Case Study

John Brookshire, a 55-year-old morbidly obese male who smokes. He presents as the next recare patient after having been away for several years. He is interested in getting his teeth “cleaned” and he has just been seated in the dental hygienist’s operatory. The dental hygienist has a 60 minute appointment set aside for him and the hygienist is about to begin a medical history review. Here are the preliminary findings:

Significant Medical History Findings

  • Smokes 1 pack of cigarettes a day
  • Alcohol: none
  • Patient visited his family physician three months ago
  • Medications:
    • Insulin, 5 units/day at bedtime
    • Acarbose (Alpha-glucosidase inhibitor), 100 mg three times a day, taken with first bite of meal
    • A1C: 9%
  • BP: 136/92 mm Hg
  • Pulse: 88 BPM

John’s blood glucose level was obtained following the health history with a reading of 55 mg/dL.


Pertinent Oral Findings

Significant findings in the intra and extra oral exam:

  • Xerostomia
  • Angular cheilosis on the left corner of the labial commissure
  • Candidiasis on the left buccal mucosa

Significant findings from the periodontal exam:

  • Generalized 5-6 mm pockets in the posterior areas
  • Generalized moderate levels of plaque

Significant findings from the dental charting:

  • Six new areas of root caries that were detected clinically