Clinical Case Presentation

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Clinical Case Presentation

• Building Blocks of Life
• Case 6
• Diabetes Mellitus Type 1

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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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Patient

• 45 year old male
• Chief Complaint (CC)
• I have a broken back tooth and it is painful to
  chew. I have not been able to sleep for the past
  two days.
• History of Chief Complaint (HCC)
• One week ago, Mr. Murray was eating at a local
  restaurant. He bit into a hard piece of bread and
  broke off a piece of his tooth. There had been a
  restoration in the molar previously.
• Medications
• Rapidly acting (Humalog) and slow acting (Lente)
  insulins

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• Social History (SH)
• Married with two children. He is gainfully
  employed as an attorney. He does not smoke and
  has the occasional alcoholic drink. He drinks 6
  to 10 cups of coffee a day.
• Family History (FH) Mother had history of type 1
  diabetes mellitus and she died from renal failure
  at age 40. Paternal grandfather had prostate
  cancer. His teenage son suffers from asthma.
• Dental History (DH)
• Mr. Murray has regular dental check ups. There
  is no periodontal disease or caries. His last
  check up was 3 months ago. He had four impacted
  wisdom teeth removed at age 21.
• Medical History (MH)
• Type 1 diabetes mellitus for 20 years. He has
  no other medical history. Mr. Murray takes
  several insulin injections every day. He has had
  mild, peripheral retinopathy in his right eye for
  the past 5 years. He has no impairment of
  vision. He has no other complications. His last
  glycohemoglobin determination was 6.5. He saw
  his physician last month for a routine checkup.
  

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• Review of Systems (RS)
• Cardiovascular Blood Pressure, 130/75. Pulse
  76.
• Respiratory Rate 17/min.
• Nervous No obvious neuropathology. However,
  the patient is dental phobic and scared of
  surgery. He has seen the movie, Marathon Man, 4
  times.
• Endocrine Type 1 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 of Diabetes Mellitus

• Fasting blood glucose
• Glucose tolerance test
• Family history
• Signs and symptoms

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Dental Management of IDDM

• Modification of insulin dose, if needed
• Determine dietary and insulin 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 patients blood glucose
• If patient feels nauseous, weak, or has abdominal
  cramps or flu-like symptoms, as patient to test
  for ketones.

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• Treatment and Prognosis
• Insulin
• Weight control
• Diet and exercise
• Target glycohemoglobin to 6.0
• One hour postprandial glucose excursions
• Progression to complications is related to HbA1c
• Retinopathy (eye)
• Neuropathy (nerve)
• Nephropathy (kidney)
• Periodontal disease

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Thank You