Periodontal+Case+2+-+Diabetes



Case #2- Diabetes __Health History__ ====Ryan Alexander is a single 55 year old Caucasian male. He works as a high school teacher.He is currently under the care of his physician Dr. White who can be reached at 1(800)899-1901 and his major reason for coming to the Riverside Community College Dental Hygiene Clinic is to get his teeth cleaned. His previous dentist Dr. Johnson saw him for an DDS Exam on June 3, 2006. He also had an FMX completed on June 3, 2006. He had an adult prophy completed on June 10, 2006, but has not been to the dentist since. He states he has bleeding gums when he brushes, and he gets ulcers in his mouth when is stressed or not feeling well. He just had a ulcer last week, and he believes it is still healing . The patient does wear glasses for far-sightedness. He drinks alcoholic beverages once a week on the weekends, usually a few beers while watching football. The patient does experience frequent urination. The patient states that he has had type II diabetes for the last five years, which he controls with medication along with diet and exercise. His blood glucose levels today were 120 mg/dL. The patient stated he had eggs, potatoes, and wheat bread for breakfast and a chicken sandwich with soup for lunch.The patient had his childhood vaccinations in 1956, last had a Hepatitis B vaccination in 2005, and had a flu vaccination in 2010. The patient has a family history of hypertension and cancer. The patient is allergic to sulfa drugs. The patient visited the ER in 1981 for a broken leg. The patient currently takes a men’s multivitamin daily, tylenol for occasional headaches and muscle aches, and Metformin daily. Ryan took his Metformin and multivitamin this morning. He states that has taken the mulitivitamin and Metformin for the past five years daily. ====

BP: 120/75, P: 70, R: 18.

Ryan is an ASA II due to his type 2 diabetes.

__Ryan’s Medications: __  Metformin 850mg daily. Taken for the management of type II diabetes. Dental implications: Taste disorder. Dental treatment preferred in the morning in order to minimize the chance of stress induced hypoglycemia. Dental Contraindications: Hypersensitivity to metformin or any component of the formulation. Men’s multivitamin 1 daily. Taken as a dietary supplement. Dental Implications: No significant effects or complications reported. Dental contraindications: none noted. Tylenol 500mg taken as needed for headaches and muscle pain. Dental implications: No significant effect or complications reported. Dental contraindications: Hypersensitivity to acetaminophen or any component of the formulation.

__Periodontal Exam: __
E&I findings: Extra oral- none.  Intra oral- mandibular tori, bilateral linea alba, and 2X2 erythematous ulceration on patient’s right buccal mucosa. TMD Findings: None Salivary Flow: adequate Maximum Opening: 50 mm

Gingival description- Free gingiva: Generalized erythematous, flat, shiny and smooth with localized bulbousness 6-8 and 22-28  Attached gingiva: Generalized pink, firmly bound to bone and stippled w/ localized edematousness 22-28.

Existing Restorations: O amalgam-2, 3, 18. 15 PFM with RCT, O composite- 30, 31

Facial Profile: mesognathic

Angle’s Classification- class II bilaterally

MBI -45% Probing depths were generalized 2-3 mm with localized 4's, 5's and 6's toward the posterior. BOP-67%

Recession- 2 mm L 22-27, 1 mm gingival recession on B 2 and 3 (toothbrush abrasion)
<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Mobility- + 6-11, 24-26.

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Fremitus- +7-10

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Mucogingival defects- none

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Calculus code-medium calculus, all 4 quads. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">ADA classification- II <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">AAP classification- Generalized slight chronic periodontitis due to plaque and calculus modified by diabetes. PI-86% <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Missing teeth and reason & impacted teeth: #1,#16,#17 and #32. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;"> Existing Restorations: #2,3 Occlussal amalgam, #15 PFM and RCT, #,18 Occlusal amalgam, O composite #30 and 31. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;"> Possible areas of decay: #2M, #4D,#14D, #18M, #30D <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Atypical Findings: abrasions on B2 and 3 toothbrush abrasion. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;"> Radiolucencies on apices (differential diagnosis): Radiolucency on the mesial root #15 Possible periapical abscess. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Intrinsic/Extrinsic Resorption (state etiology): None noted. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Root Resorption (state etiology):None noted. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Dilacerated Roots: #30 <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;">Other Atypical Anatomy Findings: None noted <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 12pt; text-decoration: none; vertical-align: baseline;"> Radiolucent/Radiopaque lesions/Foreign Objects (diff. diag.): None noted

__<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Critical Thinking Form __

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Chief complaint: Pt. is here to get his teeth cleaned. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Medical history/systemic health: Diabetes & Oral risk factors: Xerostomia, candidiasis <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Dental health diagnosis: Perio: uncontrolled, Caries:uncontrolled, Oral Hygiene: uncontrolled <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Influencing cultural and social factors: Pt's occupation may prove to be a high stress enviroment at times, and calls for much time and preparation. He may not make oral hygiene one of his top priorities. Also, nutrition habits may be affected due to is busy schedule. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Oral health belief model: Precontemplation stage of transtheoretical model; the pt. may not see a need to modify current OH habits in order to be effective. He needs knowledge in order to realize a change is beneficial. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Recommend OHI: Bass brushing technique, C-shape flossing technique, Reach flosser, alcohol free fluoride mouthrinse. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Instrument selection:Piezo, Catoni, ant/post sickles, 7/8 and 5/6 gracey, McCall's and Younger-Good. Nevis 2 and 4. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Anesthesia/ Rationale: Lidocaine 2% with epinephrine for pt. comfort and operator accessibility <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Reevaluations: 2x2 erythematous ulceration on the right buccal mucosa <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Anticipated treatment outcomes: Reduce pocket depths by 1mm and BOP by 10% <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Referrals: GP-caries # 14D, #18M, #30D <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">- Recall interval/ Rationale: 3months, to re-evaulate patient’s pocket depths, decrease MBI and BOP, assess pt. compliance w/ OH

<span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">__Treatment Plan__: <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 1: X-ray check, FMX (18 films), assessments, Nutrition counseling <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 2: DDS exam, 2nd check in, OHI- Bass brushing technique, discuss correlation between diabetes and peiodontal disease including information about how diabetes can increase inflammation. Plaque Index. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 3: OHI- Introduce C-shape flossing. Scale URQ w/ anesthesia, fl varnish <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 4: OHI- Introduce Reach flosser. Scale LRQ w/ anesthesia, fl varnish. Nutrition counseling. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt: 5: OHI- Reiterate role of plaque in inflammation and the importance of effective plaque control to prevent bone loss. Scale ULQ w/ anesthesia, fl varnish. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt.6: OHI- Recommend alcohol-free fluoride mouthrinse. LLQ w/ anesthesia, fl varnish. <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt.7: Re-eval 4-6 weeks. Nutrition counseling <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 14.66px; text-decoration: none; vertical-align: baseline;">Appt. 8: Re-care 3 month