Comprehensive dental care for a 64-Year-Old Italian Female with Multiple Health Conditions.
Patient reports her current medical conditions which include, rheumatoid arthritis with chronic pain, thyroid conditions, osteoporosis, and frequent migraines.
Medications: 100 mcg of Synthroid (levothyroxine) to manage her thyroid, 25 mg of Arava (leflunomide) for rheumatoid arthritis, 300 mg of Gralise (gabapentin) to manage chronic pain from rheumatoid arthritis, 20 mg of Paxil (paroxetine) for anxiety (which causes dry mouth), and 81 mg of Aspirin to prevent strokes (no history of cardiovascular disease). Patient is allergic to Penicillin and iodine. Her blood pressure was 136/89 and pulse was 70 BPM (stage 1 hypertension). This patient is an ASA 2 due to several managed medical conditions, allergies and stage 1 hypertension.
Dental history: Wears Invisalign inconsistently for 3 years, uses a manual soft bristled toothbrush once a day with Listerine Total Care and occasionally uses floss picks.
Social history: Previous history of smoking, does not consume alcohol.
Caries risk: Moderate
Clinical findings:
EO: TMJ: Clicking on the right side only (no pain)
IO: Raised circumvallate papillae, torus palatinus, bilateral mandibular tori.
Dental charting: Bilateral class 1 occlusion, 3mm overjet, 50% overbite, generalized intrinsic staining, localized mild attrition.
Periodontal assessment: Localized mild gingivitis mainly on the lingual surfaces of the posterior teeth.
Calculus: Light supragingival calculus
Previous dental issue: Pus filled lesion on a dental implant
Collaborative Approach:
Given this patient’s complex medical history, collaboration with her rheumatologist and endocrinologist is essential. Rheumatoid arthritis and thyroid complications can impact oral health and influence treatment outcomes, so coordinating care will ensure alignment with her overall health management. A referral was written for her dentist to do an evaluation on the pus-filled lesion on the implant. It was important that her dentist checks the site of the implant before this area was cleaned because if there was a serious infection, it could be possible that she may need premedication if that area was to be touched.
OHI:
A manual soft bristled toothbrush may not be the best option for this patient. Rheumatoid arthritis comes with dexterity issues and this patient states she has chronic pain. A powered toothbrush is definitely recommended for rheumatoid arthritis patients. A water flosser would also benefit this patient because waxed string floss is almost impossible to do for some patients with rheumatoid arthritis.
Periodontal therapy:
Addressing localized gingivitis through scaling and root planning not only improves this patient’s periodontal health, but also decreases the risk of systemic complications associated with periodontal disease, particularly in patients with rheumatoid arthritis.
Managing high blood pressure in the dental office:
As a dental hygienist, managing a patient with hypertension involves being mindful of their condition during dental procedures. I ensured that the patient was comfortable in the chair and avoided anything that could possibly increase her blood pressure. Additionally, discussing the high blood pressure with the patient and writing a referral for an evaluation with their physician is crucial for their overall well-being.
In managing the oral health of a patient with multiple comorbidities, a comprehensive approach that integrates medical and dental care is essential. Regular follow-up appointments enable continuous evaluation of this patient’s oral health status, medications, and overall well-being. This proactive approach facilitates early detection of any changes or complications, allowing for adjustment of treatment as needed. The chosen treatment plan for this patient reflects a patient-centered approach that integrates her medical and dental needs. By addressing her specific challenges and tailoring interventions accordingly, we aim to optimize her oral health outcomes while promoting overall health and quality of life.
