Medical/Social/Dental History
A young African American male age 23 presented to the clinic with Type 2 diabetes. He reports his last physical was 4 days before his hygiene appointment today and is unable to recall when his last dental cleaning and radiographs were. The primary care physician no longer prescribed for him to take insulin but his last HbA1c level was 10.6. and blood pressure was 137/85 which corresponds to hypertension stage 1. The patient reports that his primary care physician has recently increased his dosage of Metformin to 1000mgs twice a day for regulation of blood sugar. He has also been taking OTC supplements such as fish oil capsules and creatine for muscle growth every morning. Lastly, the patient smokes marijuana daily without any form of tobacco. I proceeded to ask the patient about their current home care practices, he stated that he uses an Oral B toothbrush twice a day with Arm and Hammer toothpaste, flosses with floss picks, rinses with Therabreath mouth rinse, and uses a plastic tongue scraper once a day.
Assessments/Clinical Findings
After an extraoral and intraoral exam was then conducted, a small 2mm dark pink in color asymptomatic fibroma was detected along the right buccal mucosa, bilateral linea alba, and mild xerostomia was detected intraorally. Hard/soft tissue examinations took place along with periodontal charting and calculus detection. Clinically the patient had partially erupted third molars, along with several white spot lesions on the occlusals of tooth #30 and #31. The patient’s gingiva was coronal to the CEJ, highly inflamed, bright red, and flaccid with bulbous papilla. Generalized 3-4 mm probe depths with localized 5-6 mm probe depths with moderate bleeding upon probing was also detected. There were generalized tenacious calculus deposits present both subgingivally and supragingivally. I drafted a treatment plan that required the patient to return to the clinic for two additional visits for full scaling and root debridement. These additional visits will also allow me to reevaluate the gum tissue and stress to the patient proper homecare practices
Dental Hygiene Care Plan
A full mouth series was taken on the patient to evaluate the bone level and rule out periodontal disease. It was determined that the patient has generalized moderate gingivitis with localized 10% vertical bone loss. After the drafting of the treatment plan, I communicated my findings to the patient and performed a caries risk assessment. I stressed the importance of a healthy diet with limited carbs and more vegetables not only to avoid caries but also to help regulate his blood sugar. The patient agreed to the application of fluoride varnish to aid in the prevention of caries and reduce sensitivity although an anesthetic was not needed for pain management during treatment. I recommended that the patient work on minimizing his smoking habit due to the effects it will have on his oral cavity such as dry mouth, caries, and overall health risk.
Individualized patient home care regimen
It was recommended that the patient practice meticulous home care to prevent the development of periodontal disease and a build-up in calculus. I educated the patient on the proper angulation of an electric toothbrush, and how to properly floss with string floss throughout his visits. During his revisit appointment, he would need extra time for his gingiva to heal and return to health due to the fact this patient’s healing process will be much longer due to diabetes. The patient recalled during this revisit appointment that he has been trying to implement the string flossing method but prefers floss picks. Therefore I instructed the patient to continue the use of floss picks in addition to a waterflosser to aid in the disruption of plaque. This patient was given a 3-month recare appointment along with a referral. He was urged to constantly follow up with his primary care physician regarding his HbA1c level, and blood pressure, along with a dentist for further caries evaluation.
