History: Recare/M/II – 82-year-old, Caucasian male. Vitals of 104/72, pulse: 82 (according to normal). HbA1c levels are 5.6% and HIV status is undetectable. Prescribed Amoxicillin (2g) daily for shoulder replacement, Januvia (50 mg) daily for diabetes mellitus type II, and Biktarvy (3 medication cocktails) daily for HIV. Non smoker/drinker. ASA II. The patient uses an electric toothbrush (Sonicare) with Colgate toothpaste twice a day, uses string floss twice a day, Listerine TotalCare mouthwash twice a day, and scrapes their tongue with a plastic tongue scraper twice a day. The last dental visit was 4 months ago for cleaning, exam, and x-rays (FMS). The patient reports not wearing his lower partials due to ill-fitting. Itraorally presented with a red single lesion on labial mucosa by #21 from repetitive biting, fissured tongue and constricted palate, varicosities under and left lateral side of the tongue. Generalized missing teeth, amalgam, composite, and crown restorations, a 3-unit bridge on #12-14, and mild attrition on the anterior incisors present. Gingiva appears pale-pink, with enlarged diffuse gingiva, blunted and bulbous interdental papilla, moderate inflammation and rolled gingival margins, leathery and puffy consistency, and smooth and shiny appearance. Periodontally presented with pockets of 2-5 mm, recession of 1-6 mm, CAL of 4-8 mm, class I mobility on #22 and 27, class II mobility on #6 and 9, class II furcation on #2 and 18, and mild BOP. Generalized moderate subgingival calculus on the interproximal and cervical thirds with moderate extrinsic staining. PI score of 1.2 (fair).
Diagnosis: The patient is at moderate risk for caries due to generalized restorations present. Classified as generalized medium periodontitis stage III, grade B, due to HbA1c levels, HIV status, CAL pockets of 4-8 mm, furcations, and mobility present.
Treatment and Hygiene care plan: A referral was given for lower partials. Educated the patient using the C-string flossing method for the interproximal and Modified Bass Brushing technique for the cervical thirds of his teeth. Disclosed PI. Performed prophylaxis using Ultrasonic and hand scalers with Oraquix (2.5% Prilocaine and Lidocaine) and engine polished with medium prophy paste. Applied 5% fluoride varnish. Scheduled next periodontal maintenance care (3 months).
Reflection: Following the treatment of this patient, I gained a clear understanding of the significance of acquiring a comprehensive medical history. Specific inquiries and precautions are essential when caring for individuals with conditions such as HIV and diabetes. Understanding the systemic effects of medications is paramount, given their significant role in treatment. Additionally, patient education is vital. I ensured that my patient comprehended the importance of maintaining optimal oral health.
