Patient Profile: Patient is a 63-year old White Caucasian male.
Chief Complaint: “I have a few sensitive teeth and need my teeth cleaned.”
Dental History: The patient has not seen a dentist in 8 months.
Medical History: The patient has COPD, hypertension and has experienced partial seizures without losing consciousness. He is allergic to cat hair and Penicillin. He reports a family history of hypertension and COPD. His daily medications include: (Diazepam) Valium®, (Divalproex sodium) Depakote®, (Quinapril) Accupril® (Fluticasone/salmeterol) Advair®. Vital signs recorded: Blood Pressure (RAS): 138/89; Pulse: 100 BPM; Respiration: 20 Breaths/Minute
All other assessments reported within normal limits.
Scrubbing technique observed in maxillary right and left posterior quadrants, chipped incisal edge #8 and stains in lingual pits.
Patient brushes with a medium-bristled toothbrush.
Patient does not floss and is unaware if he uses a fluoridated dentifrice.
Patient uses a phenol mouthrinse and drinks lemonade and cola daily.
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