All right so this is a case study number three i know the title is misleading but this is case study number two on dental care comm so you’re gonna pull up dental caricom you’re gonna log on and choose case study number two this is your case study number three assignment so let’s go through the patient profile together this patient is 79 year old african-american
Female she’s five foot seven and weighs 160 pounds patient report she has not had a dental checkup for several years so that should be a red flag to you there my teeth have not been cleaned in a long time and they are in bad shape this is her chief complaint make sure you address that dental history the patient has had mandibular right for a smaller extracted
One year ago and has never received a dental treatment since the patient had a hysterectomy at age 62 she suffered a mild stroke four years ago she relies solely on a cane in order to walk and occasionally suffers with shortness of breath upon exertion she recently underwent laser surgery on the retina and her right eye and her daily medications include eighty one
Milligram aspirin multiple insulin injections prilosec mevacor tenormin altes and plavix and she’s also on actonel so let’s break this down so she had hysterectomy so she is most likely well i mean at that point she would have been post-menopause anyway but she did suffer a stroke and that hurt hurt her ability to walk so she walks with a cane so that’s something
That you might need to address as well something that should raise a red flag that we recently talked about in pharmacology is the shortness of breath upon exertion so what health condition presents with shortness of breath upon exertion so perhaps she has an uncontrolled disease she’s not aware of she also recently underwent a laser surgery and the retina of
Her right eye so this would raise a red flag to me because she is also taking multiple insulin injections so one thing that you want to be leery of is neuropathic pain eye surgeries those types of things that is usually due to uncontrolled diabetes so you might want to assess her control of diabetes i mean i know you would anyway you know and getting her hba1c
Level daily medications is it looks like she’s taking a preventive 81 milligram baby aspirin her multiple insulin injections for diabetes we don’t know if it’s type 1 or type 2 it does not look like she’s taking any other oral medications so she might be a type 1 diabetic not sure she might not just be able to take oral pills and might have just gone right to
Insulin injections prilosec this makes sure you look this up this is for gerd or acid reflux so that’s something we want to hone in on how we would treat this patient mevacor or lovastatin so prefix statin this is for cholesterol atenolol this is your beta blocker this might be used for any type number of heart conditions same with ramipril you see the pro suffix
That’s an ace inhibitor and clopidogrel bisulfate this is plavix and that is antiplatelet drug and then one other thing that we need to put an alert on is the actonel so this is a bisphosphonate drug so we know in patients at risk for certain things this could lead to osteonecrosis of the job it looks like she probably taking an oral tablet but we never know if
She’s at risk she’s at risk and oral tablets can still lead to osteonecrosis of the jaw even though it’s seen more so in patients with iv therapy all right extra orally we see a large nevus that’s present on the left side of her face what should we do with this should we refer her to anybody should we do anything with this everything else is within normal limits
Supplemental information the patient is curious about a tooth power toothbrush since her hands are weak so make sure we’re addressing this how do we help patients with dexterity issues she also questions whether a mouth rinse will reduce her bleeding patient reports she brushes with a fairly hard manual toothbrush and she does not floss and as uncertain whether
She uses the floor did she’s paste bleeding index is over half of her mouth plaque free score is at 35 so 65% of her mouth has plaque all over it all right so it looks like she still has her wisdom teeth except for two of them and she also had that first molar extracted as we already mentioned so let’s take a look at her probing numbers so we’re seeing some kind
Of high numbers here so you know talk about this what should we be doing for this patient x-rays we can see if there’s any evidence of calculus we can look at any restorations look like looks like there’s a little one here a little one here overall it’s not too terrible what would her pareo level be you know look at these types of things enter orally what are we
Notice what can we see on these teeth okay what’s going on here melanin pigmentation you have tour i we have a bunch of stuff so then this is after treatment by the way so these are your questions what parts of this patients history is concerning to you today and why so take every little aspect of that patient profile even the pictures the x-rays and write down
Every single thing that is concerning to you and why so based on this patient’s medical conditions what are the dental hygiene appointment and treatment considerations for this patient so write down things that we need to double-check things that we need to modify in our appointment because of certain conditions or situations who should we be referring to at all
As as well based on what you know about diabetes and periodontal disease what conclusions might you realize that you look as you look at this patient spare donald chart so we know there’s a strong link between diabetes and pareo so what do we want to note here and explain to the patient further next we want to provide a full description of the patient’s interaural
Findings so you are going to use your into oral images zoom in on them look at every little thing and i want you to list everything that you see in her mouth that we should chart or note either into orally extra oral type things or heart tissue charting lastly we don’t have a yellow treatment form here but i do want you to write down a treatment plant how you would
Treatment plan this patient using what we normally use as a yellow sheet i want you to type out below recall for this patient goals for this patient those types of things that you all put on your treatment plan form okay alright well any questions about this go ahead and please let me know this is the most complex one that we’ve done lots of drugs in here make sure
You look up these drugs in your drug book for all of the side-effects and all that kind of information and just let me know if you have any questions as you get started thanks
Transcribed from video
DHY 116 – Case Study #3 Instructions By Jennifer Suminski
