Full Name | Michael Thompson |
Date of Birth | August 8, 1963 |
Sex | Male |
Occupation | College Professor |
Presenting Complaint | Michael has lost a tooth due to periodontal disease and is interested in a dental implant to replace the missing tooth. He is concerned about aesthetics and functionality. |
Medical History | Allergies: None known. Previous surgeries or hospital admissions: Underwent coronary artery bypass grafting (CABG) 2 years ago following a heart attack. Recovery was uncomplicated. Chronic illnesses: Has hypertension and type 2 diabetes, both controlled with medication. Autoimmune diseases: None. Current medications: Metformin 1000mg twice daily, Lisinopril 20mg once daily, Aspirin 81mg once daily. Negative reactions to medications: No known reactions. History of bleeding disorders or prolonged healing: Prolonged healing observed following CABG. Lifestyle habits: Ex-smoker (quit 2 years ago), occasional alcohol (1-2 times per month), no recreational drugs. |
Dental History | Recent dental procedures: Tooth extraction 6 months ago due to periodontal disease. Ongoing dental problems: Chronic periodontitis under management. Oral infections: No recent oral infections. |
Bone Health | Conditions affecting bone health: None. Medications affecting bone health: None. |
Oral Hygiene Habits | Brushes twice daily and uses dental floss regularly. Uses a mouthwash recommended by his dentist. |
Lifestyle | Diet: Predominantly plant-based with occasional fish. Exercise: Light exercise (walking), 5 times per week. Significant weight fluctuations: Lost 20 lbs over a 1-year period after the heart attack. |
Psychological and Emotional Health | Mental health diagnoses: None. Unusual stress or pressure: Moderate stress related to academic responsibilities. |
Obstetric and Gynecologic History | N/A |