Case study #2 High blood pressure (M/III-B)
New patient: 53 year old East Asian male presented to clinic for a regular cleaning and checkup. Patient was diagnosed with high blood pressure by their PCP and has been taking Olmesartan 12.5mg every night before bed for the last 2 years. Patient is a social drinker and smokes about 7 cigarettes daily. ASA 2 due to high blood pressure, medications, and smoker/drinker. Patient states they experience dry mouth upon waking due to mouth breathing. Patient also has sensitivity to cold on their upper teeth. Patients last dental exam was done in June 2021, however no radiographs were taken due to no insurance. Last dental radiographs were done more than 5 years ago. Patient currently wears a temporary flipper denture for placement of implant on lower anterior teeth. Patients reported OHI consists of using a sodium monofluorophosphate toothpaste 2-3x daily using a medium bristled toothbrush. Patient flosses rarely, almost never and does not currently use any oral rinses. Patient does not use any tongue scrapers.
Upon assessment patient presented with TMD during EO examination, patient states they do not have pain. For the IO examination patient had mandibular tori present with unilateral linea alba on the left side. Patient also had keratinized tissue on labial mucosa due to lip biting. Patients gingiva had generalized cratered pink margins and felt smooth. Patient had light stippling and generalized inflammation along the gingival margins. Localized embrasure spaces on tooth #6,7, 8, 9, 10. Localized gingival inflammation and bone trauma present on tooth #24-26. Patient is missing teeth #1,2,14,15,16,17,24,25,26,32. With an implant on #8 and an implant crown. Patient does not remember when the implant was done but states it was more than 10 years ago. Patient also has diastema present in between #8,9 possibly due to short upper labial frenum. Patient had a Class II occlusion with a 5mm overjet and 50% overbite. For the periodontal charting, patient had generalized 1-3mm pockets with localized 4-6mm pockets on the molars. Patient also had localized 2-6mm of CAL and moderate BOP. FMS was recommended for patient to see bone loss. Patient had localized supra gingival calculus on the upper and lower anteriors, and localized sub gingival calculus on posterior teeth. Treatment plan consisted of 3 visits. Periodontal status was determined to be Stage 3 Grade B according to the AAP classification and guidelines. Radiographs were also utilized for diagnosis. General referral form was given to patient for care to a Periodontist and for high blood pressure.
Visit #1: Discussed medical, social, and dental history. Reviewed patients OHI. Completed all assessments (EO/IO, dental/perio charting, calculus detection. Disclosed with disclosing solution and educated patient on Modified Bass toothbrushing method. Treatment plan was discussed with patient prio to treating. Scaled teeth #3 and #4-D using only hand scalers.
Visit #2: Discussed any changes to medical, social, and dental history. Reviewed OHI from last visit. Exposed FMS radiographs and copy of radiographs were given to patient. Radiographs were utilized to diagnose periodontal status. Any findings on radiographs were rendered to patient. Disclosed with disclosing solution and educated patient on different interdental aids. Recommended patient to use interdental brushes to clean between the embrasure spaces as well as diastema. Applied topical Benzocaine 20% generalized to quadrant 1 and 4 prior to scaling. Scaled quadrant 1 and 4 using ultrasonic and handscaler.
Visit #3: Discussed any changes to medical, social, and dental history. Reviewed OHI from last visit. Disclosed with disclosing solution and educated patient on different oral rinses. Recommended patient to use an antiseptic rinse daily. Applied topical Benzocaine 20% generalized to quadrant 2 and 3 prior to scaling. Scaled quadrant 2 and 3 using ultrasonic and handscaler. Engine polished with medium prophy paste and applied 5% sodium varnish. Post op instructions were given to patient and recommended patient to come back every 3 months for recare.
