Case study #1 Asthma and Diabetes
Med HX : 76 year old white female ASA 2 BP: 110/82(Hypertension stage 1) pt. has type 1 diabetes current HBa1c level 6.1. She takes Humalog and Lantus once a day.Pt also has asthma and has her albuterol inhaler for emergencies . The patient is aware that she has a limited jaw opening and stated it is due to issues with her TMJ. She is currently going to NYU for therapy to treat her TMJ issues.
DEN HX: Pan X ray at NYU Dental clinic in July 2023
Oral examination: During intraoral examination a palatal tori and bilateral mandibular tori was present. During dental charting there was a overbite 10 %,overjet 4mm, and bilateral class 2 occlusion. During calculus detection the patient had generalized heavy sub gingival and supra calculus with heavy bleeding upon probing and exploring . The periodontal status presented as generalized 3 to 4 mm pockets with localized pockets up to 7mm in the molars . Since the patient has diabetes it can increase her severity of periodontitis which explains the deep periodontal pockets.
Link between diabetes and periodontitis: Having diabetes can suppress a person’s immune system, therefore this can cause more inflammation of the gingiva because the body can not fight off the bad bacteria in the mouth which ultimately results in damage of the bone. Periodontitis can also affect the patient’s diabetes because the inflammation can increase the severity of insulin resistance which will make it harder to manage the blood sugar levels. Periodontitis can raise blood sugar levels which make diabetes management more challenging. This is why it is crucial for the patient to continue having routine cleanings every 3 months and maintain adequate homecare. As well as continuing to manage her diabetes with medication and diet or nutrition.
Treatment implementation– Based on my assessments the patient is classified as a heavy Stage 3 Grade B periodontal case. Due to the patient’s pain tolerance and limited mouth opening I decided to only conduct assessments on the first visit. I split up her case into 2 consecutives visits. One visit I worked on Q1 and Q4 and the final visit I worked on Q2 and Q3. Each visit I ensured my patient had something to eat in the morning and ensured she had a sweet snack to control her blood sugar. I also took multiple breaks as needed so her jaw could rest, then continued treatment. I also ensured during each appointment that her albuterol inhaler was on the counter . As for homecare I recommended this patient to start flossing more often. I specifically recommended her to use a normal string floss due to her tight contacts between each teeth and to increase her brushing habits as she only brushes once a day. I educated the patient on the importance on brushing at night as well as demonstrated how it should be done. I also provided nutrition counseling to ensure she is eating healthy foods to maintain her sugar level. Lastly, I gave the patient a referral to seek periodontal treatment as she does have deep pockets which could result in bone loss .
