Initial visit

  • 39yo Asian Male
  • In need of a cleaning
  • Vitals 116/89 P:84
  • Patient was diagnosed with Gout diseases and high cholesterol in 2010
  • Medications: Uloric 1x/day for the past 2 years; Colchicine 1x/day for the past 4 years.
  • Dental consideration :Xerosmomia
  • ASA II


  • EO findings: Asymptomatic bilateral swelling of the submandibular glands
  • IO findings: Bilateral linea alba
  • Bilateral Class I; Overjet:5mm; Overbite:5%

Dental charting

  • Generalized moderate attrition and wear facets with molar pattern.
  • Abfraction on the medial of #30
  • Patient has all 3rd molar erupted
  • No active lesions present.

`Periodontal charting

  • Generalized heavy BOP
  • Generalized probing depths of 1-6mm
  • Localized 7mm probing depths with molar pattern
  • Generalized recession of 1-3mm.


  • FMS exposed at 7mA, 70kVp
  • Generalized horizontal bone loss of >15%, corresponding with Stage II periodontitis
  • Generalized heavy tenacious calculus, no active lesions.



  • Patients was diagnosed with Stage II based on his bone loss level determined with radiographs. Grade C due to the destruction of periodontium being proportional with the amount of biofilm deposits as well as his smoking habits of 20 cigarettes per day.
  • Low risk caries with no active lesion present.
  • Generalized, heavy tenacious supra gingival calculus with heavy tenacious sub gingival calculus.
  • Generalized heavy staining.
  • Heavy case value.

Treatment Plan

  • Visit 1: Start assessment, Exposed FMS,scaled LR quadrant using local anesthesia  and probe LR
  • Visit 2: Scale UR quadrant using local anesthesia and probe the UR quadrant
  • Visit 3: Scale UL quadrant using local anesthesia and probed UL quadrant
  • Visit4: Scale LL quadrant using local anesthesia and probed LL quadrant, engine polishe with medium grit trophy paste, Apply 5% NaF varnish

Treatment plan implementation

  • Visit 1: Started assessments, stopped at periodontal probing due to high pain and sensitivity, exposed FMS and determined stage and grade with radiographic findings. P.I.: 2.0. Modified bass technique was implemented due to most of the biofilm was present on the cervical third of the teeth. IAN block was performed by the doctor on floor using  1 carpule of Carbocaine 3% no epi ; Lidocaine HCL 2% 1:100k epi was administered for a Mental infiltration administered by me. Scaled and probed LR quadrant
  • Visit 2: P.I: 1.7. Modified Bass technique perviously implemented was reinforced and a proper flossing method was introduced. Scaled and probed UR quadrant after administering 1 carpule Lidocaine HCL 2% 1:100k epi for PSA, MSA, ASA.
  • Visit 3: P.I 1.6. Flossing technique was reinforced. Scaled and probed UL quadrant 1 carpule Lidocaine HCL 2% 1:100k epi for PSA, MSA, ASA.
  • Visit 4: P.I: 1.7. Listerine Total Care Stain Remover was introduced and recommended to the patient due to high demineralization of his teeth as well as the presence of heavy extrinsic stains. Scaled and probed LR quadrant after adimistering IAN block using 1 carpule Carbocaine 3% no epi. Engine polished using medium grit prophy paste, applied Fluoride Varnish 5% NaF.
  • 3 Months recare.