Emily Middleton



PERIODONTAL CARE PLAN (PCP)Male Age: 30Date of initial exam: 09/06/2019 Date completed 12/2/20191. Medical History: (systemic conditions altering treatment, pre-medication, medical clearance) explain steps to be taken to minimize or avoid occurrence, effect on periodontal diagnosis and/or care) The patient is unsure of the date of his last physical. Undiagnosed underlying conditions can contribute to both the severity and the rate of progression of periodontal disease.The patient had abnormally high blood pressure readings at two separate appointments but has not seen a physician in several years. Because of this the patient is classified as ASA II. Both the undiagnosed hypertension and lack of routine medical care can contribute to the severity and the rate of progression of periodontal disease as well as the complexity of treatment. The patient uses a vape pen containing nicotine daily. Tobacco use has been proven to be a significant risk factor for the development of periodontal disease. It is associated with increased pocket depths, loss of attachment and alveolar bone and a higher rate of tooth loss over time. 2. Dental History: (past dental disease, response to treatment, attitudes, dental I.Q., chief complaint, present oral hygiene habits, effect on periodontal diagnosis and/or care)The patient presents for a cleaning. He has no current complaints and states that he feels “fine” about his teeth. The patient has little understanding about plaque and the effects inflammation can have on oral tissues and periodontal disease development and progression. The patient also seems unconcerned with his oral health with no indication that he will change his habits in the near future. The combination of lack of knowledge and lack of concern give this patient a poor prognosis at this time with the probability of further destruction of periodontal tissues a distinct possibility due to the continued inflammation and constant presence of bacteria. The patient has a history of infrequent dental exams. His last visit was in 4/2019 for an extraction and x-rays only. After explaining to the patient the importance of regular dental care, he seems uninterested and generally unconcerned about his dental health. The patient is aware of hygiene concerns but unmotivated to change his habits at this time.His lack of concern and infrequent care can affect both the severity and rate of progression of periodontal disease and increase his risk for increased pocket depths, attachment loss, and can increase the possibility of tooth loss due to periodontal disease.The patient indicated that he drinks 2 sugar containing drinks daily. Repetitive exposure to sugar encourages the growth of plaque and contributes to demineralization over time.The patient exhibits poor plaque control and states he only brushes once per day and does not floss. His plaque score is 1.3 at his first visit which indicates that his brushing is good and likely just infrequent. After discussing the importance of flossing and the relationship of inflammation to the progression of periodontitis, the patient still seems unconcerned with his oral health. The presence of biofilm at the gingival margin due to poor plaque control causes an inflammatory response which has been proven to contribute to the development of periodontal disease and the rate of progression over time. Without effective oral hygiene habits, the patient could continue to experience active destruction of periodontal tissues. The patient exhibits signs of chronic gingivitis and moderate periodontal disease. Chronic inflammation can contribute to the rate of progression of periodontal disease.The patient had tooth #3 extracted due to a large carious lesion and periapical abscess. The patient was referred for possible caries/demineralization on #17, #18, and #19. Poor biofilm control contributes to the formation of caries and tooth loss contributes to the loss of alveolar bone in the regions where teeth are extracted. This loss of bone can affect adjacent teeth as well thus contributing to the overall severity and complexity of periodontal disease.The patient uses a vape pen containing nicotine daily. Tobacco use has been proven to be a significant risk factor for the development of periodontal disease. It is associated with increased pocket depths, loss of attachment and alveolar bone and a higher rate of tooth loss over time. Because of all of the previous factors, the patient’s periodontal and caries risk scores are high. Without modification of current habits and change in current attitudes toward dental care, the patient could experience progression of periodontal disease at a moderate to high rate. This progression would include possible increased periodontal pocket depths, loss of clinical attachment, loss of alveolar bone and eventually possible tooth loss due to periodontal disease. 