Case Overview
This case involves a 70-year-old female patient presenting for periodontal maintenance with a history of Stage 2 Hypertension and significant anxiety regarding antihypertensive medication. The clinical challenge was to provide education on the systemic risks of uncontrolled blood pressure while building enough rapport to encourage the patient’s own medical compliance, using interprofessional collaboration to support her health journey.
Patient Profile
Age: 70
Sex: Female
ASA: 3
Chief Complaint: “Come for teeth cleaning.”
Clinical Notes
S:
Medical History: Patient has Stage 2 Hypertension and a history of breast cancer. She takes Vitamin D, B12, elderberry, and turmeric supplements. She sees her PCP a few times a year.
Social History: Non-drinker, non-smoker.
Dental History: Regular clinic visitor. Uses a manual toothbrush (now switching to electric) and flosses 3x/week.
Patient Feedback: The patient was very afraid of taking blood pressure medication. She told me she believes the medicine will hurt her more than the high blood pressure itself. I talked to her about why it is important to treat it. By the end of the visit, she said she would talk to her sister—who she trusts—to ask how the medicine works and if it helped her. This shows she is starting to change her mind about seeing the medication as a helpful tool.
O: Vitals: 148/95 mmHg.
Extraoral/Intraoral: Enlarged lymph node on left side (<1 mm, non-tender). Coated and fissured tongue.
Periodontal Charting: Generalized 1-3 mm PD; localized 4-5 mm PD on back teeth. Generalized recession on lower teeth. Mild BOP.
Dental Charting: Class 1 occlusion, diastema between #24 and #25.
Calculus: Light supragingival calculus on lower front teeth (lingals).
A:
Case Value: Light.
Periodontal Status: Stage 1, Grade B.
Caries Risk: Moderate (CAMBRA).
P:
Procedures Performed: Updated medical history, EO/IO, OHI (tongue scraper), hand and ultrasonic scaling (Q1-Q4), polishing, and 5% NaF varnish.
Intervention: Worked with clinical faculty to explain the heart health risks of untreated Stage 2 Hypertension to the patient.
Recall: 4-month periodontal maintenance interval recommended.
Patient Education
I explained to the patient that high blood pressure is often called a “silent killer” because it can damage the heart without any warning signs. I emphasized that managing her blood pressure is just as important as her dental health. For her home care, I reviewed the Modified Bass brushing technique and gave her instructions on how to use a tongue scraper for her fissured tongue. We also discussed her plan to consult with her sister about her medication so she could get more information from a trusted source and make an informed choice.
Clinical Reasoning
My main goal was to keep the patient safe while helping her understand why she needs to manage her high blood pressure. I realized that just lecturing her like a student wouldn’t work because she was truly afraid of the medicine. I decided to ask the supervising Doctor to join our conversation to help explain the risks of her high blood pressure. I noticed the patient felt more comfortable hearing this from a faculty expert, which helped her take the situation more seriously. By staying calm and not pushing her too hard, I was able to give her the information she needed to make her own choice while still looking out for her overall health.
Reflection
This case was a very important lesson for me. It taught me that a dental hygienist is also a health advocate. Dealing with a patient who was afraid of her own medicine taught me that I need to be patient and use my “soft skills.” I learned that when I create a safe and comfortable space without judging the patient, they are more likely to listen and trust me. Seeing her decide to talk to her sister about the medicine felt like a big success. It showed me that good results in the clinic depend a lot on the trust I build with my patients. I am also continuing to follow my professor’s advice to stay organized with my instruments so I can handle these types of light cases efficiently and have more time for patient education.