![Picture](/uploads/2/5/6/8/25686586/7850722.jpg)
Case Study
Demographics:
Patient: Richard B.
Age: 37 years old
Gender: Male
Race: Caucasian
Physical Assessment: 6'2" athletic stature
Mental Assessment: patient seems happy as always but sighs as he stands and with a slight limp, walks toward his room for treatment.
Social Assessment: Richard is a creature of habit: work, managing his daughters sports traveling teams year round, home for dinner with his wife, evening news and a few drinks before bed.
Medical Assessment:
-Richard mentioned swelling in his right calf, he was sure he pulled a muscle while on an evening walk with his wife. His wife continues nagging him to see his doctor...she's beginning to worry.
-he has had several appointments with the dermatologist for removal of benign sun spots on his arms, hands, face, and ears.
-patient continues to take his anxiety and anti-depressant medication daily as per the patient, "life is chaotic! The medication soothes me."
-Richard has suspicion he isn't drinking enough water through the day and his wife has eliminated salt from his diet. They notice swelling of the hands and ankles.
Dental History:
-Bridge: #2-4, #13-15
-MOD amalgam restorations: #5, 12, 20, 21, 30, 31
-PFM: #22 ,29
-Generalized moderate attrition which patient has recently invested in a nightguard (stress related).
-Generalized light staining on both maxillary and mandibular facial/lingual anteriors from several cups of coffee a day and glasses of red wine in the evening.
-Generalized BOP
-patient complains of dry mouth from medications and bronchodialator when needed for seasonal asthma.
-routine cleanings every 6 months
EO/IO Assessments:
-painful ulcerations (gingiva,buccal mucosa, tongue and the palate)
-slight pink rash on nose and cheeks (butterfly-shaped)
-xerostomia
-inflammed gingival margins
-leukoplakia
-Dysgeusia (abnormal taste)
-Glossodynia (burning mouth syndrome)
Communication: * SLE is such a varied disease with so many potential problems caused by the disease or its treatment *
-pre-treament consultation advised (if patient has SLE) with physician-find out extent of systemic manifestations
-obtain thorough medical/dental history
-ask about current medications being taken
Appointment Planning: * Systemic complications such as renal and cardiac impairment may occur. Establishment and maintenance of optimal oral health are of paramount importance!*
-early morning or evening appointments are best to reduce sun exposure.
-two-three month recare visits will be appropriate when treating one with SLE.
Client Positioning:
-No specific position is recommended, however, the patient should choose a position that is most comfortable for him/her
-possible discomfort from arthritis
DH Procedures: Pay close attention to any significant changes in health history, medications, and EO/IO.
Safety Precautions: Drug consideration will be crucial. Aspirin and anti-inflammatory drugs may cause increased bleeding. Leukopenia with corticosteroids or cytotoxic drugs may predispose patient to infection, use of postoperative antibiotics can be considered with surgical procedures.
Oral Health Instruction (OHI):
-daily/consistent removal of: biofilm and local irritants
-proper flossing instruction
-fluoride
-pit and fissure sealants
-proper diet (maintain lower levels of sugar)
-saliva substitute (Biotene/Xylitol)
-extra soft toothbrush
-topical steroid
Personal Reflection: The purpose to research further on SLE was due to my Father being diagnosed about 7 months ago. What he thought was a pulled muscle, turned out to be a large blood clot in his right calf. This diagnoses was mindblowing to the family in that studies show the disease strikes mostly women, 90% of all cases and the strong familial aggregation that exists among first degree relatives of the patient....to our knowledge no one lived nor is living with SLE. Since he's been diagnosed, my family and I have witnessed the day to day struggles it plays on ones body. Nevertheless, I come from a close net family and when life throws us lemons, we throw watermelons right back!=) Whether my Dad or a patient in the operatory chair, I can pass on the knowledge I've gained from this assignment and provide informative tools to help those who may encounter oral manifestations or daily obstacles that arise from SLE.
Additional Information:
I found this particular video helpful to get a good representation of what takes place with the autoantibodies when attacking the immune system. Please watch: http://www.youtube.com/watch?v=H_QKeq70sbI
Lupus International has a section designated solely to Lupus and Dental Concerns. It will give the lupus patient a better idea of to consider while in a dental setting in the FAQs portion. http://www.lupusinternational.com/Related-Conditions/Dental-Concerns--1.aspx
What a great website, very useful! It describes the disease and its symptoms. It contains information about diagnosis and treatment, as well as current research efforts supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other components of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH). If interested: http://www.niams.nih.gov/Health_Info/Lupus/
Images from:
Lupus CIDPUSA Foundation (2013). Image. Lupus. Retrieved from http://www.cidpusa.org/SLE.html [Accessed 28 January 2014]