3. Oral Examination: (lesions noted, facial form, habits and awareness, consultation, effect on periodontal diagnosis and/or care)The patient exhibits a mandibular torus on the left side.The patient has a 2mm white ulcerated lesion on the right side on the floor of the mouth near the base of the tongue.The patient’s tongue exhibits some scalloping of the edges.The patient has a history of stress-related clenching and grinding but does not use a mouth guard. Functional habits are a major etiologic factor which can lead to malformation in dento-facial structures. Habits which apply force to the teeth can damage the teeth and the supporting structures which can contribute to the severity of periodontal disease if habits are not modified. 4. Periodontal Examination: (color, contour, texture, consistency, etc., effect on periodontal diagnosis and/or care)The patient exhibits with generally scalloped, red, edematous, tissue upon clinical exam with generally rolled margins and bulbous papillae. The is no suppuration present upon exam or probing. Papillary and marginal surface texture as well as that of the attached gingiva is generally smooth and shiny.The patient’s clinical exam revealed generally inflamed tissues due to poor biofilm control. The redness and edematous tissues indicate active disease and the potential for worsening of the periodontal condition. The presence of bacteria and inflammation over time likely contributed to bone loss and widened PDL spaces evident at 23, 24, 25, 28, and 29. Periodontitis Stage: II Periodontitis Grade: B Extent & Distribution: Generalized bone loss less than 15% Describe determining factors/ etiology behind Stage, Grade. & Extent of disease findings: The patient exhibits bone loss in the coronal third of the root surface at 28, 29, 23, 24, 25 and generalized bone loss in the coronal third in the upper and lower left and right posterior quadrants. The patient also presents with probing depths greater than 5mm on five different teeth which shifts his periodontal classification to Stage II.Because of the patient’s amount of bone loss compared to his age (between 0.25 and 0.5) and due to the fact that the patient uses nicotine regularly throughout the day, his periodontal condition is predicted to progress at a moderate rate, and he is classified as Grade B. b. Gingival Description:Appt 1: 9-6-2019Architecture: generally scallopedColor: generalized red Margins: generalized rolledPapillae: generalized bulbous No suppuration presentSurface texture (papillary and marginal): generalized smooth and shinySurface texture (attached): generalized smooth and shinyThe redness and inflammation present on exam at the patient’s first appointment indicate active disease. Unless treatment is rendered and the disease process is halted the patient is at continued risk for worsening periodontitis. Appt 2:9-13-2019Gingival condition is unchanged from the initial perio assessment:Architecture: generally scallopedColor: generalized red Margins: generalized rolledPapillae: generalized bulbous No suppuration presentSurface texture (papillary and marginal): generalized smooth and shinySurface texture (attached): generalized smooth and shinyApp't 3:10-4-2019Gingival condition is unchanged from the initial perio assessment:Architecture: generally scallopedColor: generalized red Margins: generalized rolledPapillae: generalized bulbous No suppuration presentSurface texture (papillary and marginal): generalized smooth and shinySurface texture (attached): generalized smooth and shinyApp't 4:10-10-2019 Architecture: generally scallopedColor: generalized red, pink in mandibular rightMargins: generalized rolled; normal in mandibular right with the exception of facial of 25-27Papillae: generalized bulbous; normal in mandibular right with the exception of facial of 25-27No suppuration presentSurface texture (papillary and marginal): generalized smooth Surface texture (attached): generalized smooth and shiny; smooth in mandibular rightApp't 5:10-22-2019Architecture: generally scallopedColor: generalized pink; red in facial of lower anterior and margins of mandibular molars (17-19 & 30-32)Margins: generally normal; rolled in mandibular facial 22-27 and mandibular molar area 17-19 and 30-32 facial and lingualPapillae: generally normalNo suppuration presentSurface texture (papillary and marginal): generalized smooth Surface texture (attached): generalized smooth App't 6:11-14-2019Architecture: generally scallopedColor: generalized pink; red: margins of mandibular molars (17-19 & 30-32)Margins: generally normal; rolled: mandibular molar area 17-19 and 30-32 facial and lingualPapillae: generally normalNo suppuration presentSurface texture (papillary and marginal): generalized smooth Surface texture (attached): generalized smooth Appt 7:11-25-2019Architecture: generally scallopedColor: generalized