as efficient as possible and use my time wisely. I ultrasonic scaled the quadrant in
about 45 minutes and got it checked off. I began fine scaling the quadrant but wasn't able to get it checked off
before we ran out of time. I scheduled him for a full 4-hour appointment next week, in which I will finish finescaling quadrant 3, perform the last formal patient education session, and also try to complete scaling on the next
quadrant. I expect his gingival tissue to be greatly improved in quadrant 3 next appointment, and I also expect
there to be barely any bleeding on probing next appointment, since all of the bleeding has been found in quadrant
3. His learning level is action, because he is slowly taking the steps needed to improve his oral health. I expect
even more goals to be met when we meet again next week.
Fifth Appt. 9/22/15

I reviewed his M/D history, then took his plaque score- 0.5 (good). This is an improvement toward one of his
long term goals because it is lower than last appointment! His bleeding score is 0%, which is lower than last
appointment and also an improvement toward one of his short-term goals! He then told me that he has begun
flossing twice a week, when he was not flossing at all before. The appearance of his gingival tissues are
continuing to improve, especially quadrants 3 and 4. The overall appearance of the other quadrants are also slightly
improved due to the patient's new flossing habit. This is an improvement toward another one of his short-term
goals! After this, we moved to the patient education room for his last formal patient education session. First I went
over all of his long and short term goals, and I congratulated him on the goals he has accomplished so far. I asked
him if he has any questions about brushing or flossing, and then I began teaching him about the caries process and
diet. I taught him that caries are formed whenever you eat sugar, and the bacteria on your teeth eat the sugar and
secrete an acid that breaks down enamel. I taught him that "sticky" foods that stay on the teeth longer have a
greater potential to cause damage. After I explained these things, we went to the sink and I got him to brush and
floss again so that I could modify his technique. He did very well on both of these skills, and I only had to make a
few minor corrections. I then asked him if he has any questions, and reminded him that we are a team. After the
session ended, we went back to my cubicle and I began fine scaling quadrant 3. When I got that checked off, I
began ultrasonic scaling quadrant 1. When I got that checked off, I began fine scaling that quadrant and did the
Gracey curet skill evaluation on that quadrant. I got this checked off right in time before the clinic day ended. I
expect the gingiva in all quadrants to be greatly improved next appointment, due to his new habit of flossing. I
especially expect quadrants 1, 3, and 4 to be the most improved. His learning level is involvement, because he is
becoming involved by taking even more steps at home to improve his oral health.
Sixth Appt. 10/1/15
I reviewed his M/D history, then took plaque score- 0.3 (good). This is, again, an improvement from the last
appointment and another step closer to achieving one of his long term goals, to reduce his plaque score. His
bleeding score is 0% again, which is an accomplishment of one of his short-term goals under halting the
progression of periodontitis. His toothbrushing method is now considered to be the bass method, and he tells me
that he makes sure to brush his teeth for two minutes each time. He also informed me that he now flosses three
times a week instead of twice a week. The appearance of his gingival tissues have improved tremendously,
especially the quadrants I have already scaled- quadrants 1, 3, and 4. The color of his gingival tissues have
changed from a reddish color to a pink color that is just a little brighter than what "healthy" gingival tissue would
look like. Next, I educated him chair side about malocclusion. I explained to him that he has malocclusion because
of some missing teeth and teeth that have drifted because of the teeth that are missing. I explained to him the
importance of flossing between those teeth and cleaning out debris that could get trapped in some of the gaps
between his teeth. I also educated him on fluoride. I told him that whenever acid from bacteria pulls minerals out
of the teeth, fluoride helps put the minerals back in the teeth, and prevents formation of a cavity. He seemed to
comprehend what I was saying very well. I then began ultrasonic scaling quadrant 2. I got that checked off, then
began fine scaling that quadrant. I got that checked off, then did plaque free and fluoride trays. I told him not to eat
or drink for 30 minutes after the appointment, in order for the fluoride to be completely effective. I then scheduled
him back in 2 weeks for post-periodontal evaluation. I encouraged him to continue his new oral hygiene habits at
home so that we can see a great change in his gingival tissues when he comes back. I expect all of his gingiva to
look almost completely healthy whenever he comes in in two weeks. His learning level is involvement, because he
is now very involved and invested in his oral health. This is a huge leap from where we started at the beginning of
treatment, and I expected the leaps to come even larger from this point forward.
Seventh Appt. 10/14/15
I reviewed his M/D history, then took his plaque score- 0.3 (good). His bleeding score is 0%. His toothbrushing
method is still improving, and I now consider it to be a moderate speed bass method. This is a huge improvement
form where we began. The appearance of his gingival tissues have come such a long way since his first
appointment. The tissue in all quadrants are a pink color that makes them look more healthy than they ever have. I
then educated him chair side about 3rd molars and making sure he adequately cleans his while brushing and
flossing. I explained that although 3rd molars are hard to reach, that is even more a reason to clean them properly.

I then performed full periodontal charting for the second time, and I found that a few of his periodontal pockets
had improved. I then evaluated his gingival index again, and I found that his score is now 1.2, which is an
improvement from the first appointment. I then placed arrestin in two periodontal pockets found on tooth #16.
Ending gingival statement is slight periodontitis with no bleeding. He has no referrals, and he will come back in
for recall in 3 months. I believe that the patient will continue to improve his oral hygiene habits. He truly cares
about his health and well-being, I just don't think he was properly educated about his oral health before he came to
our clinic.