68 years old, black female, Medium calculus case value/ Type II Perio.
This is an ASA 2 patient. She has a past medical history of high blood pressure, beginning stages of Type II diabetes and glaucoma. Patient stated that her recent A1C level was a 6.4 and her blood sugar reading that morning was 103.
Due to these conditions, the patient was taking 320 mg of Valsartan HCTZ daily for high blood pressure, 81mg of baby aspirin every morning as a coagulant, 40 mg of Simvastatin for high cholesterol, 2.5mg Glipidize once a day for Type II Diabetes, and Latanoprost eye-drops once a day for Glaucoma. Some side effects that were a concern to me were the excessive bleeding of gums from taking Glipidize. Carvedilol, a Beta-blocker, also can have the adverse effect of gingival enlargement.
Based upon assessment, the patient was a good candidate for Arestin due to generalized moderate bleeding and generalized 5-7mm pocket depths in the posterior regions. Consideration was given to the type of medication the patient was on that can cause gingival enlargement and bleeding. Nevertheless, the patient was not keeping good home care and her pocket depths did not reduce after scaling and root planing. Radiographs revealed significant horizontal bone loss, which confirmed the possibility of Arestin. Pockets that were chosen for the treatment of Arestin were 11 sites ranging from 5-7mm. The patient’s medication was not a concern for interference with the antibiotic. After SRP, a consent was signed with the patient, the Arestin was place and post-op instructions were given.
After three weeks, patient’s Arestin sites were evaluated and there was sign of improvement in 9 out of the 11 sites by 1-2mm. The positive change concluded that the Arestin worked.
6mm pocket depth on the distal lingual of tooth #3
5mm pocket depth on the mesial lingual of tooth #17
Radiographs showing significant bone loss.
