Assessment: A 68 years old, Caucasian male patient visited to get a dental cleaning. BP- 110/70, corresponds to normal. NKA reported. Patient stated that he sustained injury due to a fall to his wrist and had left wrist surgery with placement of pins in Mar’23. Patient stated his physician did not request antibiotics for dental visit. Patient is under the care of Endocrinologist and Cardiologist. Last check up with Endocrinologist was in 12/19/23. Patient’s Hba1c: 6.6 (Mar’23), 7.1(Sep’23), 6.3(Dec’23). Patient reported that he takes Metformin 1000mg twice a day, Prandin 4mg 3x/day, Farxiga 5mg 1x/day/ Mounjaro injection 15mg for diabetes. Metoprolol 200mg at night, Losartan 100mg once a day, Chlorthalidone 25mg for hypertension. Tamsulosin 0.8mg capsule once a day at night for benign prostate hyperplasia. Low dose Aspirin 81mg to prevention of clotting. Takes Omeprazole 40mg once daily in morning for GERD, Allopurinol 50mg once a day for prevention of gout. ASA: 2 due to controlled diabetes, hypertension, benign prostate hyperplasia, GERD. SH: No illicit drugs, non-smoker, no alcohol consumption. DH: Patient stated that his last dental cleaning was Dec’23 and had 4BWs Nov’22. Patient stated that #18 extracted at 2014. Patient reported he uses Sonicare electronic TB, Sensodyne TP, flosses twice a day, Colgate fluoride oral rinse daily. 3M 0.63% Stannous fluoride oral rinse occasionally.
| brand name | Generic name | Pharmacologic Category | Therapeutic Indication | Dental Effect | Adverse Effect |
| Fortamet | Metformin | Biguanide antihyperglycemic agent | Management of type II diabetes | A metallic taste in the mouth | nausea, vomiting, diarrhea |
| Prandin | Repaglinide | Meglitinide | Improve glycemic control in diabetes | Sore throat, bleeding gum | Anxiety, blurred vision |
| Farxiga | Dapagliflozin film-coated tablets | SGLT2 Inhibitors | Glycemic conrtrol with type II diabetes | Swelling of your lips, tongue or throat | Hives, anxiety |
| Monjaro | Tirzepatide injection | Glucagon-like Peptide-1 Agonists | Glycemic conrtrol with type II diabetes | Swelling of your lips, tongue or throat | Hives, anxiety, nausea, diarrhea |
| Kapspargo | Metopolol | Beta-blocker | Treat hypertension | Hypotension | Blurred vision, Chest pain |
| Cozaar | Losartan | Angiotensin II receptor blocker | Treat hypertension | Hypotension | Fainting, back pain |
| Edarbyclor | Chlorthalidone | Diuretic | Treat hypertension | Xerostomia | Dizzness, diarrhea |
| Flomax | Tamsulosin | Alpha-1A, Alpha-1B adrenergic receptor | Treat benign prostatic hyperplasia | Tooth disorder | Abnormal ejaculation, dizziness |
| Aggrenox | Aspirin | Salicylate | Treat fever, inflammation , reduce risk of cardio event | Xerostomia | Headache, upset stomach, |
| Konvomep | Omeprazole | Proton pump inhibitor | Treat GERD | Bleeding gum | Diarrhea, headache |
| Aloprim | Allopurinol | Xanthine oxidase inhibitor | Reduce serum uric acid in patient with gout | Bleeding gum | Chills, Cloudy urine |
EO: A large superficial raised tan colored lesion, 12mm, under left eye orbit present since childhood. Patient was seen dermatologist Nov’23, asymptomatic, and was recommended to not remove it.
IO: Bilateral linea alba. Left side buccal mucosa flat red irregular border line macule and right side buccal mucosa elevated 2x2mm white papule present, pt states that he bit his cheek few days ago. Deep fissured tongue. Attached gingiva on apical of #22 has 3x3mm solid raised lesion present -asymptomatic.
Occlusion: Bilateral class I, overjet 4mm, overbite 30%. Attrition on all anterior teeth.
Gingiva appeared slightly red, soft, non-stippled with rolled and inflamed margins and bulbous papillae. Generalized moderate marginal gingival inflammation. Gingiva is generally located coronal to CEJ with localized areas of recession apical to CEJ.
Generalized PD 2-5mm in the posterior, 2-4mm in the anterior. Moderate BOP. No mobility or furcation. Calculus was localized posterior subgingival calculus. – case type decided as medium. Stain was heavy along the gingival margin.
DIAGNOSIS: Generalized Periodontitis Stage I, Grade B. Caries risk was moderate due to visible plaque and existing restorations / CAMBRA done – encouraged to use fluoride products, regular dental care, oral hygiene.
Since patient took less than 2 years ago, x-rays were not recommended. Reviewed 4VBWs exposed at Nov’22. Radiographic findings were no caries, calculus noted, generalized horizontal bone loss less than 15% noted.
PLAN/ Implementation:
- first visit – completed assessment. Acquire PI score: 1.0. OHI: Introduce modified bass electronic toothbrush technique/ Patient was able to re-demonstrate it on his own. Ultrasonic scaled 1,4 quadrants. Re-eval and rescaling needed Q1,4.
- Second visit – Reviewed med hx, EO/IO. Acquired PI score: 0.8- decreased. OHI: reviewed modified bass electronic toothbrush technique and introduced flossing techniques/ patient was able to demonstrate it on his own. Hand scaled and used ultrasonic to scale all quadrants to completion. Engine polished, applied 5% varnish sodium fluoride/ post follow up instruction was given. Tx completed.
Evaluation: I saw this patient in third semester first and he came back to see me in fourth semester again – I recommended 3 months recall since patient has periodontitis. The patient was very cooperative and had a strong will to maintain systemic and oral health due to his history of several systemic diseases. After seeing the patient 3 months later, there was localized calculus build up, but there was no significant difference, and the gingiva was also maintained in good health with no significant difference. I tried to spend enough time checking the medical history in every visit and proceeded with scaling while continuing to communicate with the patient. At every visit, the patient left satisfied.
