Case Study 1

Patient Profile: Patient is a 42-year old African-American female, 5’6” and weighs 180 lbs. She lives in a metropolitan area and works in a delicatessen. Patient reports she needs her teeth cleaned and has not seen a dentist in eight years.

Chief Complaint: "Some of my teeth hurt and my gums bleed when I brush my teeth. I have never had my teeth cleaned and I think this will prevent my bad breath."

Dental History: Her last dental appointment was to remove a third molar and radiographs were exposed at that time.

Medical History: The patient reported that five years ago she was diagnosed with an ovarian tumor which resulted in a surgery to remove the ovary. She currently takes: (Amlodipine besylate) Azor®, (Olmesartan) Benicar®, (Atorvastatin calcium) Lipitor®, (Glipizide) Glucotrol®, bioidentical hormone replacement therapy and a daily 81 mg aspirin. Her blood pressure was recorded at 135/85.

Extraoral Examination:

  • Assessment reported all within normal limits.

Supplemental Information:

  • Patient questions why her gums bleed and her teeth are sensitive.
  • She reports using a phenol mouthrinse weekly.

Health Behaviors:

  • Patient brushes once daily with a hard manual toothbrush and fluoride toothpaste.
  • Patient never flosses.

Bleeding Index: 55%

Plaque Free Score: 30%

PERIODONTAL CHARTING

Case_1

STUDY MODEL

Mandibular Anterior Lingual-Maxillary Palatal Mandibular Anterior Lingual/Maxillary Palatal
Full Direct Full Direct
Right Side Right Side
Left Side Left Side

RADIOGRAPHIC IMAGES

Click to view a larger image:
R
ur_apic
r_bite
Ir_apic
u_k9_k9
I_k9_k9
lu_apic
I_bite
II_apic
L

Intraoral Images

Full Direct Full Direct
Full Direct Full Direct (Four months post-treatment)(Four months post-treatment)
Maxillary Anterior Palatal Maxillary Anterior Palatal
Mandibular Anterior Lingual Anterior Lingual
Right Side Right Side

QUESTIONS

Your Faculty has access to the answers in this case study. Please ask them to look in the Faculty Corner for the answers to this case.
  1. The patient’s medications are used to treat all the following conditions except one.  What is the EXCEPTION?
  1. What is the BEST description for the technique error(s) observed in the maxillary anterior sextant radiographs?
  1. From viewing the radiographic images, which teeth require immediate dental treatment?
  1. The ASA physical status classification for the patient is:
  1. Which category BEST represents the patient’s blood pressure recording?
  1. What BEST describes the erythematous appearance in the gingival tissues surrounding the facial of the maxillary and mandibular anterior teeth?
  1. In order to improve the diagnostic quality in the maxillary right posterior periapical radiograph, the clinician needs to:
  1. What anatomical landmark observed in the maxillary anterior palatal intraoral image extends outwardly from the midline in the hard palate?
  1. What MOST likely occurred to the exposed radiographic images in the mandibular anterior sextant periapicals?
  1. The implementation phase of dental hygiene care specific to this patient includes all of the following except one.  What is the EXCEPTION?