Hypertension Patient

53 y/o African American female L. G presented to our clinic for routine oral hygiene care; she mentioned that she was having pain when masticating on her upper left molar teeth. Reviewing the patients’ medical history, she disclosed that she is a non-smoker, had no recent hospitalizations, is  allergic to penicillin and is taking Irbesartan and Hydrochlorothiazide for several years to treat Hypertension condition. After taking her initial blood pressure reading of 147/ 91, stage I hypertension, she was given an ASA II classification.  Although her blood pressure was high, she had taken her medications as instructed and was given authorization to continue her visit by the dentist on the clinic floor. Since the blood pressure was high I gave the patient some water and multiple breaks throughout the treatment.

First I did an EO/IO examination, noted that she presented with multiple black and brown papules on the face and neck, bilateral movable nodules adjacent to mandibular bone, unilateral left side crepitation, dry mouth due to mouth breathing, maxillary torus, bilateral linea alba, short lingual frenum, scalloped tongue and moderate leukoedema on buccal mucosa. the patients’ dental restorations were intact but caries were observed on #2- L, #9- I and #32-O. Class I molar occlusion visible w/ 50% overbite and 6mm overjet. Attrition was present throughout the dentition. L.G presented with gingiva that was pale pink, soft, not resilient, rolled edge margins w/ blunted and cratered papilla.

picture was acquired from google images  example of leukoedema

Continuing with examination, periodontal examination was done. The periodontal pocket depths ranged mostly from 3-4mm with localized 5-6mm and on #15 a 7-9mm with severe mobility noted. Radiographic evidence from 2013 supported a type II with localized type III/IV periodontal status, the radiographs showed generalized horizontal bone loss and areas of furcation involvement. There was heavy bleeding on probing, inflammation, as well as generalized supragingival and localized subgingival calculus. Thus, the patients’ case value was a heavy/ II localized III/IV. Plaque index was taken with a 1.3 scoring.

After all assessments were completed, I discussed with the patient the plan of treatment that would be taken and completed in a estimate of three visits. In this conversation, I advised the patient to consult with her physician regarding her elevated blood pressure while taking her medications as directed. I also advised her on using Crest pro- health or Biotene as oral rinse because it could help with the dry mouth while keeping the oral cavity clean after brushing. I also recommended her to bring water to her appointments which seemed to help with the drying of the mouth throughout treatment and blood pressure readings. Although this had not been L.G first visit at our facility, she did show signs of being nervous which may have impacted her blood pressure reading, this allowing me to use positive reinforcing words throughout treatment as well as giving the patient some control to stop treatment when felt necessary.

Once treatment was completed, the patients’ gingiva responded positively by becoming firmer and with decreased bleeding. Although during each visit the patients’ initial blood pressure was at a stage 1 hypertension level, through carefully and asking the correct questions I was able to complete her treatment while not providing any risks to the patients health.

Arestin Placement

23 y/o Hispanic male with no medical history, conditions, medications, hospitalization or allergies; T. C presented to our clinic for routine oral hygiene care. In the EO/IO examination pt. presented with acne scar inferior to left border of the jaw, right side crepitation, biliateral linea alba and mandibular tori. The patient’s dentition was class 1 molar occlusion with 20% over bite and 3mm overjet; attrition visible throughout dentition and central mandibular anterior crowding noted. Patient present with enlarged pigmented gingiva and moderate marginal/ papillary inflammation. Probing depths ranged between 2-6mm with moderate bleeding upon probing. The patient’s case value was M/II with radiographic and clinical evidence. I recommended Arestin for the patient, because I believed that he would benefit from it. The patient came back for Arestin placement  a week and  a half  after scaling was completed on the area of placement.

♦ Initial probing depths: #2-ML (5mm),#3DL (5mm), #3DB (5mm), #30ML (5mm), #30DL (6mm), #31ML (6mm)

Periodontal bone level graph by Dentimax

Patient presented for re- evualuation, several weeks later, of Arestin spots. Visually the gingiva had minimal to no inflammation and enlargement was decreased significantly. The patient disclosed that he followed post op instruction and implemented oral hygiene instructions given into daily routine; which worked positively in favor of the health status of his gingiva.

♦ Probing depths after SRP and Arestin placement:#2-ML (3mm),#3DL (4mm), #3DB (4mm), #30ML (4mm), #30DL (4mm), #31ML (4mm)