Case #1 Patient with Anemic Condition
This patient was a young female, and was one of my patients who had anemia. When treating a patient with systemic conditions during a dental visit, it is crucial to prioritize their overall health and well-being. I began by obtaining a comprehensive medical history, including information about the type and severity of the patient’s anemic condition, transfusion status, and any associated complications. The patient has thalassemia, an inherited anemic disease in which the body naturally lacks red blood cells and hemoglobin to carry oxygen around. Patient reported that this condition ran in her family. The patient was under the care of her PCP. The patient did not need any blood transfusion. She used to take iron supplements a few years ago but stopped her medication after gaining approval from her PCP. The patient had a check-up and blood work recently. The patient’s vitals were measured to be BP: 96/72 normal. Pulse: 68 normal. The ASA classification for this patient was ASA II. The patient was not taking any medication and did not use any tobacco products or drink any alcohol. The patient’s last dental cleaning and check up was in 2019. Patient reported that she used Phillips sonicare power toothbrush to brush two times a day. The patient was within an acceptable range for dental cleaning.
Thalassemia can increase the risk of bleeding and bruising; this needs to be taken into consideration during the treatment. During the assessment it was noted that the patient has multiple restorations on occlusal surfaces and possible recurrent caries. The patient had a medium level of calculus. The patient had a generalized moderate level of gingivitis but no periodontist disease was observed. Findings were confirmed with radiographs. During the treatment, Oraqix was used for the initial visit. Patient was feeling sensitive thus local anesthesia was taken into consideration for future treatments. Patient had light BOP during perio assessment but was bleeding more heavily later on during the cleaning and scaling. 2% lidocaine 1/100,000 epi was
used for the patient at the following visit for pain management and bleeding control. Also, chair positioning and patient positioning were very important in this case. When the patient has anemia, in this case the patient has thalassemia. The patient lacks RBCs and hemoglobin to carry oxygen throughout her body. It would cause a sudden drop in BP if the patient was laid down too far back and got up too quickly. I made sure the patient was being placed in no more than 45° angle of chair positioning (semi-supine) and I slowly raised her up throughout her treatment. I practiced standard infection control measures to minimize the risk of infections. This patient was complete and tolerated the treatment well.
Case #2 Out of Scope Case Patient/ Dental Anxiety
This case that I’m going to present is an out of scope case according to NYCCT dental hygiene department policies and protocols. The patient was a middle-age male. The patient had dental anxiety and stated that he has never had a dental cleaning done before. The patient decided to come in because he felt one of his teeth was mobile. The patient did not have any systemic diseases and reported that he does not smoke nor drink alcohol. The patient’s vitals were BP: 134/83 which corresponding to stage one hypertension, pulse: 91 normal. The patient’s ASA classification was ASA II. Patient reported to use soft manual toothbrush to brush one to two times a day. Patient reported to use waterpik occasionally and not using any oral rinse. During the dental hygiene visit, I talked to the patient in a calm and soft tone. I was being supportive by telling him it was very brave and amazing that he could come to our clinic. I tried to manage any possible stress and anxiety that he might have about the dental checkup. During assessment, it was noticed that the patient had bilateral, movable, submandibular lymph nodes which patient reported to be asymptomatic. Patient had an ulcer on the middle of lower lip, sized about 2 mm in diameter. The patient also had bilateral linea alba, bilateral maxillary exotosis, and 1mm petechiae on the left side of buccal mucosa near tooth #3 and #30. The patient had edge to edge bite, 0 overject/ overbite. The patient had generalize severe gingival recession. #30 had level 3 mobility. #24 to 25 had level 1 mobility. #31 was extracted and no crown was placed. The patient gingival tissues were severely inflamed, generalized read an in large gingival margin, smooth texture, flaccid consistency with generalize heavy BOP. The patient had extremely heavy calculus. The patient had severe periodontal disease. A full mouth series of radiographs were exposed after gaining the patient’s consent. The radiographs indicated generalized over 50% of horizontal bone loss, para apical pathology was seen between #18 and 19; furcation involvement of #2, # 3, #14, #15, #19, and #30. The patient was classified to be a stage IV, grade B for perio staging and grading. (Out of scope for NYCCT dental clinic). The clinical and radiographic findings were confirmed with a dentist on the floor. The patient was referred to see periodontists. A referral and a copy of radiographs were given to the patient. I along with the faculty explain the situation and the periodontal condition to the patient. The patient understood.
