Generalized Arthritis Patient Case Study

Our patient is a 49 year old female.  She has generalized arthritis.  The patient has had back surgery within the last six months.  She has had reconstructive surgery on her lip several times from constantly biting it. She is currently under the care of a physician for arthritis, back pain, high cholesterol, and bi-polar.  She experiences anxiety.  The patient is also being treated for obsessive compulsive disorder.   The patient has not had any professional dental care in over eight years.  Her last radiographs were taken in January of 2012.  She brushes three times a week with a medium automatic toothbrush and uses floss and mouthwash.  Her gums bleed often, and hot, cold, and sweets causes her discomfort.  The patient has migraines and sinus infections often.  She clenches, grinds, chews on one side, and breathes through her mouth.  She also is a tongue and lip biter.  The patient drinks alcoholic beverages rarely and eats chips and junk food between meals. Her diet survey reveals a very high intake of sugar and beverages. The patient is on eighteen different medications.

An intraoral exam of the patient revealed that the she has periodontal disease.  Her gingiva is spongy and inflamed.  Probing depths reached fours, but not above.   Exploring revealed heavy calculus on mandibular anteriors and premolars.  The patient has scars on the buccal mucosa, tongue and lips.  Radiographs revealed that she has generalized horizontal bone loss.  She has a great deal of extrinsic staining.  She has amalgam and composite restorations.  A few of her teeth have abfraction due to her clenching and grinding.  The patient is missing tooth #1, #16, #17, #19, and #32.  

The patient has recognized a need to get her oral condition under control, and is aware of the importance.  However, she says that she wants to remain a type 2 patient so that she can be seen in our clinic regularly and not have to wait.

Clinical goals for this patient include: prevent trauma from grinding and clenching, arrest bone loss, prevent future bone loss, arrest inflammation of the gingiva, prevent future caries, and arrest periodontal disease activity. Therapeutic interventions that have been done to achieve our goals include: oral self-care evaluation, diet survey discussion, plaque control, periodontal therapy, debridement, fluoride treatment, and plaque control.