A 58-year-old man presents to a dental clinic with concerns of bleeding gums and persistent bad breath. He first noticed his gums bleeding during brushing about 6 months ago. It has become more frequent. He also feels that his upper front teeth have started to “look longer”. Some teeth feel slightly loose, particularly when chewing. His medical history is notable for type 2 diabetes mellitus, diagnosed 8 years ago. His most recent glycated hemoglobin (HbA1c) was 8.2%. He also has hypertension, for which he takes lisinopril. He has a 20-pack-year smoking history and currently smokes about 15 cigarettes per day. He reports brushing his teeth once daily and rarely flosses. He denies any allergies. Initial laboratory studies from his primary care physician last month are as follows:

WBC: 8,500/mm³ (4,500-10,000)

Hemoglobin: 14.1 g/dL (13.5-17.5)

Hematocrit: 42% (41-53)

Platelets: 220,000/mm³ (150,000-400,000)

Glucose (fasting): 155 mg/dL (70-99)

HbA1c: 8.2% (<5.7%)

Creatinine: 1.0 mg/dL (0.6-1.2)