Question

Javier is a 45 year old surgical technologist who has been referred to the dental hygiene clinic for "deep cleaning" by his general dentist. He has type 2 diabetes mellitus, but due to his poor glycemic control, recently he has had to add insulin to his drug regimen. His medications include neutral protamine Hagedorn insulin, repaglinide (Prandin), colesevelam (WelChol), simvastatin (Zocor), lisinopril (Prinivil), and a baby aspirin. His blood pressure is 150/94, heart rate is 98, and his respirations are 15 breaths per minute. When you ask him how well his diabetes is controlled, he looks embarrasses and mumbles, "Okay, I guess." When you ask about his A1C, he says it was 8 the last time he visited the doctor. You do a finger stick test, and his results are 250. You asked him when his last visit was to the doctor, and he states that he hasn't been in several months due to a heavy work schedule of surgeries. You ask him if he has eaten because it is late in the day, and you know that he just came from the hospital. He says he has eaten and has take his medications. As you examine his oral cavity, you note that his gingiva is fiery red and erythematous, and he has several areas that appear to be periodontal abscesses. His probe readings range from 4-8mm, and there is spontaneous, excessive bleeding upon probing. The lower anterior mandibular teeth have grade 2 mobility.

All of these treatment modifications would be appropriate for Javier except which of the following?
A. Treat any infection aggressively
B. Schedule appointments before mealtime
C. Approach surgical therapy with caution to avoid tissue trauma
D. Utilize stress reduction protocol during dental appointments
E. Use caution with drugs such as epinephrine, glucocorticoids, or opioid analgesics

Answer 1

The least appropriate treatment modification for Javier, considering his medical history with type 2 diabetes mellitus, is to schedule appointments before mealtime as it increases the risk of hypoglycemia.

Step-by-step explanation:

Javier is a 45-year-old surgical technologist with poorly controlled type 2 diabetes mellitus requiring intensive dental care, including a deep cleaning. Given Javier's medical history and current state — particularly his diabetes management, medications, and oral health status — his dental treatment plan must be carefully considered to minimize risk and maximize efficacy. Among the listed treatment modifications, option B ('Schedule appointments before mealtime') would be the least appropriate for Javier. This is because Javier has type 2 diabetes that is not well controlled, and scheduling appointments before meals can increase the risk of hypoglycemia, especially since he is on insulin and other diabetes medications.

Treating any infections aggressively (option A) is crucial due to the heightened infection risk associated with diabetes. Approaching surgical therapy with caution (option C) is also important, as any tissue trauma can lead to delayed healing and increased risk of infection. Utilizing a stress reduction protocol (option D) is beneficial since stress can elevate blood glucose levels. Lastly, caution is warranted with drugs such as epinephrine, glucocorticoids, or opioid analgesics (option E) as these can also affect blood glucose levels.