Transcript Patient - Images

Clinical Case Presentation
Diabetes Mellitus Type 2
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Template for CCP
•Chief Complaint (CC)
•History of Chief Complaint (HCC)
•Medications (M)
•Social History (SH)
•Family History (FH)
•Dental History (DH)
•Medical History (MH)
•Review of Systems (RS)
•Diagnosis -Risk Assessment (DRA)
•Differential Diagnosis (DD)
•Treatment (Tx)
•Prognosis (PR)
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Include clinical pictures here
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Type 2 Diabetes Mellitus
A 55-year old obese female has a 15-year history
of type 2 diabetes mellitus. She also has high
levels of cholesterol, high blood pressure, and
anginal pain. She is taking oral hypoglycemics for
her diabetes, medications for her hypertension,
and lipid lowering drugs for her cholesterol
(Lipitor®, atorvastatin calcium). She has redness
(erythema) on the roof of her mouth. She will
need a complete upper and lower denture. She
has recently complained of excess urination
during the day and at night, dry mouth, fatigue,
and swings in her blood sugar levels. She finally
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admitted to eating cake and cookies.
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Patient
• 55 year old female
• Chief Complaint (CC)
• The roof of my mouth burns and feels dry and I need
dentures.
• History of Chief Complaint (HCC)
• The patient complains of fatigue and says that her blood
sugar is very high (over 300 mg%) and at times also very
low. She is urinating more than usual. She wants her dentures
so she can chew comfortably.
• Medications
• Oral hypoglycemic, blood pressure medication, lipid
lowering drug
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• Social History (SH)
• She has had difficulty controlling her weight most of her
life. She is obese. She also admits to eating cake and
cookies. She claims to have lost 20 pounds over the past
year.
• Family History (FH)
• She has a mother who is diabetic and a father with high
blood pressure.
• Dental History (DH)
• She has had many problems with her teeth. Most of her
teeth were lost because of caries, periodontal disease, and
her neglect.
• Medical History (MH)
• She was diagnosed with type 2 diabetes mellitus 15 years
ago. She has chest pain (angina), especially after she walks
up a flight of steps. Her blood pressure was diagnosed
approximately 5 years ago.
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• Review of Systems (RS)
• Cardiovascular – Blood Pressure, 140/95. Pulse 80.
• Respiratory – Rate 17/min.
• Nervous – No obvious neuropathology. However, the
patient is dental phobic and uneasy about being asked
questions pertaining to her health. He has seen the movie,
Marathon Man, 4 times.
• Endocrine – Type 2 diabetes mellitus
• Renal – BUN 15 mg/ml (8 to 23 mg/ml); creatinine 0.8
mg/ml (0.6 to 1.2/dL)
• Gastrointestinal - unremarkable
• Skin and mucosa – Color and texture of skin and mucosa
WNL. No persistent lesions or moles.
• Osteoarticular – WNL
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Diagnosis and Risk Assessment
Diagnosis consistent with uncontrolled
diabetes and increased risk for
recurrence of oral infection
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Dietary Questionnaire
Does not carefully match her intake of
carbohydrate with her medication. She
finally admits to eating cake and
cookies.
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Diagnosis of Diabetes Mellitus
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Fasting blood glucose
Glucose tolerance test
Family history
Signs and symptoms
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Dental Management of Diabetes Mellitus
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Modification of diabetes medications, if needed
Determine dietary and medication regimen prior to treatment
Obtain most recent glycohemoglobin determination
Have glucose or other readily absorbable form of carbohydrate
available
Determine need for antibiotics
Know the signs and symptoms of profound hypoglycemia (A
first-rate medical emergency)
Have a glucometer, test strips, and sterile lancets available to
test patient’s blood glucose
If patient feels nauseous, weak, or has abdominal cramps or flulike symptoms, as patient to test for ketones.
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Treatment and Prognosis
Medications
Weight control/blood pressure control
Diet and exercise
Target glycohemoglobin to 6.0%
One hour postprandial glucose excursions
(particularly for type 1 DM)
“Whenever I get the urge to exercise, I lie
down and wait for the feeling to pass.”
—Mark Twain
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Thank You
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