Case #4

This wiki is the being used as a housing location for these case scenarios. Each student is to answer each of the case scenarios and turn in for grading as per the course syllabus.

Dorothy is a 57 year old female who weighs 220 lbs and is 5 feet tall, and she is seeking relief of the soreness in her mouth. She complains that when she brushes her teeth, her gums bleed. When you examine her oral cavity, you note the presence of white patchy areas on the tongue.

A month ago Dorothy had three toes amputated at a same-day surgery center, and she cannot feel her remaining toes. She has generalized moderate with localized severe periodontitis. She currently has a respiratory infection for which she is taking 500 mg of cephalexin four times a day and Entex LA twice daily. Recently her blood glucose levels have been between 240 -300 in the evening.

Her medication regimen is:
Insulin, NPH, 35 U in the morning, 10 U in the evening
Glyburide, 10 mg qd
Metformin, 850 mg bid
Maxzide, qd
Femstat vaginal crème q hs for the past three nights

Dorothy’s blood pressure was 165/92. You step out of the room to sign up for a pathology check and when you return, you find Dorothy unconscious.

1. Identify the symptoms and complications that Dorothy has related to her diabetes.
2. What should her HgA1c levels be?
3. What is the etiology of the white patches on her tongue?
4. What are the drugs for that Dorothy is taking?
5. Do the dosages seem reasonable? Are any excessive?
6. What are the indicated uses that the drugs are being taken for?
7. Do any of the drugs have a dental contraindication or drug-to-drug interactions?
8. What oral complications does each drug have – if any?
9. What procedures should have occurred prior to treating patient?