Read the case notes and complete the writing task which follows.

Notes:

Assume that today's date is 30 August 2018

Mr Hunter attends medical and dental practitioners very irregularly.

PATIENT DETAILS:

Name:                          Mr William Hunter
Address:                     404 West Road, Newtown
DOB:                            04 Dec 1964

Medical background:

• Diabetes type 2
• Attendance at doctor − irregular
• ↑OBP (150/95)
  

Medications:

• Metformin hydrochloride (Diabex) 500mg b.d.
• Captopril (Capoten) 25mg b.d.

Social background:

• Smoker (25 cigarettes per day). Poor diet

Dental history:

• Last dental visit 2015 – 3 extractions (exo’s)
• Irregular attendance − doesn’t like dentist (since childhood)
• Brushing − irregular (forgets to brush). Never flosses

09 Aug 2019 − Comprehensive initial examination

Extraoral examination:

• No cervical lymphadenopathy
• Incompetent lips

Intraoral examination:
Soft tissues                       Draining sinus adjacent to tooth 36, no buccal swelling
Saliva                                  Appears thin, mouth dry
Hard tissues                     Missing teeth − 14/17/18/22/28/37/38/45/47/48
Restorations                    11MD/12M/16MOD/23M/26MO/44O

Periodontal Screening and Recording (PSR)  333
                                                                                                  333

Oral hygiene                      

• Poor
• Gross calculus deposits supra & sub gingivally
• Gingivae bleed readily on probing with exudate from pockets
  

Radiographs:
Bitewings L and R

• Caries 36 DO. No other carious lesions noted
• Generalised horizontal bone loss & vertical defects

Periapical radiograph 36

• Radiolucency associated with distal root

Special Tests:
Percussion test 36

• Slightly tender to percussion – not particularly painful

Sensibility test

• Negative to CO2 & electric pulp test
  

Palpation

• No pain

Diagnosis:

1. Pulpal necrosis with draining sinus 36 associated with disto-occlusal
   carious lesion
2. Moderate to severe generalised periodontitis – to be confirmed after full
   periodontal examination
3. Poor oral hygiene

Treatment plan:

1.  Extraction (exo) or root canal treatment (RCT) 36
2.  Full periodontal (perio) chart & diagnosis
3.  Oral hygiene instruction w full-mouth scaling & root planing
4. Smoking cessation
   

Discussions:

• Exo or RCT 36 − Pt will advise at next visit
• Provided info on RCT & exo, advised of costs & risks

30 Aug 2019 − Examination
On examination:

• Full perio chart completed – confirmed diagnosis
• Gross scale of supragingival calculus, full mouth
• Pt consented to blood sugar level (BSL) test (finger prick test) − result 20mmol/L
  (normal range: 3.0 to 5.5mmol/L)

Discussions:

• Pt does not want to see periodontist
• Advised will need 4x quadrant scaling visits with local anaesthetic − Pt agreed
• Pt chooses Exo 36 at next visit
• Pt last saw doctor (Dr Wong – Newtown Medical Centre) for diabetes in February
  2019
• Risks of exo with current BSL’s − advised to see doctor, get diabetes under control
  before exo
• Referral to doctor re poor diabetes control, smoking cessation, necessity for
  extraction 36 – risk of further infection

Writing Task:

Using the information given in the case notes, write a letter of referral to Dr Wong, general practitioner at
Newtown Medical Centre requesting further assessment and management of Mr Hunter’s blood glucose
levels. Address your letter to Dr Tanya Wong, Newtown Medical Centre, 77 North Road, Newtown.
In your answer:

•  Expand the relevant notes into complete sentences
  
• Do not use note form
• Use letter format

The body of the letter should be approximately 180–200 words.