pink; slightly red just around margins and posterior to #17 (patient complains of recurring inflammation posterior to this tooth)Margins: generally normal (slight splotchy redness right at margins but no swelling present)Papillae: generally normalNo suppuration presentSurface texture (papillary and marginal): generalized smooth Surface texture (attached): generalized smooth c.Plaque Index: Appt 1: Not available 2: 1.3 (good) 3: 1 (good) 4: 1.6 (good) 5: 1.3 (good) 6: 1 (good) 7: .83 (good)d.Gingival Index: Initial: 1.65 (fair) Final: 1 (fair)e.Bleeding Index: Appt 1: 18% 2: 75% 3: 41% 4: 53% 5: 30% 6: 33% 7: 0% f.Evaluation of Indices and effect on periodontal diagnosis and/or care: 1. InitialThe initial assessment shows that the patient has Stage II, Grade B periodontitis.The initial plaque score of 1.3 is evaluated as good, however, the presence of plaque post-brushing and the fact that the patient brushes infrequently and has significant calculus build-up indicates that there is poor plaque control overall. Poor control of biofilm is a major contributing factor to inflammation and progression of disease at a faster rate, so it is important to help the patient learn the importance of biofilm control and halting the active disease state.The initial gingival index is 1.65 which is evaluated as fair, but the patient had inflammation in most recorded areas indicating active disease as well.The initial bleeding index of 18% indicates active disease as well. Unless the bacteria and inflammation are eliminated, the patient’s condition can be expected to worsen over time at the moderate rate predicted by his initial periodontitis staging and grading indices. If the patient applies all practices which we will discuss during patient education, the progression of periodontitis can be halted. 2. FinalThe final assessment shows that the patient has Stage II, Grade B periodontitis. The final plaque score recorded was 0.83 which is a significant improvement from the initial appointment. The patient’s final gingival index was 1 which is also a significant improvement from the initial appointment. The patient’s final bleeding score was 0%.The patient does continue to use a vape-pen containing nicotine.The fact that the patient managed to implement new self-care routines and eliminate his inflammation shows great progress toward halting the patient’s progression of periodontitis. If the patient is able to maintain his current hygiene habits, I believe his prognosis is fair. g.Periodontal Chart: (Record Baseline and First Re-evaluation data, effect on periodontal diagnosis and/or care)1. Baseline:The patient has pocket depths of 4 on FACIAL: MBD surfaces of 32, M of 30, B of 17,LINGUAL: M of 16, D of 15The patient has pocket depths of 5 on FACIAL: D 17, D 30, D 31LINGUAL: D 19, M 18The patient has stage II, grade B periodontitisThe fact that the patient has 5mm pocket depths on multiple teeth, increases his periodontal stage from an initial stage I based on bone loss to a stage II due to increased complexity of disease.The patient’s initial bleeding scores are 18% and then 75% (using indicator teeth only).The extent of bleeding indicates an active disease process which means that the process of periodontitis progression has not yet been arrested and the patient is at risk for increased severity of periodontitis over time.2.Firstevaluation: The patient’s bleeding score at his 2 week post calculus treatment evaluation was 0%. The patient had generally improved CAL measurements with no pocket depths of 5 or greater.If the patient maintains new habits, it is possible his periodontitis can be halted, however, his use of nicotine is a possible significant contributing factor the progression of periodontitis.5.Dental Examination: (caries, attrition, midline position, mal-relation of groups of teeth, occlusion, abfractions, effect on periodontal diagnosis and/or care) The patient is missing tooth number 3 (extracted due to caries/periodontal abscess), fractures are present on 6-11, 14D, 21D, 21-28, 17-19 referred for possible caries on the occlusal surfacesOcclusion classifications are as follows: Right molar relationship unclassifiable due to the extraction of #3Right canine relationship: Class ILeft molar relationship: Class ILeft canine relationship: Class IOverjet and midline shift are within normal limitsThe disruption in the molar relationship may eventually cause the disruption of the patient’s occlusion in the rest of his dentition due the possibility of drifting over time. It is also possible that the occluding tooth to #3 will super-erupt since there is no opposing force to keep it in its current place. The abnormal shifting of his dentition could possibly lead to further destruction of periodontal tissues localized to this area due to the fact that teeth shifting too quickly can cause the resorption of bone and damage to the surrounding periodontal structures. The many fractures on the patient’s teeth are due to trauma from a car accident. These areas are biofilm retentive which can cause the patient to retain more plaque/bacteria on the surfaces of his teeth. The presence of plaque and bacteria accelerate the progression of periodontal disease if not removed. 