In this case, I will be talking about the patient with high cholesterol, high blood pressure, cancer, and the impact it has on her mouth. 

Oral Interview

This case will present a 74-year-old Hispanic female with a history of breast cancer, high blood pressure, and high cholesterol. The patient was recently hospitalized due to breast cancer. She had radiation therapy (20 sessions) for 4 weeks and finished it in April 2023.

Medications:

  • Lovastatin for high cholesterol
  • Triamterene for high blood pressure
  • Anastrozole for breast cancer
  • Multivitamins
  • Calcium
  • Vitamin D

BP 1st reading: 165/91 P 84

BP 2nd reading 165/100 P 80

The patient was in a rush to get to her appointment and forgot to take her medicine in the morning. Since the patient was previously seen in the clinic, the doctor gave permission to complete all assessments and gave the patient a referral to see her primary doctor for medical clearance. ASA 3

The patient is not drinking or smoking.

She complains of a dry mouth. She is brushing two times a day with a manual toothbrush, Crest toothpaste, and Listerine alcohol rinse at night. She is not flossing or using a water flosser. The last time she saw a dentist was a year ago. The patient reported having tooth #5 removed. The last dental cleaning was in May 2021.

Assessments

EO: 2x2mm round white raised lesion on the back of left ear

IO: bilateral linea alba, mandibular tori. tonsil stones

Dental Charting: Overbite 10%, Overjet 3mm, Occlusion Class I bilateral.

Gingival Statement: The gingiva was generalized moderate red, inflamed, soft, and smooth. The gingival margin was moderate red and rolled on the lingual side on the maxillary and mandibular arch by the premolar and molar areas. Localized mild bulbous on mandibular facial anterior teeth.

Periodontal Charting: Generalized 1- 4 mm pockets with localized 5 and 6 mm. Generalized recessions of 1-2 mm. Furcation involvement class 1 on tooth #30. Generalized mild BOP

PI score: 2 (poor)

CAMBRA: high due to xerostomia, and active caries

Radiographic Statement: Using 7 mA and 70 kV FMS, 20 images were taken. There were suspicious caries and retained root tip of tooth #12, localized calculus present on the mandibular anterior, suspicious lesions around the apex of tooth #12, furcation involvement tooth #30 and no impacted teeth. Generalized horizontal bone loss of up to 30%. The patient is missing teeth #1, 5, 14, 16, 17,  19, 31, and 32.

Implementation

She was classified as having generalized light periodontitis, stage III, grade B. Based on the assessments, a treatment plan was developed. There were two appointments to complete the patient.

Initial visit: medical history was taken, all assessments completed, PI score, treatment plan signed, and dental radiograph completed. Referral given.

1st revisit: Quadrants whole mouth was scaled to completion, with Topical 20% Benzocaine Gel. Engine polished and applied 5% Sodium Fluoride Varnish.

OHI: electric toothbrush with soft bristles twice a day; flossing with regular string floss at night; biotene mouthwash for xerostomia due to patient medications.

Evaluation

The patient recare is on a 3-month.  Patient started to floss with floss picks after instructions were given. The patient did not  changed her oral rinse to Biotene mouthwash to minimize xerostomia. She never came back for her 3 months recare.