(High Cholesterol, ASA II)
A 69-year-old Hispanic female presents to the clinic for dental cleaning and examination.
CC: “I have sensitivity to hot and cold, and I need a dental cleaning.”
Health history:
BP: 97/67 P: 57 corresponds to normal.
Patient reports being in ok medical condition, has no allergies, and has had no surgeries in the past five years. Has high cholesterol but does not take any medications for it, ” my Dr said I just have to watch what I eat, I have on-and-off pain in the left arm due to frozen shoulder.” was diagnosed with Artrosis, but is under control as per the last physical exam done in May/2025, ” patient Reports ” sometimes I forget things, I guess it’s part of the age.” Does not take any prescribed medications, but takes Tylenol for pain when need it, and Omega-3 to support health when she remembers. ASA II.
Profile:
Last dental cleaning 9/2025, and last dental treatment on 2/2026, were done overseas, where two cervical fillings were done ( without taking X-rays). Reports brushing 2 x day using a manual soft tooth brush, and Colgate toothpaste, does not floss or use mouthwash, and brushes her tongue 2 x day with the same TB; feels sensitivity to hot and cold, last set of X-rays more than 10 years ago.
Clinical finding:
Extraoral examination: WNL, first visit a palpable nodule on the right side of the neck, asymptomatic, which wasn’t present anymore on the second visit.
Intraoral examination: patient has extreme vascularity sublingually, bilateral flat dark purple lesions on the buccal/labial mucosa, asymptomatic. 1 cm dark purple lesion on the back of the left side of the soft palate, asymptomatic ( patient was not aware of it), pronounced palatal suture, multiple 1-2 mm dark red lesions on the buccal mucosa, “I bite my cheeks while asleep.”
Dental charting:
bilateral class I occlusion (right side confirmed with rest of present molars due to tooth # 30 and canines missing ), Overbite 15 %, Overjet 4 mm, severe attrition on anterior teeth.
Missing teeth # 6, 11, 15, 17, 27 & 30.
Composites on teeth # 4, 5, 12, 13, 20, 21, 22, 23, 28, on cervical surfaces.
occlusal surfaces on 18, 19, 31,32, 32, and 3 OB, 14 MOB, 29 DOB.
Amalgam on teeth # 1O, 2DO.
Grade 1 mobility on teeth # 25, 26, 28, and 29.
Furcation grade 1 involvement on tooth # 19.
Gingival and periodontal statement: the gingiva looks enlarged, pink/pale, soft in texture, GM is apical to CEJ, papilla is blunted/cratered.
Calculus statement: localized subgigival clickable calculus on posterior teeth, localized supragingival calculus on mandibular anterior lingual surfaces.
PI: 1/GM-fair Stain: Medium.
Radiographic statement: FMS exposed on 3/2026, possible recurrent caries observed on teeth # 7 & 10 M, 13D, 18D, subsingival calculus observed on distal surfaces of 2, 4, 5, 23, and Mesial surfaces of teeth # 3, 7, 8, 19, interproximal btw teeth # 12 & 13. Tooth # 11 is unerupted, >33 % generalized HBL observed, patient informed of findings.
Dental Hygiene diagnosis: after completing all the assessments, the patient is classified as Periodontitis stage III/B due to >33% HBL, grade 1 mobility on teeth # 25, 26, 28 & 29, and furcation involvement on tooth # 19. Hypersensitivity related to cervical recession on multiple teeth.
Dental Hygiene treatment plan of care: the treatment plan for this patient was focused on stabilization through reducing gingiva inflammation and bacteria load through SRP, also educating about the importance of having good oral hygiene and the relation between oral health and systemic health.
Patient received referrals immediately for oral/periodontal evaluation. Oral Hygiene instructions on how to implement the Modified Bass brushing technique could improve biofilm accumulation and reinforce the use of interdental aids, due to the blunted papillae, and also recommend rinsing with water after meals, and the use of Sensodyne TP for sensitivity.
Nutritional counseling discussing the link between high cholesterol and systemic health, and the importance of Omega-3 for inflammation.
20 % Benzocaine topical anesthetic and 1 carpule of 1.7 ml of 2% Lidocaine 1:100K Epinephrine local anesthetic administered for pain management via PSA/MSA/ASA for the maxillary area and Buccal and Mental infiltrations for the mandibular area. (Patient tolerated well). Hand scale/ cavitron whole mouth, engine polish with medium grit prophy paste, and 5% NaF Varnish applied. (Patient happy with the results).
Reflection: The principal takeaway in this case is the danger of a “silent disease” despite the patient feeling in ok health condition and having a minor sensitivity, the fact that she did not have X-rays done for a decade reinforces the importance of regular diagnostic imaging, especially when previous treatment was performed without X-rays. This could have identified early-stage HBL by revealing the alveolar bone height before it would be clinically visible. Radiographs provide the only way to accurately measure the distance between CEJ and the alveolar crest. Caching these silent changes early allows for intervention and stabilization before periodontitis progresses to the 33% HBL, that leaded to grade 1 mobility observed today.
Clinical evidence before
After