6.Treatment Plan: (Include assessment of patient needs and education plan)Appt 1: Update medical historyPre-rinseHead/neck examDental charting with x-raysPeriodontal assessmentVertical bitewing x-raysPlaque scoreBleeding scoreRisk assessmentInformed Consent: Referrals for 17, 18, 19Patient Education: Discussed proper brushing, flossing, what calculus is, and periodontitis with the patient. The patient’s initial learning level is awareness. He has been given the information he needs to make changes to improve his oral health, but he is not interested in implementing them at this time. We will discuss these topics further during his formal patient education sessions and work together to create goals which he feels he can maintain to improve his health.Appt 2: Review medical/dental historyPre-rinseX-ray retakesPlaque and Bleeding Score to monitor progressAssess gingival conditionPatient Education session 1: Plaque/BrushingUltrasonic Quadrant 1Full periodontal charting on Quadrant 1Fine Scale Quadrant 1 I will discuss the goals I have worked on for the patient and work with him to ensure both long and short-term goals are reasonable and achievable for him.Patient Education Session 1:To begin, I will ask the patient if he knows what plaque is and what causes it in order to assess his knowledge of the disease process.I will then use my flip-book to show him what it is and teach him about bacteria and the formation of plaque.I will discuss the patient’s plaque score and the meaning of it and show him the proper method of brushing on my typodont. I will then have him show me the method on the typodont and practice at the sink where I will help him adjust as needed. I will redisclose and assess the plaque once again in order to teach the patient the importance of effective brushing techniques. I will discuss with the patient why it is important to brush twice daily.To end the session, I will ask the patient to define plaque and to tell me what causes it.I will then give a brief review of our goals and ensure that the patient agrees that all of the goals presented are reasonably achievable for him. I will emphasize to the patient that I am here to give him all of the tools he will need in order to improve his oral health, but he is an integral part of the team as well and that he must be committed to our treatment plan in order for it to be successful.LTG 1: Patient will implement a new habit of brushing twice daily instead of onceSTG 1: Patient will define plaque and tell me what causes it by the end of his first appointmentSTG 2: Patient will demonstrate proper brushing technique by his next appointmentSTG 3: Patient will brush twice daily at least two days per week and increase by one extra day per week until he reaches 7 full days per week. Appt 3: Update medical historyPre-rinsePlaque score and bleeding scoreGingival conditionPatient Ed Session 2: Perio/FlossingUltrasonic Quadrant 2Full periodontal charting on quadrant 2Fine Scale Quadrant 2Patient Education Session 2:To begin I will review the definition of plaque and what causes it with the patient.I will have the patient brush and redisclose to assess brushing again.I will ask the patient if he knows what periodontitis is and what causes it.I will use my flip-book to show the patient the effects of chronic periodontitis and use his FMX to show him that he has bone loss.I will explain to him that while periodontitis can not be reversed, with good oral hygiene it can be halted so that he does not lose more bone or eventually lose teeth due to advanced periodontitis. I will teach him that flossing is essential to maintaining healthy oral tissues and show him the proper method of flossing and have him demonstrate both on the typodont and in front of the mirror.I will discuss flossing aids with the patient and make sure he understands that using some of these is better than not flossing at all.I will discuss his bleeding score with him and teach him that bleeding is a sign of disease in the mouth so lowering his bleeding score is a good indication that he is improving his oral health. I will once again review goals and make sure he understands that while I am providing him with the skills he needs to be at his healthiest, it is ultimately up to him to put everything into practice and to form healthy habits. LTG 2: Patient will lower his bleeding score from 18% to 0% by his final appointment and halt the progression of periodontal disease. STG 1: Patient will define periodontitis and understand the relationship between