Case Study 12

Patient Profile: Patient is a 71-year old White Caucasian female.

Chief Complaint: "I am concerned about the stain on my teeth and would like it removed. The gold is wearing on one of the molars. Does that mean the crown will need to be replaced?"

Dental History: The patient saw a dentist ten years ago when the crowns were placed. She has followed recommendations for dental hygiene recare appointments every 6 months at a dental hygiene program clinic.

Medical History: Patient had breast cancer six years ago which required a mastectomy. She received six months of chemotherapy and nine weeks of radiation and reports no complications since. She is taking no prescribed medications at this time; however, she does report taking one baby aspirin daily to thin her blood. The patient has a history of stomach ulcers and hernias for which she took prescribed medications in the past. She has encountered no problems with GI difficulties in the past 12 months. She reports she suffers with occasional arthritis and takes a pain reliever, not ibuprofen, yet she cannot recall its name.

Extraoral Examination:

  • The patient's facial symmetry, lips, TMJ, and larynx were within normal limits.
  • Submandibular and posterior cervical lymph nodes were palpable.

Supplemental Information:

  • At the first appointment, the patient presented with minimal bleeding upon probing and one-third of all tooth surfaces exhibited supragingival plaque at the gingival margin.
  • At the second appointment, the patient demanded that all tooth surfaces be polished with a rubber-cup polisher.
  • At third appointment, the patient presented with multiple intra-oral blisters.

Health Behaviors:

  • Patient brushes with a manual brush twice daily using a circular motion.
  • She flosses once daily and remarked she needs assistance with her technique.

Social History: The patient reports smoking a pack of cigarettes daily for 50 years.

PERIODONTAL CHARTING

case12

RADIOGRAPHIC IMAGES

Click to view a larger image:
R
left1
Left 2
left3
upper
lower
right1
right2
right3
L

Full Direct Full Direct
Right Lingual Right Lingual
Left Side Left Side
Right Side Right Side
Left Palatal Left Palatal
Right Palatal Right Palatal
Mandibular Occlusal Mandibular Occlusal
Maxillary Occlusal Maxillary Occlusal
Mandibular AnteriorLingual Mandibular Anterior Lingual
Maxillary Palatal Maxillary Palatal

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. Which tooth serves as a fixed bridge pontic?
  1. What radiographic error(s) is/are evident in the maxillary left posterior periapical radiographs?
  1. Which of the following OTC pain relievers would be appropriate for the patient’s arthritic pain?
  1. Which of the following items could result in constriction of the blood vessels?
  1. Which of the following classifications BEST describes the embrasure between the mandibular right canine and first premolar?
  1. What is the patient's AAP classification?
  1. Which oral hygiene aid would be the BEST recommendation for this patient?
  1. Which of the following anatomical structures is visible on the patient's left bite-wing radiograph?
  1. What would be the first step in addressing the patient’s tobacco use?
  1. The clinical appearance evident on the facial aspect of #6-11 is MOST likely due to: