Case Study 36

Patient Profile: Patient is a 70-year old retired White Caucasian male; Height: 5ft, 10”; Weight: 230 lbs

Chief Complaint: “After all my dental visits, I still have a really dry mouth.”

Dental History: The patient has been receiving regular dental care during the past 18 months including non-surgical periodontal therapy.

Medical History: The patient has type 2 diabetes, hypertension, GERD and had a full hip replacement 2 years ago. His orthopedic surgeon requested pre-medication prior to any dental work. He is allergic to Penicillin. His Hb A1c value is 7.2%.

Daily medications include: (Enalapril) Vasotec®, (Glipizide) Glucotrol®, (Sitagliptin) Januvia®, (Omeprazole) Prilosec®.

Vital signs recorded: Blood Pressure: 139/90; Heart rate: 100 BPM; Respiration: 20 Breaths/Minute.

Health Behaviors:

  • Patient brushes with a medium bristled toothbrush twice daily but does not floss. He uses a phenol mouthrinse two to three times daily and notes a burning sensation on his tongue and a very dry mouth.

Extraoral Examination:

  • All assessments within normal limits.

Intraoral Examination:

  • Bleeding Index: 55%
  • Plaque Score: 65%
  • Generalized inflamed gingival tissues
  • Social History: He reports a history of smoking approximately one pack of cigarettes daily.

PERIODONTAL CHARTING

Periodontal Chart - case 36

RADIOGRAPHIC IMAGES

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Panoramic Radiograph - case 36
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QUESTIONS

Your Faculty has access to the answers in this case study. Please ask them to look in the Faculty Corner for the answers to this case.
  1. Based on the patient’s history and clinical findings, the true Risk Factors for periodontal disease that this person possesses are:
  1. What BEST describes the type of implants this patient has?
  1. What BEST describes the osseous defects viewed radiographically on tooth #29?
  1. Based on the clinical and radiographic findings, which of the following implants have a poor prognosis?
  1. The dental hygienist can BEST assist the patient’s chief complaint by:
  1. Based on his medical history, gingival condition and clinical findings, what oral hygiene recommendations would you make for this patient?
  1. The patient’s orthopedic surgeon has requested pre-medication prior to any dental procedure. What would be the most appropriate course of action?
  1. Based on the patient’s HbA1c value, how would you council the patient?
  1. What is the radiolucent area superimposed over the ramus and neck of the mandibular condyle appearing on the panoramic radiograph?
  1. Taking into consideration, this patient’s history, bleeding score, periodontal and radiographic findings, what is the best general diagnosis of his condition according to the 2019 AAP Classification of Periodontal and Implant Diseases?