Mr. Tomlinson is a 48-year-old patient who is new to your dental office. He works as a computer technician in a large local firm. This is his first job following an extended tour of military duty. During his initial visit, Mr. Tomlinson explains that he has no dental problems, but he decided to make an appointment for a "cleaning" since he has a new dental insurance plan. He tells you that everyone in his family has always had pretty good teeth, so he is certain that you will not find anything wrong with his teeth or with his old fillings PATIENT HEALTH HISTORY On the day of his first visit to your dental office, Mr. Tomlinson’s blood pressure is 132/82 mm Hg and his pulse is 64 beats/min. Review of Mr. Tomlinson’s health history reveals that he is taking two medications: atorvastatin tablets and fluticasone propionate nasal spray. He states that he is currently under treatment for post-traumatic stress disorder (PTSD) that has resulted from his multiple military deployments. Clinical Photographs for Mr. Tomlinson 1. What factors in Mr. Tomlinson’s health history will be critical for the dental team to consider during treatment? Mr. Tomlinson is on atorvastatin medication which is known to cause dry mouth, itchiness in some and in few bleeding from gums was also noted. Mr. Tomilnson had come to get his teeth cleaned. The dentist has to be careful regarding this and vitamin K has to be kept handy incase of emergency. Fluticasone nasal spray is corticosteroid used in case of allergic rhinitis. This may cause throat irritation and mucosal irritation too . This has to be considered in Mr. Tomlinson dental treatment. 2. What signs of inflammation are evident on Mr. Tomlinson’s clinical photographs? 3. What etiologic risk factors for gingival and periodontal diseases are evident from Mr. Tomlinson’s clinical evaluation? 4. Does Mr. Tomlinson’s periodontal evaluation indicate that he has attachment loss on some of his teeth? How did you arrive at your conclusion? 5. What etiologic risk factors for gingival and periodontal diseases are evident Mr. Tomlinson’s radiographs? 6. On Mr. Tomlinson’s radiographs, what specific findings indicate that the alveolar bone level is normal or abnormal? Presence of generalized horizontal bone resorption about 15 % 7. How should you characterize Mr. Tomlinson’s periodontal condition? Do you think that he has gingivitis, periodontitis, neither, or both? What clinical or radiographic findings did you use to reach your conclusion? 8. Develop a step-by-step plan for nonsurgical periodontal therapy for Mr. Tomlinson. 9. What information should your team give Mr. Tomlinson about his periodontal condition? 10. What should Mr. Tomlinson be told about the possible need for periodontal surgery later in his treatment? 11. What should Mr. Tomlinson be told about the need for continuing treatment such as periodontal maintenance?
