Patient profile: Kelly, 10 year-old female, parents are separated, sharing to care for Kelly. Patient is attended with the father.
Medical history: Kelly has diabetes type I, undercontrolled by taking insulin
Dental history: NAD
Social history: Kelly loves school, plays basketball on the weekend.
Oral hygiene: brushes twice daily, morning and night, children’s fluoride toothpaste.
Consent: father consents for an examination and x-rays
Risk assessment:
Kelly is in high risk of caries
Clinical examination
Extra-oral: NAD
Intra-oral:
- Gingival examination:
- Hard tissue:
- Teeth present: #16, #55, #54, #53, #12, #11,#21, #22, #63, #64, #65, #26
- #36, #75, #74, #73, #32, #31, #41, #42, #84, #85, #46
Diagnostic: caries on
ICDAS 04 – #54DO, #64DO,
ICDAS 05 – #85MO, #84DO
ICDAS 06 – #85
Discussion and treatment plan:
Kelly has Type I diabetes and taking insulin which makes her in high risk of caries. The study is shown that type 1 diabetes is highly prevalence to risk of periodontitis and dental caries as glycemic control play an important role in the development of perioontal complications. Diabetes medication decreased salivary flow which increase risk of caries by increasing the cariogenic bacteria to metabolize and make enamel demineralizing acids.
Mechanism of diabetes:
- Higher level of inflammatory mediator:PGE2, IL-11 beta, TNF in GCF
- Defect in PMN activity
- Accumulation of AGEs
- Pocket microbiota
Diabetic in children also cause accelerated dental development, delayed wound healing. Hypoglycemia is a serious clinical concern in children, therefore oral health provider should consider book morning appointments, check blood glucose level every time special for extraction.
Treatment done today: examination, bitewing x-rays, OPG, whole mouth debridement to see if she complaint in dental chair.
Treatment plan:
Extract 54, 64,74,84 due to large caries and the permanent teeth bubs are nearly erupted.
Restore 55,65,75,85
Treatment plan
- Debride whole mouth and prophylaxis to see how the patient is compliant.
- Restore 55 with GIC, EXO 54
- Restore 65 with GIC, EXO 64
- Restore 75 with GIC, EXO 74
- Pulpotomy and SSC for 85, EXO 84
- Recall 3 months
Next visit: Restore 55 with GIC, EXO 54