Due to the changing structure of our clinical general practices groups within the VCU clinics, there are minimal opportunities to evaluate patient initial response after initial oral disease control therapy. Luckily, I have had a few patients this last year who received therapy, were released to maintenance, and were in need of reevaluation. Below, I have outlined one such patient who had received nonsurgical scaling and root planing therapy approximately 9 months prior to seeing me. He had his evaluation of initial therapy (EIT) about 6 weeks after treatment, and had been seen only for restorative procedures in the intervening months. I performed a comparison of my periodontal assessments and biofilm accumulation with those noted at the time of his EIT. My faculty and I were in agreement about his worsening periodontal condition. Importantly, the patient had a highly complicated medical history, which included frequent usage of nitroglycerin for angina and a history of two separate myocardial infarctions with several cardiac surgeries over the last two decades. In conjunction with worsening periodontal status, I, along with my faculty, deemed referral to a periodontal specialist was the best course of action for the patient, and palliative maintenance was performed at this visit to minimize inflammation in preparation for his upcoming visit with the specialist. I learned how tenuous periodontal recovery can be immediately after initial therapy. This experience reinforced the scientific evidence which recommends these severe patients be seen every 3 months indefinitely after release from therapy for essential reevaluation and biofilm control.