The patient is a 62-year-old Asian male and is ASA II due to having Type 2 Diabetes. He takes Metformin 1000mg 2x day, Acarbose 100mg 3x day, and Atorvastatin Calcium 20mg 1 tab at nighttime. His most recent HbA1c was 6.5, showing his diabetes is well-controlled. The patient uses a soft manual toothbrush twice daily and also uses toothpicks. He does not use floss, mouth rinse, or tongue cleaners. His PI score was 1.33 (fair) on the initial visit and 1.16 on the revisit.
Upon doing the extra-oral examination, a few scars and macules were noted, all WNL. Clicking of the right side TMJ was also noted; the patient reported that he had dislocated his jaw 10 years ago from “opening his mouth too wide” and it has not reoccurred since. The intra-oral examination showed bilateral linea alba, bilateral fordyce granules near the parotid gland, short lingual frenum, scalloped tongue, enlarged mucosal papilla on the left side where he is missing tooth #18, as well as a 2mm petechiae on the right inner labial mucosa. The patient has had a number of restorations, and his radiographs show that he has retained roots on #18, as well as a large overhang seen on #15-M. Calculus and generalized horizontal bone loss, about 30%, can also be seen.
The patient was determined as a Heavy case with localized Stage III Grade B periodontitis. The Modified Bass technique was demonstrated on the initial visit, and flossing was demonstrated on the revisit. While giving the oral hygiene instructions to the patient, I also stressed the importance of maintaining and keeping his diabetes under control, as it will have an effect on his periodontal status. The use of floss/floss picks was also encouraged rather than the use of toothpicks, as I felt that floss would be better at removing the interproximal biofilm buildup. 5% Sodium Fluoride varnish was applied and post-op instructions were given. Overall, I felt that the treatment went well and that the patient seemed willing to work on his oral health. A 3-month recall was recommended for this patient due to his periodontal status.
