The Case of George Murray

1. The Case of George Murray • George Murray, Patient • Age 45 • Treating broken molar in an insulin-dependent diabetes patient • Presented by: Group “T” Katie Clough, Ara Fatoure, Daniela Chobor, Maryam Boroujerdi-Rad, and Greg Kinsinger

2. Mr. Murray’s Medical History: • No sign of periodontal disease or caries • Minimal occlusal amalgam restoration on tooth number two • Patient has a phobia of dental and surgical work • Patient preference is no implants or surgery

3. Background Questions: Universal Tooth Numbering System • Universal Tooth Numbering System for Adults: in order to locate tooth number two on Mr. Murray (see red arrow) Mosby’s Dental Dictionary Zwemer

4. Background Question: Insulin • Insulin: A protein hormone secreted by the beta cells of the pancreatic islets that serves as a hormonal signal of the fed state; it is secreted in response to elevated blood levels of glucose and amino acids and promotes the efficient storage and utilization of these fuel molecules by controlling the transport of metabolites and ions across cell membranes and regulating various intracellular biosynthetic pathways. Insulin secretion is also influenced by several gastrointestinal hormones and by autonomic nervous activity. Dorland's Illustrated Medical Dictionary, Edition 28

5. Background Question: IDD • IDD = Insulin Dependent Diabetes • High risk of periodontal (gum) disease • Gum infection = increased blood sugar • Diabetes is harder to control Dorland's Illustrated Medical Dictionary, Edition 28

6. Background Question • Occlusal: Of or relating to the grinding or biting surface of teeth, pertaining to the contacting surfaces of opposing occlusal units (teeth or occlusion rims). Pertaining to the masticating surfaces of the posterior teeth. • Amalgam: Alloy of mercury with another metal that is solid of liquid at room temp according to the proportion of mercury present and is used esp. in making tooth cements. • Restoration (prosthetic restoration): Broad term applied to any filling, inlay, crown, bridge, partial denture, or complete denture that restores or replaces lost tooth structure, teeth, or oral tissues; a prosthesis. Mosby’s Medical Dictionary

7. P: Patient / Problem: - Patient: - 45 year old male who is an insulin dependent diabetic - Problems: - Broken molar - Patient has a phobia of dental and surgical work I: Intervention: - How to restore or replace the broken molar in a manner which is sensitive to patient’s fears and wishes while taking into consideration the insulin dependent diabetes health issue. C: Comparison: - What would be the treatment of a patient who is not an insulin dependent diabetic? O: Outcome: - Careful determination and assessment of the situation leading to a successful treatment plan in which the patient’s molar is successfully restored without putting the patient’s health at risk.

9. Bibliographic Citation With Abstract Dental Management of Diabetics • The primary responsibility of the dentist in the management of diabetic patients is to deliver treatment in such a way as to minimize disturbances of metabolic balance. Physical and emotional stress, infection, and surgical procedures will tend to alter control of the patient's diabetes. In general, appointments should be of short duration in the morning and patients should be encouraged to maintain their standard treatment regimens. If doubt exists on the part of the dentist as to the degree of control of blood glucose levels in diabetics, the patient's physician should be contacted before treatment is begun. Patients with type I diabetes (IDDM) are more likely to develop glucose imbalance during treatment than are those with NIDDM. • Glucose drinks should be available if patients complain of symptoms of hypoglycemia. Following dental treatment patients should be instructed to resume their normal diet. If this proves to be impossible, medical advice should be sought immediately. Burket’s Oral Medicine and Diagnosis - Lynch