Atherothrombosis

= Case #7 - Patient with Atherothrombosis =

[[image:gingival_hyperplasia.JPG width="370" height="256" align="center"]]
Age: 34 Vitals: BP: 149/90. P: 72. R: 18 Medical History: High blood pressure, overweight Medication: Plavix is taken to prevent heart attack __Plavix__: used to reduce rate of atherothrombotic events in patients with recent MI or stroke or unstable angina. //Dental implications:// no information available to require special precautions. //Dental contraindications:// aspirin may be taken in conjuntion with for 12 months following the placement of a stent and should not be discontinued early due to increased risk of catastrophic thrombosis leading to MI and or death.
 * Medical History**

Dentist of record: Dr. Smile Last Cleaning: April 2001 Radiographs: FMX 10-7-08
 * Dental History**

Free: generalized erythematous, bulbous, diastema between 6 and 7, 7 and 8, 10 and 11, and 23-26, clefted on 7, 8, 10, 11, 22-27, and smooth Attached: generalized erythematous, edematous, and shiny
 * Gingival Description**

E & I: bilateral crepitus, bilateral linea alba, hairy tongue Maximum opening: 56mm Skeletal class: mesognathic Angles class: bilateral Class I molar relation MBI: 100% BOP: 32% Probing depths: generalized 4-5 mm, localized 6 mm on 18DL Mobility: + on 4-13 Fremitus: + on 4-13 Attachment Level: 2B: 4mm; 3B: 5mm; 6B and 11B: 4mm; 14B: 3mm; 31B, 30B, 19B, and 18B: 5mm; 19L: 4mm; and 23 to 26: 2mm Furcation: class I on 3, 19, 30; Class II on 14 Mucogingival defects: on the buccal 22, 24, and 17; on the lingual: 23 to 27 Calculus code: medium/heavy Generalized ADA III AAP: generalized aggressive chronic periodontitis due to plaque and calculus, modified by systemic disease PI: 100%
 * Assessment findings**

Electronic toothbrush with Bass technique because patient has difficulty with brushing with manual toothbrush on the lingual side Floss with floss aid and oral irrigation due to gingival hyperplasia Fluoride toothpaste and mouthrinse with fluoride because patient has xerostomia. Oasis 3X/day Patient should have a 3-month recare because of his gingival hyperplasia, systemic disease, medication, and periodontal involved.
 * OHI**

RMH Assessments DDS exam 2nd check in
 * Treatment Plan**
 * Appt.1**

PI and OHI Scale LL: 18 & 19 Anesthesia CHX
 * Appt 2**

Scale LL: 20 & 21 Anesthesia CHX
 * Appt 3**

Scale LL: 22- 24 Anesthesia Oral Irrigation
 * Appt 4**

Scale UL: 14 &15 Anesthesia CHX
 * Appt 5**

Scale UL: 9-13 Anesthesia CHX on 13 Oral irrigation
 * Appt 6**

Scale LR: 30 & 31 Anesthesia CHX
 * Appt 7**

Scale LR: 25-29 Anesthesia CHX on 29 Oral irrigation
 * Appt 8**

Scale UR: 2 & 3 Anesthesia CHX
 * Appt 9**

Scale UR: 4-8 Anesthesia Oral irrigation
 * Appt 10**

4-6 week re-eval Fluoride tx 3-month recare
 * Appt 11**

Patient overall prognosis is good.

Questions
1. Patients in their 30s are at low risk for atherothrombosis. Atherothrombosis is more common in smokers and obese people. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

2. Will a patient who takes medication for atherothrombosis need a med consult prior to treatment? a. No b. Yes, if pt currently take blood thinner medication c. Yes, if the patient has been diagnosed but is not taking any medications d. b and c

3. Atherothrombosis of the coronary and cerebral vessels is understood to be a disorder of inflammation and innate immunity, as well as a disorder of lipid accumulation. As a disease marked by inflammation, periodontitis is not linked to incident cardiovascular disease. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

4. The patient is taking Plavix to prevent heart attack. After you provide root planning, you should recommend him to take a. Tylenol b. Aspirin c. Ibuprofen d. None of the above

5. According to the patient's gingival condition, what types of possible medications may the patient be taking? a. Antidepressant b. Beta blocker drugs c. Calcium channel blocker drugs d. a and c e. All of the above

6. Atherosclerosis is caused by accumulation of fatty materials on the inner walls of arteries. Atherothrombosis occurs when blood clots or necrotic tissue travels in an artery. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

7. Atherothrombosis is the major cause of a. Acute coronary syndromes (ACS) b. Cardiovascular death c. Both of the above d. None of the above

8. Atherothrombosis is another name for atherosclerosis. Atherosclerosis is a diffuse process that starts early in childhood and progresses asymptomatically through adult life. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

9. Atherothrombosis is the leading cause of mortality in the industrialized world. Recent evidence suggests that inhibition of tissue factor or elements in the tissue factor pathway (i.e., factors VIIa and Xa, or thrombin) has the potential to further improve outcomes in atherothrombosis. a. Both statements are TRUE. b. Both statements are FALSE. c. The first statement is TRUE; the second statement is FALSE. d. The first statement is FALSE; the second statement is TRUE.

10. Later in life, atherosclerosis is clinically manifested as a. Coronary artery disease b. A stroke c. A transient ischemic attack d. Peripheral arterial disease e. All of the above

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