Case Study #1
A 74 year old Caucasian male, ASA 3. Patient took premedication of 4 tablets of Amoxicillin 500mg an hour before treatment due to aortic and mitral valve replacements on 11/2020. Patient got clearance from cardiologist and he takes 81mg of Aspirin as needed. The patient presented with a raised scar like tissue on the midline of the dorsal surface of his tongue approximately 2cm by 1cm in size due to a skin graft from his left arm. Pt had a malignant tumor removal of a leiomyosarcoma and his right submandibular salivary gland is absent due to the surgery. The patient’s probing depths were generalized 1-3mm with severe recession. He has a class 1 furcation on #19 and #30 and miss #23-#26. I exposed an fms which revealed generalized horizontal bone loss. Additionally, I gave the patient a referral for possible caries. Due to his periodontal charting and radiographs, he has Stage 3 Grade C periodontitis. The patient is a medium case value for calculus. I used the Slimline ultrasonic, hand scaled, and engine polished to remove the calculus and generalized biofilm. I applied 5% sodium fluoride varnish and gave him post operative instructions. I advised the patient to use a soft bristled tooth brush, and I gave him a proxy brush to clean his furcations. I scheduled the patient to return in 3 months.
Case study #2
85 year old African American male, ASA 3. Patient takes blood pressure medication to keep it controlled and sees his endocrinologist 3 times a year. Patient takes 1 tablet of Metformin 500mg every morning for Type II diabetes. Patient ate before his appointment and did not recall his most recent HbA1C, but states that his doctor was not concerned. Patient takes 1 tablet of Amlodipine Besylste 100mg every morning, 1 tablet of Furosemide 20mg every morning, and 1 tablet of Eliquis 2.5mg 2 times a day for high blood pressure. The patient takes 1 tablet of Tamsulosin 0. 4mg and Finasteride 5mg every evening for enlarged prostate. Patient takes 1 tablet of Pravastatin 20mg every evening for high cholesterol. Patient has Glaucoma that is controlled and takes Lumigan 0. 01 (bimatoprost opthalmic solution). He takes over the counter Calcium 600mg tablet with Vitamin D3, 1000 IU 2 times a day and B complex with folic acid plus vitamin C once a day.
Patient states that he had a blood clot in 2016 and was in a coma for 2 weeks. He had surgery to get the blood clot removed in July 2016. Patient reported that he saw pus around 2 years after the surgery and got it evaluated by his doctor. Patient has a scar on his forehead due to a childhood falling accident. Patient presented with attrition and abfraction on the linguals in sextant 5. He presented with generalized red, inflammed, and spongy gingiva with rolled gingival margins. Patient presented with localized moderate to heavy bleeding with 4-11 mm probing depths on the posteriors. He has class 1 mobility on #7,8,9,18,19,23,24, and 25. He has generalized subgingival calculus in all quadrants, heavy accumulation of plaque and soft debris. He is classified as periodontitis Stage 3 Grade B and has a moderate caries risk due to existing restorations. I kept the patient in semi-supine due to his medical history throughout the appointment. I administered 2 carpules of Lidocaine 1:100,000 in MSA and PSA during each appointment while standing up. The dentist administered papillary injections to the anteriors and a mandibular block of Carbocaine 3%. I used the Powerline ultrasonic, hand scaled, engine polished, and applied 5% sodium fluoride varnish with post operative instructions. I advised the patient to rinse with salt water, gave him a proxy brush, and recommended for him to come back in 3 months. A referral was given for the inflammation on his maxillary anteriors under his bridge, which revealed around 30% of bone loss. Patient was given a referral for periodontal disease and a copy of his x-rays for restorative work.
