Case Study 18

Patient Profile: Patient is a 68-year old White Caucasian male who is semi-retired from farming.

Chief Compliant: "My teeth feel rough, look brown and my mouth is dry. I also have a sore spot behind my last tooth on the lower right side."

Dental History: The patient had a dental exam and bitewing radiographs four years ago.

Medical History: The patient takes (Diltiazem) Cardizem®, (Atorvastatin calcium) Lipitor®, one aspirin, (Omeprazole) Prilosec® and two (Naproxen) Aleve® daily. His blood pressure was recorded at 140/92. He was diagnosed several years ago and underwent surgery for the removal of a basal cell carcinoma lesion from his face and head. The patient was recently diagnosed with a Dupuytren's contracture and has undergone surgery to repair the ligament in his left hand and currently receives physical therapy weekly. He has smoked a ½ pack of cigarettes daily for 36 years.

Extraoral Examination:

  • Several nevi are noted on his face and neck.

Supplemental Information:

  • A vigorous scrubbing motion has been used on the facial aspect of his teeth and gingiva.
  • He does not brush his tongue or lingual surfaces of the teeth.
  • He is interested in whitening his teeth.

Health Behaviors:

  • Patient states he brushes twice daily.
  • Patient flosses twice weekly or whenever he thinks about it.



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


Click to view a larger image:
radiograph - left 1
radiograph - left2
radiograph - left3
radiograph - upper
radiograph - lower
radiograph - right1
radiograph - right2
radiograph - right3

Left Side Left Side
Full Direct Full Direct
Maxillary Occlusal Maxillary Occlusal
Mandibular Anterior Lingual Mandibular Anterior Lingual


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 daily use of NSAIDs and aspirin can increase his risk for:
  1. What BEST identifies the cause for loss of tooth structure observed in the maxillary occlusal intraoral image?
  1. When using G.V. Black's classification of restorations, what BEST describes tooth #5?
  1. The position of tooth #12 is BEST described as:
  1. The BEST description for the gingival contour around tooth #10 is:
  1. What is the radiopaque U-shaped formation observed on the maxillary left molar periapical radiograph?
  1. What BEST describes the clinician's error resulting in the left premolar bitewing radiographic image?
  1. All of the following will address the patient’s chief complaint except one.  What is the EXCEPTION?
  1. The patient's medical history findings indicate risk for all of the following.  What is the EXCEPTION?
  1. The image demonstrated in the lower right canine periapical radiograph is MOST likely due to: