This study focuses on a 35 year- old White Female patient who came in for a “Dental cleaning”. When she arrived the medical history was filled out and vitals were taken. She was placed into the Hypertension Stage 1 category ( BP 101/84 P: 66) and a ASA II, she was given a referral to take care of that. Her medical history pertained of her most recent visit being in September 2023 as a follow up appointment from May 2021 for her Gallbladder removal. No significant findings were noted during her followup. This patient presented with Amenorrhea which is the absence of menstruation, and this was diagnosed by her PCP 1 year prior. The patient also presents with Hidradentitis supportiva which was diagnosed 2 weeks prior to the appointment, along with Gastroesophageal reflux disease or GERD occurring on a daily basis for 3 months. The patient also presents with hay fever which she suppresses with Zyrtec. She was a nonsmoker but previously a social drinker, and due to her diagnosis of GERD she stopped. The patient stated she was taking Several medications that were prescribed by her doctor: Elinest 0.3mg QD for Amenorrhea , Sertraline 100mg QD for anxiety , and Omeprazole 20mg QD for GERD. She also takes OTC Calcium supplements 650mg and Vitamin D 200IU QD. Her last dental checkup was in February 2022 for SRP along with radiographs of 4HBW. when asked about her dental homecare habits she claimed to brush twice a day with a soft bristled manual toothbrush using the Fones circular brushing technique, with Parodontax toothpaste. She flosses with waxed string floss 1-3 times on a weekly basis and does not use any mouthwash. Patient presents with sensitivity to cold on the mandibular posteriors.
CLINICAL FINDINGS
Extraoral/Intraoral Findings: After completing a ExtraOral cancer screening exam on the patient, everything was presented within normal limits. However, after thoroughly completing a Intra oral exam the patient clinically presented with a decrease of saliva excretion from salivary glands. GERD is a condition where stomach acid regularly flows back into the esophagus, causing irritation. This irritation can affect various parts of the mouth and throat, leading to symptoms like dry mouth. This is also caused as a side effect from several medications she is taking such as Elinest, and Sertraline, Omeprazole and Calcium supplements. She also presented with Palatal torus, bilateral Mandibular torus as well as bilateral lines alba and a severely white coated tongue.
Dental charting: The patient presented with a Class 2 Bilateral occlusion, along with a 4mm overjet and 40% overbite. Erosion is present along the maxillary and mandibular anterior linguals, which is an effect of acid reflux and gastric issues. She also presented with occlusal composite restorations, along with impaction of #17. #1,16,32 were not clinically present. The gingiva presented as Generalized dark pink gingiva with enlarged gingival papillae and red gingival margins , along with localized pinkish red rolled non stippled gingiva with a spongy/bouncy consistency in the Maxillary and mandibular posterior regions, coronal to the CEJ.
Calculus: Generalized moderate supra gingival and subgingival calculus, Localized heavy supra gingival and subgingival calculus on the Anterior mandibular linguals and the posterior buccal/ lingual aspects of both the maxilla and mandible. Brown and Black staining also present along the occlusal grooves of the molars.
Periodontal Charting / Diagnosis : After completing a full mouth periodontal assessment with the UNC-15 probe, the patient presented with probing depths ranging from 1-4mm with localized gingival recession on #2, #3, #14, #15, #19, #31 of 1mm on the direct buccal aspect with generalized Bleeding on Probing ( BOP). Due to the objective results of completing all assessments, this patient was diagnosed as a Moderate gingivitis generalized extent due to the inflammation of her gingiva and probing depths of 4mm which indicate inflammation due to subgingival calculus/bacteria buildup, along with bleeding on probing and during calculus detection.
CAMBRA – Caries Risk Assessment: After conducting a questionnaire focusing on caries risking habits, it was concluded that this patient is at a Moderate risk for Caries due to her medications and systemic conditions causing dry mouth and reducing salivary flow production.
Dental Hygiene Care Plan
Educate the patient about the risks of gastric medications and explain that it could be the cause of dry mouth, erosion, and periodontal disease.
PI/OHI: I taught the modified bass brushing technique while also suggesting that the patient use an electric toothbrush as an alternative. In addition, there is the c-shaped flossing method. I recommended using both parodontax and Colgate sensitive along with Therabreath Dry mouth Mouthrinse. I discussed the benefits and importance of nightly brushing and flossing. I reviewed diet with the patient and emphasized the dangers of eating a high-fat diet, such as fried food, which can exacerbate acid reflux symptoms.
A total of one visit was needed for treatment. The patient was due for X-rays and due to the impaction of third molar #17, and reported pain on the lower left, I insisted and educated the patients on the benefits of taking a Panoramic radiographs with 4 HBW, which were to have a visual of their entire mouth and jaws, detecting impacted teeth, assessing bone abnormalities, evaluating dental development, and educating patients regarding their current oral health status which the patient happily agreed to. A copy of the radiographs were given to her on a USB flash drive to take home. Following radiographs came SRP of the whole mouth along with stain removal with engine polishing and fine prophy paste, and concluding her visit with 5% sodium fluoride varnish to help with her erosion and sensitive enamel. Lastly , a referral was given to the patient for her HTN vitals.
Managing a patient with both dry mouth and gastroesophageal reflux disease (GERD) requires a multifaceted approach aimed at addressing the underlying causes and symptoms of both conditions. Through thorough medical evaluation, including a review of medications and lifestyle habits, healthcare providers can tailor treatment plans to alleviate symptoms and improve overall oral and digestive health. This may involve medication adjustments, lifestyle modifications such as dietary changes and weight management, and emphasizing good oral hygiene practices. Saliva substitutes and dietary counseling can help manage dry mouth symptoms and reduce the risk of oral complications, while regular follow-up appointments allow for monitoring of progress and adjustment of treatment as needed. By taking a holistic approach to care and fostering collaboration between medical and dental professionals, patients can receive comprehensive management of their conditions to improve their quality of life and reduce the risk of complications.