bleeding and active disease and how flossing helps stop it by the end of this appointment.STG 2: Patient will floss at least twice per week increasing by once per week until he is flossing daily.STG 3: Patient will lower his bleeding score by 5% per appointment until he reaches a bleeding score of 0% which will indicate that his disease progression has been halted.Appt 4: Update medical historyPre-RinseGingival conditionPlaque scoreBleeding scorePatient education session 3Ultrasonic scale quadrant 3Full periodontal charting on quadrant 3Fine scale quadrant 3Patient education session 3: Caries/FluorideTo begin we will review previous sessionsI will ask patient how he is progressing toward his goals regarding brushing and flossingI will use my flip book to show patient pictures of cariesI will teach the patient what causes caries – bacteria/fermentable carbohydrates/susceptible tooth surface/extended exposure/increase in acidityI will discuss with the patient that consuming sugary drinks with a fat/protein rich meal will help reduce the effects on teeth by preventing the drop in pH which occurs when they are consumed aloneI will discuss with the patient the 3 teeth the dentist marked for referral due to caries and show him these teeth on x-rays.I will discuss the benefits of fluoride (slows growth of bacteria/prevents caries/helps add minerals back to enamel) with the patient and the sources of fluoride (public water, rinses, toothpaste, prescription sources)I will recommend that the patient implement a daily source of fluoride in addition to his toothpaste to help reduce the bacterial count in his mouth and slow the caries process.I will review goals again and reiterate that now that the patient has been given all of the information and tools he needs to prevent growth of caries and progression of periodontitis to a more severe stage, it is ultimately up to him to take responsibility for his oral health. I am here to help him, but his attitude and commitment to oral health are the most important factors in his success.LTG 3: Patient will use a fluoride mouth rinse daily to help arrest the caries processSTG 1: Patient will understand how fermentable carbs and bacteria influence the growth of cavities by the end of this appointmentSTG 2: Patient will limit sugary drinks to one daily and consume them with a meal whenever possibleSTG 3: Patient will use a fluoride rinse at least twice weekly and increase once daily until he is using a fluoride rinse dailyAppt 5: Update medical historyPre-RinseGingival conditionPlaque scoreBleeding scoreUltrasonic scale quadrant 4Full periodontal charting on quadrant 4Fine scale quadrant 4 Appt 6:Update Medical history Pre-rinse Plaque scoreBleeding scoreFinal periodontal charting with CALPlaque freeFluorideReview all goals and patient progressLearning Level/Patient attitudesEnding gingival condition7.Radiographic Findings: (crown root ratio, root form, condition of interproximal bony crests, thickened lamina dura, calculus, and root resorption; effect on periodontal diagnosis and/or care)Radiographic findings include:Generalized mild bone loss in all quadrants except the upper anteriorWidened PDL space at 28, 29, 23,24,25Missing tooth #3Generalized calculus notable in all quadrantsThe radiographic findings along with other clinical findings place patient in periodontitis stage 2, grade B 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.9-06-2019 – Updated medical history, statement of release, pre-rinse, head and neck, perio assessment, dental charting with x-rays, pt ed over brushing, flossing, calculus formation (LL awareness) Patient has little interest in changing habits at this time informed consent, referrals for occlusal surfaces of 17,18, 19Dental charting with x-rays, risk assessment, bleeding score (18%)9-13-2019 – Updated Medical history, pre-rinse, plaque score (1.3), Bleeding score 75%, vertical bitewings, gingival index (1.65/fair), Patient ed over flossing and bleeding (LL awareness)Patient still shows little interest in changing habits.10-4-2019 – Updated medical history, pre-rinse, plaque score (1), bleeding score 60%, ultrasonic mandibular right, perio charting, patient education session 1: discussed plaque and bleeding scores, bacteria, inflammation, future goals, brushing methodLL: awareness10-10-2019 – Updated med hx, pre-rinse, plaque score 1.6, bleeding score 53%, fine scaled mandibular right, ultrasonic mandibular left, perio charting, patient education session 2: reviewed plaque and brushing, asked patient about his progress toward goals. The patient states that he is using a fluoride rinse daily as recommended. He is flossing once or twice a week when he remembers. Showed patient a flossing technique and gave him some options to try. Discussed periodontitis and why flossing and brushing are important in order to halt the progression. The patient