Dr Bethany Pinnock

Doctor of Medical Dentistry

25 Primrose Avenue
Kingston 4
Jamaica

November 6, 2022

Dr Veronica Wong
General Practioner
236 Ferry Lane
Kingston 5
Jamaica

Re: Medical Clearance for Mrs. Lindsay Taylor-Graham (D.O.B. - 11/04.1943)

Dear Dr Wong,
Our mutual patient, Mrs. Lindsay Taylor-Graham, has presented to the Smile-A-While Dental
clinic with the chief complaint of “I have a hard time chewing my food!”. I would like to
commence treatment with Mrs Graham, however, I have some concerns about her health and
medical history and how it will affect the treatment process and effectiveness.

Examination of her oral cavity and evaluation of the radiographs have revealed that Mrs
Graham is missing most of her posterior teeth, hence her difficulty when chewing her food.
Another concern is the severe attrition of her lower anterior teeth (#22 - #27) because of the
maxillary 4-unit porcelain crown and bridge that occludes with and wears away the incisal edges
and cusp tips of these teeth. She has a severe overbite with little to no occlusion taking place
within the oral cavity. Her dental diagnosis would be Moderate Generalized Periodontitis Stage
III Grade B as well as malocclusion.

Mrs Graham’s medical history notes that she suffers from hypertension, a kidney disorder,
arthritis and has a hearing impairment. For hypertension and overall cardiac health, she is
taking Betapace (sotalol - 80mg, b.i.d.),Pravachol (pravastatin - 40mg daily) and Exforge
(amlodipine and valsartan - 160mg b.i.d). For treatment of the arthritis, she is on Bayer (baby
aspirin (81mg daily). Lastly, in the management of her kidney disorder, she is taking Vitamin D
(2000 units daily), calcium (daily), multivitamins (daily), and magnesium chloride (2 tabs daily).
Her dental history shows that she does her 6 month recall visits.
Her social history notes that she is a retired widow, on a fixed income and opts for extraction vs.
treatment depending on costs, and smokes approximately four (4) cigarettes daily.

I am concerned about her kidney disorder. A patient with kidney disease is at risk for the
development of cavities and periodontal disease. I am therefore requesting that she does the
following tests to evaluate the state of her kidney:
Glomerular Filtration Rate Test
Serum Creatine Levels
Blood Urea Nitrogen Levels

Due to Mrs Graham being hypertensive and having problems with her cholesterol and cardiac
activity, I will forgo the use of epinephrine when administering anesthesia to fulfill any future
dental treatments that require LA administration.

I am hoping to begin treatment as soon as the results from the requested lab work has come
through. I would begin with scaling and root planing, place porcelain crowns on tooth #22 and
#27. I will then extract the mandibular incisors and begin the fabrication of maxillary and
mandibular partial dentures. To address her concerns with chewing her food in the interim, I will
place an immediate denture. I will also seek consultation for a periodontist as to address her
periodontal health and present disease.

I look forward to partnering with you in the restoration of Mrs Graham’s oral and sytemic health.
Thank you in advance for your assistance.

Dr Bethany Pinnock
DMD