Comprehensive Dental Care for a 65-Year-Old African American Female with Diabetes, Hypertension and High Cholesterol.
Patient reports her current medical conditions which include type 1 diabetes, hypertension, and high cholesterol.
Medications: Insulin (levemir) 10 mg for type 1 diabetes, Glucophage (metformin) 1 g for type 1 diabetes, Toprol XL (metoprolol) 50 mg for hypertension, Qbrelis (lisinopril) 40 mg for hypertension, Microzide (hydrochlorothiazide) 25 mg for hypertension, and Zetia (ezetimibe) 10 mg for high cholesterol.
Last HbA1C: 5.4%
ASA 2 due to the several managed medical conditions and type 1 diabetes
Dental history: Uses a soft manual toothbrush twice a day with a water flosser
Clinical Findings:
EO: TMJ-clicking on the left side only
IO: Enlarged tonsils, coated tongue, hyperkeratinized retromolar pads, nodule on the left tonsillar pillar (invagination)
Dental charting: Bilateral class III occlusion, posterior and anterior edge-to-edge occlusion, posterior cross-bite on the right premolars, abfractions on #’s 3, 4, 5, 9, and 28
Caries risk: High
Gingival statement: Gingiva is generalized pink with blunted and puffy interdental papilla.
Periodontal charting: Generalized 1-3mm PD with localized 4mm PD. Generalized recession especially in the maxillary right molar region (3mm of recession).
Radiographic Statement: Generalized horizontal bone loss of about 15%
Periodontal status: Stage II, Grade B
Treatment plan:
Routine doctor visits
For a patient with these medical conditions, it was important to ask if she is seeing her endocrinologist and cardiologist regularly. Collaboration with her endocrinologist and cardiologist will ensure that her dental treatment aligns with her diabetes and cardiovascular management. Medication interactions and potential implications for dental procedures were also discussed with the patient.
Preventative care
The importance of meticulous oral hygiene practices was stressed to the patient. I discussed how diabetes and periodontal disease have a bidirectional relationship and it is essential that she stays on top of her oral hygiene which she does in fact do a great job at. Since she is currently using the manual soft bristled toothbrush, I recommended the Sonicare powered toothbrush to avoid future areas of recession. The patient reported that she does brush very abrasively so the powered toothbrush will definitely benefit her since Sonicare has the feature that reminds the user when they are brushing too hard. The importance of 3-month dental cleanings was also stressed to the patient since she is a Stage II, Grade B. I explained to her that periodontal disease is not reversible, but the aim is to stop the progression of the disease.
Oral lesion evaluation
The patient was informed about the nodule on the left tonsillar pillar. A referral was written for her ENT to ensure it’s not malignant. This lesion will be checked at every visit to detect any changes in size or appearance.
During the process of obtaining this patient’s medical history, I asked if she checked her blood sugar levels and if she ate in the morning which is a very important question to ask diabetic patients. I also made sure that she was comfortable throughout the visit to ensure that her blood pressure did not increase since she is taking several high blood pressure medications. Routine dental cleanings (every 3 months for her case) and collaboration with her healthcare providers are essential components to not only manage her oral health, but her overall systemic health as well.