seems more motivated to try and brush and floss following this session: LL – self interest10-22-2019 – Updated med hx, pre-rinse, fine scaled LL, ultrasonic UR, perio charting, plaque score 1.3, bleeding score 30%, Pt Ed: discussed all goals from patient Ed (flossing, brushing twice daily, daily fluoride rinse), patient states he is flossing at least a few times a week using a floss aid I provided for him. Third patient Ed session delayed until next appointment due to lack of time.11-14-2019 – Updated med hx, pre-rinse, finished all scaling, Patient Ed session 3: Discussed caries and bacteria, discussed all previous goals again, showed patient which teeth the dentist recommended referrals for, recommended patient follow-up with dentist within 3 months to have these places evaluated, gave the patient some handouts covering all of the topics we have covered in our sessions in case he has any questions, reviewed brushing and flossing methods and adjusted as needed, plaque free, finished all perio charting, plaque score 1, bleeding score 33%11-25-2019 – Updated med hx, pre-rinse, plaque score .83, bleeding score 0%, Gingival index 1 (fair), noted patient’s gingival condition including generalized splotchy redness localized to the margins of the gingiva (This could possibly be due to a local irritant or vigorous brushing prior to his appointment, though, as he had no bleeding at this appointment). Post calculus evaluation and perio charting, pt Ed: discussed importance of brushing twice daily LL: self interestPatient still is not brushing twice daily but is flossing most days and using a fluoride rinse every day. 9.Prognosis: (Based on attitude, age, number of teeth, systemic background, malocclusion, tooth morphology, periodontal examination, recare availability)Based on the patient’s change in attitude and the fact that he has implemented some new self-care methods but not all, I believe his prognosis is fair. The patient is also still using nicotine a few times daily which is detrimental to his periodontal health as well. The patient does seem willing to maintain regular visits, but he is somewhat reluctant. 10. Supportive Therapy: Suggestions to patient regarding re-evaluation, referral, and recall schedule. (Note: Include date of recall appointment below.)I recommended that the patient see a dentist regarding the referrals for teeth 17-19 within 3 months of our last visit. The patient has been placed on a 4 month recall schedule due to his risk of moderately rapid progression of periodontitis. This is primarily because of his nicotine use and because of the fact that he has developed periodontitis at such a young age.The patient’s recall appointment has been scheduled for 03/2020. 11.Assessment of Changes: (note “Grade” at the end of treatment, compare changes in periodontitis classification, changes in plaque control, bleeding tendency, gingival health, probing depths, effect on periodontal diagnosis and/or care)The patient’s plaque score decreased from 1.3 when first recorded to .83 at his last appointment. His bleeding score steadily decreased from appointment to appointment to finally reach 0% bleeding by his last appointment. His gingival index also decreased from 1.65 to 1. He also had generally reduced probing depths as well, and he had no probing depths greater than 4mm at his last appointment and required no Arestin administration. Due to these changes, I believe the patient’s prognosis for halting periodontitis is fair rather than poor as initially predicted.12.Patient Attitudes and Cooperation:The patient started this experience stating that he would likely never floss, but his attitude changed immensely over the course of our appointments. I believe he benefited immensely from patient education sessions, and he was genuinely interested in learning about periodontitis and is now more concerned about his oral health. He is somewhat reluctant to come to follow-up visits but he has been very cooperative at each of his appointments. 13.Personal Evaluation/Reaction to Experience:Providing comprehensive care and patient education to a periodontitis patient has been a great learning experience for me. I feel like there are a lot of things that I now feel much more confident with such as measuring tissue height and periodontitis staging and grading. It was very rewarding for me to see the changes my patient made as we progressed through our appointments as well. DATE________________________ NAME_________________________________________PERIODONTAL CARE PLAN EVALUATIONPART 2LIT Dental Hygiene Competency P.3PC.9PC.10PC.12PC.13Continuously perform self-assessment for lifelong learning and professional growthSystematically collect, analyze, and record data on the general, oral, psychosocial health status of a variety of patients.Use critical decision-making skills to reach conclusion about the patient’s