S:

Julia Morales, age 65, has lung cancer, which has been treated with chemotherapy and radiation, and now she has stopped treatment.

CC: “Loose denture and burning mouth”

Med HX:

Stage 4 adenocarcinoma of the lung diagnosed 4 years ago by bronchoscopy (right upper lobe). Received radiation and chemotherapy. Naturopathic treatment with aromatherapy oils and acupuncture.

wt. loss, fatigue, weakness, lack of concentration/focus.

high blood pressure, angina, pitting edema, dyspnea on exertion

Hysterectomy at age 44

Allergies: NKDA

Medication HX:

- Stopping chemo- Palliative or comfort care focus- Phenergan 25mg by mouth every 4-6 hours for nausea/vomiting- Vitamins and supplements for nutrition- Oxycodone 20mg by mouth every 4 hours as needed for pain- Ibuprofen 200mg by mouth every 4-6 hours as needed for pain

Social Hx;

College graduate/business degree; ran small nursery till age 50.

10 years smoking after college (1982

Religion: Unitarian

Dental Hx: Pt has dental phobia. according to her this is the reason she lost most of her teeth. MX. Upper denture is only 4 years old but it is loose now. Pt reports that denture and partial denture do not fit well. Pt is satisfied with the look of her teeth. Pt has trouble chewing food bc denture "clicks"

or comes loose while chewing. Pt reports slight sensitivity in lower L posterior occasionally, no pain. Pt doesn't remember having a dental cleaning.

O:

BP: 133/91 mmHg P: 69 bpmBlood sugar: 145 mg/dL

Clinical Exam:

EOE: WNLIOE: Bilateral bone depression between ridge and RMP. Redness under denture along with some white patches. Redness around the corner of the mouth. TMJ: R pop upon openingOSC: Negative

Hard Tissue:

Pt has full upper dentureLower has FPD on lower with 29, 27, 23, 22, & 20 as retainer teeth

20: recession, check after SRP22: check after SRP 23: check after SRP27: recession, check after SRP29: check after SRPTeeth seem sound, but recheck margins of crowns after cleaning

A:

Candidiasis / Angular cheilitis

Perio Dx: Generalized chronic periodontitis

Perio Risk: moderate due to long-span bridge forces

Caries risk: high due to dry mouth OC risk: high due to smoking