Case Study 10

Patient Profile: Patient is a 35-year old White Caucasian male, 5’10” and weighs 160 lbs. He has been HIV positive for 10 years.

Chief Complaint: “My front tooth recently fell out and I would like to have it replaced. I have canker sores frequently which are painful and burn. My tongue sometimes has sores on it and I have a bad taste most of the time.”

Dental History: The patient is fearful and apprehensive about dental treatment and has not received dental care in the past fifteen years.

Medical History: The patient has a family history of depression, bi-polar disorders, suicidal attempts, alcoholism and hypertension. He has a weight loss greater than 10 lbs. over a period of three months. His recent CBC panel indicated: CD4 T-lymphocyte count at 350, platelet count was 20,000/mcl and neutrophils at 400 cells µL. He currently takes: (Acyclovir) Zovirax®, (Lorazepam) Ativan®, (Zidovudine) Retrovir®, (Indinavir sulfate) Crixivan®, (Clonazepam) Klonopin® and (Triazolam) Halcion®. His blood pressure was recorded at 130/80.

Extraoral/Intraoral Examination:

  • Hard, swollen, non-tender fixed nodes were palpable in the anterior and posterior cervical regions.
  • Slight cracks were noted at the corners of the mouth.
  • White plaques were wiped away from the buccal mucosal tissue in the right cheek.

Supplemental Information:

  • Moderate to heavy calculus deposits.
  • Bleeding upon probing in most all areas.
  • Painful dry mouth.
  • Has tried numerous OTC mouthrinses to treat bad taste.
  • Mobility and furcation involvement.

Health Behaviors:

  • Uses a medium bristled toothbrush once daily with a horizontal brushing action.
  • Never flossed.
  • Rinses with whatever is advertised for bad breath.
  • Uses toothpicks to remove food particles.
  • Drinks several carbonated drinks daily.
  • Former smoker.

Bleeding Index: 55%

PERIODONTAL CHARTING

Case10_Peridontal

RADIOGRAPHIC IMAGES

Click to view a larger image:
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Mandibular
Posterior Bitewings
Mandibular Posterior Periapicals
Maxillary Anterior Sextant Periapicals (canine-to-canine)
Mandibular Anterior Sextant Periapicals (canine-to-canine)
Maxillary Posterior Periapicals
Posterior Bitewings
Mandibular Posterior Periapicals
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Intraoral Images

Full Direct Full Direct
Maxillary Palatal Maxillary Palatal
Mandibular Occlusal Mandibular Occlusal
Left Side Left 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. Antiretroviral medications may negatively interact with what other medication the patient is currently taking?
  1. According to the CDC classification for HIV patients, what CD4 T-lymphocyte count category does this patient represent?
  1. What is required to improve the diagnostic quality in the maxillary left premolar periapical radiograph?
  1. Halcion® was prescribed for the patient to treat what condition?
  1. The patient’s profile and reported findings are characteristic to all the following except one. What is the EXCEPTION?
  1. What BEST classifies the periodontal disease represented in the patient?
  1. The patient reports a history of canker sores.  The etiology MOST likely responsible for this outbreak is:
  1. Based on the assessment findings, the BEST treatment protocol for this patient is:
  1. Regarding the patient’s profile, all of the following are correct statements except one. What is the EXCEPTION?
  1. The following pathogens can MOST likely be identified in the patient’s crevicular fluid except one. What is the EXCEPTION?