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C L I N I C A L P R A C T I C E ABSTRACT
Background. Treatment planning for
and managing the care of elderly patients
can be complicated for a number ofAreasons.
D
A
J
To understand the patient’s needs, one
✷ ✷
must understand the environment in which
N
CON
the patient functions.
IO
CASE REPORT Case Description. The authors present
T
T
A
N
I
C
a case that illustrates some of
A theI Nsocial,
U
The complexities
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G ED
R
economic, financial and transportation
1
TICLE
issues that are involved in treating elderly
involved with patients, as well as how the dynamics of the
interpersonal relationships influence the
much on what dental care Hypertension Vasotec (Merck, Loss of taste, oral Orthostatic
was given but instead on and Heart Failure Miami Lakes, ulceration, hypotension; a need for
Fla.) (enalapril xerostomia, stress reduction, short
the interaction between maleate) ACE lichenoid and appointments and
the dentist and the inhibitor angioedema limit vasoconstrictor
patient and how the Hypertension Aldactone Gingival bleeding, Confusion, muscle
treatment evolved. (Searle, Pea- xerostomia and weakness and need for
pack, N.J.) lichenoid stress reduction
(spironolactone)
CASE REPORT diuretic
An 85-year-old woman Atrial Flutter Lanoxin (Glaxo- Sensitive gag Orthostatic
sought care at The Uni- SmithKline, reflex hypotension,
teeth nos. 18-22). There was a lost incisal restora- and hypertension, we needed to limit the vasocon-
tion on tooth no. 24 and recurrent caries on tooth strictor to 0.036 milligrams of epinephrine or two
no. 31. cartridges and aspirate before injection during the
College faculty and students in the oral patient’s dental appointments.19 It also was advis-
pathology, radiology and medicine department able to not schedule the patient for an appoint-
conducted an initial periodontal examination, ment before 9:00 a.m., due to a diurnal variation
and they identified general gingival inflammation in the stickiness of the platelets and the increased
and bleeding on probing on all teeth. They noted risk of experiencing another myocardial infarction
interproximal probing depths of 4 mm or less for or a stroke between 6 a.m. and 9 a.m.20,21
all teeth with the exception of a localized probing Our protocol suggested that we would need to
depth of 7 mm on the mesio-facial aspect of tooth decrease the patient’s stress by having shorter
no. 22. dental appointments and a positive environment,
The prosthodontist (T.J.L.) conducted an as well as having her sit up slowly to avoid ortho-
assessment of the vertical dimension of occlusion static hypotension at the end of the appointment.
using esthetics and speech that showed that pairs Our protocol for all medically compromised
of teeth were in contact, providing stability and patients at every appointment is that the dental
function. The occlusion was not overclosed by assistant seats the patient and then take the