Mr. Z. was my patient today. He is a 58-year-old male who presented for a recare appointment. He is currently taking cholesterol and oral diabetes medications. I had seen him previously one time only at his initial appointment in the practice. At that time, he was diagnosed with moderate, generalized chronic periodontitis. His radiographs revealed moderate bone loss in the posteriors, with pocket depths ranging from 3-6 mm generally. There was heavy subgingival calculus evident on radiographs.
At the time of the initial appointment, I treatment planned Mr. Z. for four quadrants of scaling and root planning with anesthesia. These were scheduled with the dentist, because he had the time available to get the treatment accomplished sooner. (The doctor takes an active role in nonsurgical periodontal treatment as needed, and is very capable!)
Fast forward to today, 18 months later. I noted on the record that Mr. Z. had opted out of a formal re-evaluation appointment. Today’s visit was his first time back at our office since his quadrant debridement. He informed me that he does not take care of his teeth as recommended, and that we would most likely need to “start again from scratch.”
As I re-evaluated his soft tissue, I could see that the deep scalings had been effective in minimization of most pocketing. However, there was still a fair amount of bleeding with new calculus present in the lower anteriors, as well as generalized biofilm and debris. I asked him if he had changed any of his self care after the quadrant debridement visits? His response was, “No.” He reported that he was still brushing his teeth twice a day “some of the time,” and that he was not using any means to clean his teeth interproximally.