Introduction: A 39-year-old adult male underwent a regular biannual dental examination and routine scaling. The patient reports suffering from anxiety, he is a teacher, a non-smoker, a non-drinker and a regular dentist. During his initial examination on 06/23/13, the patient was seen for a routine complete scaling and polishing with reinforced oral hygiene instructions, including flossing technique. dental. He presented with excellent oral hygiene to this appointment, which reflected his commitment to good oral hygiene; brushing your teeth twice a day and flossing once a day. This was further confirmed by patients' plaque scores at 5% and bleeding scores at 4% with only minimal supragingival calculus on the lower anterior teeth. There was no erythema or edema on the gingival tissues. Additionally, extra-oral examination revealed no abnormalities. His BPE was 111/121 and he had no restorations and was given a “low caries risk” status. However, during a recent visit dated 12/23/13, the patient's gingival condition had deteriorated, showing an increase in plaque scores of 34% and bleeding scores of 63%. Intraoral examination also showed generalized edema and erythema throughout the mouth in response to this increase in plaque bacteria. The presence of supragingival calculus on the lower anterior teeth and on both sites of the upper oral molars and the patient's BPE is now 212/121, which places the patient's caries risk at a "high" status. The patient still suffers from anxiety and has been taking the selective serotonin reuptake inhibitor - Fluoxetine 20 mg (BNF 2014:251-254) once daily since his last visit and the patient reports very low motivation due to of a recent separation from a...... middle of paper.... .. Oral say. 2006; 12:1-21. [PubMed] EA on the ground, Allan RB. Summary article: oral ulceration - etiopathogenesis, clinical diagnosis and management in gastrointestinal clinic. Food Pharmacol Ther. 2003; 18:949-62. [PubMed] Crispian Scully, Handbook of Oral Disease, Diagnostic and Management, Martin Dunitz 1999 Patient leaflet from the NHS Direct website - Mouth Ulcer, www.cks.nhs.uk/patient [05/17/14] Stedman's Medical Dictionary (2006) - http http://www.medilexicon.com/medicaldictionary.php?t=95403Medical-Dictionary http://www.medicaldictionaryweb.com/Ulcer-definition/British National Formulary; British Medical Association.2014 (or www.bnf.org)NHS Scotland (2012) Oral Health and Nutrition Guidance for Professionals Scotland [05/10/14]British Society of Periodontology. Guide for young practitioners in periodontology.2012. Available at: www.bsperio.org.uk