Case Study 17

Patient Profile: Patient is a 60-year old White Caucasian male who is a traveling salesman.

Chief Complaint: ''My last appointment was over six months ago so I know I have a lot of deposit on my teeth and am anxious to have it removed."

Dental History: The patient has followed preventive care recommendations for six month recall/recare intervals for years.

Medical History: The patient has minor vision loss in each eye. He experiences a nasal discharge due to the continued use of nasal spray. The patient has minor hearing loss. He has been under a physician's care for cluster headaches in the past. The patient had a history of peptic ulcers 21 years ago and underwent hernia surgery 24 years ago and has encountered no problems with either since. The patient currently takes a daily regimen of: (Amlodipine besylate) Norvasc®, (Fosinopril sodium) Monopril® and (Omeprazole) Prilosec®. The patient suffers from heel spurs and takes nine OTC (Ibuprofen) Motrin® daily.

Extraoral Examination:

  • The patient experiences crepitus bilaterally and has received restorative care as needed.
  • He experiences painful aphthous ulcers in numbers from one to several at a time lasting from 7-14 days in areas as lips, gingiva and tongue.
  • He discontinued the use of tobacco several years ago.
  • The patient reports the ulcers have occurred since he discontinued smoking.

Supplemental Information:

  • He demonstrates a vertical and horizontal scrubbing motion.

Health Behaviors:

  • Patient reports brushing 2-3 times daily.
  • Patient flosses daily.

Bleeding Index: 60%

Plaque Free Score: 25%

PERIODONTAL CHARTING

case 17

STUDY MODEL

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

RADIOGRAPHIC IMAGES

Click to view a larger image:
R
left 1
left 2
left 3
upper
lower
right 1
right 2
right3
L

Left Side Left Side
Right Side Right Side
Maxillary Anterior Sextant Maxillary Anterior Sextant
Mandibular Anterior Sextant Mandibular Anterior Sextant
Mandibular Anterior Lingual Mandibular Anterior Lingual
Right Lingual Right Lingual
Full Direct Full Direct

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 BEST instrument of choice to scale the calculus exhibited in the mandibular anterior lingual sextant is:
  1. What nerve would be involved if anesthesia was required to effectively scale/debride tooth #2?
  1. In reviewing the patient's intraoral images, what phase in the dental hygiene process of care requires immediate intervention?
  1. According to G.V. Black's classification of restorations, what is the BEST description for tooth #4?
  1. Using a furcation probe to assess the involvement on tooth #31, the dental hygienist discovers the probe partially enters the furcation area and will not pass completely through. What classification has been described?
  1. All of the following are valid reasons for the dental hygienist to seek additional information from the health history and extraoral findings except one. What is the EXCEPTION?
  1. What characteristic BEST describes the patient's centric occlusion according to Angle's classification of malocclusion?
  1. The posterior bitewing radiographs demonstrate technique error due to what?
  1. What BEST describes the radiographic error in the maxillary left premolar periapical image?
  1. The facial characteristics observed on teeth #8, #9 are due to what?