Case Study 19

Patient Profile: Patient is a 62-year old White Caucasian male who is retired and lives with his wife.

Chief Complaint: "I want my teeth to be better."

Dental History: The patient has received two scaling and root planning sessions using 2% xylocaine with 1:100,000 epinephrine in the UR and UL posterior sextants at separate appointments.  He additionally received occlusal adjustments due to heavy contacts on teeth #8 and #32.  At the completion of the SCRP appointments, he was recommended for a 6 week re-evaluation appointment to further assess his periodontal condition and subsequently a 3 month recall/recare appointment was scheduled.

Medical History: He reports to be in good health, takes no prescription medications, is allergic to bee stings and Penicillin.  He smoked 1-2 packs of cigarettes daily for 20 years and quit eight years ago.

Extraoral Examination:

  • The patient's gait, facial symmetry, lips and TMJ are within normal limits.

Supplemental Information:

  • Patient is interested in whitening his teeth.

Health Behaviors:

  • Patient brushes 1-2 times daily with a power toothbrush.
  • Patient flosses every other day.

Bleeding Index: 25%

Plaque Free Score: 60%

PERIODONTAL CHARTING

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
radiograph 1
radiograph 2
radiograph 3
radiograph 4
radiograph 5
radiograph 6
radiograph 7
radiograph 8
L

Intraoral Images

Full Direct Full Direct
Maxillary Maxillary
Left Lingual Left Lingual
Mandibular Anterior Lingual Mandibular Anterior Lingual

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. What is the BEST auxiliary aid to introduce into his daily home care regimen?
  1. The patient exhibits mobility in the mandibular anterior region. What BEST describes this classification?
  1. What is the BEST instrument of choice to remove the subgingival deposits and effectively debride teeth #8 and #9?
  1. The radiopaque area observed in the mandibular right anterior periapical radiograph is MOST likely:
  1. The patient's allergy to Penicillin can create what potential reaction?
  1. The patient reports his front teeth are separating.  The BEST reason for this can be attributed to:
  1. What BEST describes the enlarged tissue extending from tooth #7 to #11 observed in the maxillary anterior palatal intraoral image?
  1. At the patient's recall appointment, the BEST index to evaluate plaque removal after detailed OHI had been provided at the initial appointment is:
  1. The occlusal relationship demonstrated on the patient's left side is classified as:
  1. What will correct the clinician’s error observed in the right premolar bitewing radiograph?