dental hygiene needs based on all available assessment data.Provide specialized treatment that includes preventive and therapeutic services designed to achieve and maintain oral health.Evaluate the effectiveness of the implemented clinical, preventive, and educational services and modify as needed.All information should be 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 ic areaPointsExcellent5Good4Fair3Unacceptable2Periodontal ExamGingival Exam & Dental Indices 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 any characteristics of the gingival exam by quadrant. Evaluates an indices and relates that indices to periodontal disease Fails to describe any characteristics of the gingival exam by quadrant. Fails to evaluate any indices and relate to periodontal disease Periodontal ChartDescribes 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 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 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 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. dateTreatment provided, OH education, pt. response, complications Describes many of the treatment procedures provided, OH education, pt. response, and complications by appt date.Describes several of the treatment procedures provided, OH education, pt. response, and complications by appt date.Describes any of the treatment procedures provided, OH education, pt. response, and complications by appt date.Fails to describe any of the treatment procedures provided, OH education, pt. response, and complications by appt date.Improvements, Diet recommendations, learning level Describes many of the pt. improvements, diet recommendations, and learning level. Descriptions are kept by appt date.Describes several of the pt. improvements, diet recommendations, and learning level. Descriptions are kept by appt date.Describes any of the pt. improvements, diet recommendations, learning level, STG & LTG attained, and expectations. Descriptions are kept 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. dateSTG & LTG attained, ExpectationsDescribes many of the STG & LTG attained, and expectations. 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 STG & LTG attained, and expectations. Descriptions are kept by appt date.Fails to describe the STG & LTG attained, and expectations. Descriptions are not kept by appt date.PrognosisDescribes many prognosis characteristics by attitude, age, number of teeth, systemic background, malocclusion, tooth morphology, recall availability, and periodontal examination.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.Fails to describe any prognosis characteristics by attitude, age, number of teeth, systemic background, malocclusion, tooth morphology, recall availability, and periodontal ic areaPointsExcellent5Good4Fair3Unacceptable2Supportive therapyDescribes many of the suggestions made to patient regarding re-evaluation, referral, and recall schedule. Includes date of recall appt.Describes several of the suggestions made to patient regarding re-evaluation, referral, and recall schedule. Includes date of recall appt.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 includedAssessment of changesDescribes many of the changes occurring from trt including classification, plaque control, bleeding, gingival health, probing depths.Describes several of the changes occurring from trt including plaque control, bleeding, gingival health, probing depths.Describes any of the changes occurring from trt including plaque control, bleeding, gingival health, probing depths.Fails to describe any of the changes occurring from trt including plaque control, bleeding, gingival health, probing depths.Pt. Attitudes and cooperationPersonal evaluation/reaction to experienceEvaluates comprehensively patient’s attitude and cooperation including patient’s mental and emotional status, temperament and attitude. Comments on personal evaluation/reaction to experience.Evaluates patient’s attitude and cooperation including patient’s mental and emotional status, temperament and attitude. Comments on personal evaluation/reaction to experienceFails to evaluate patient’s attitude and cooperation including patient’s mental and emotional status, temperament and attitude. Comments on personal evaluation/reaction to experienceFails to evaluate patient’s attitude and cooperation including patient’s mental and emotional status, temperament and attitude. No comments on personal evaluation/reaction to experienceWriting & Basic requirementsThoughts 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. 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. 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. 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. Many records are not updated or properly identifiedTOTAL POINTS(50 points possible) ................
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