Patient: Delores Taylor
TYPE: At Home
Referral Source: Jonathan Ripp, MD
SPECIAL NEED: Unable to leave the house to seek the necessary treatment.
MEDICAL HISTORY: Major depressive disorder, BPPV, Orthostasis, Atrial Fibrillation, Hypothyroidism,
CHIEF COMPLAINT: Severe oral pain and trouble eating
Mrs. Delores Taylor * is a 91-year-old woman with a complex medical history that includes atrial fibrillation, orthostasis, benign paroxysmal positional vertigo, hypothyroidism, major depressive disorder and generalized pain. She takes multiple medications for these conditions. Mrs. Taylor is able to live at home with assistance from her daughter and round-the-clock home health aides. Her care is overseen and coordinated by her private Care Manager, Betsy Lichtenstein.
Mrs. Taylor had been experiencing deterioration of her overall dental health, a result of medication-induced xerostomia (chronic dry mouth that often causes rapid tooth decay). Her tooth decay had progressed to the point that her bridge was lifting off its anchoring teeth like a trapdoor and was in danger of breaking off (a potential airway obstruction). She also began to have discomfort in her lower left molar, and had resorted to eating only soft foods. Betsy knew a referral was imperative and recalled meeting the House Call Dentists team at a National Association of Professional Geriatric Care Managers (NAPGCM) chapter meeting. She made the call.
For Mrs. Taylor’s initial consultation, Dr. Kelly Yu visited her residence in Manhattan with portable dental equipment. After performing an oral health examination and taking digital x-rays with immediate imaging, Dr. Yu recommended a treatment plan with the patient’s own priorities regarding discomfort, function and aesthetics in mind. During a second house call visit, Dr. David Blende and Dr. Ilya Miloslavsky completed Mrs. Taylor’s treatment while she sat comfortably in her reclining chair, taking breaks as she needed. A third house call was made by Dr. Miloslavsky to seat her crowns. Mrs. Taylor is now on a 3-month recall program and will receive maintenance care in her home.
*patient’s name has been changed at her family’s request
Significant dental caries
Dr. David Blende, Dr. Kelly Yu, Dr. Ilya Miloslavsky
Scaling and Root Planing: 4 quadrants
Extractions: 1, 2
Composites: 3, 5, 32
Crowns: 4, 12, 13, 14, 15, 20
Decoronation (capitate): 12, 18, 23, 24, 25, 29
Crown Bridge: 21 – 28