Case Study 2

Patient Profile: Patient is a 79-year old African-American female, 5’7” and weighs 160 lbs. Patient reports she has not had a dental check-up for several years.

Chief Complaint: “My teeth have not been cleaned in a long time and are in bad shape.”

Dental History: The patient had the mandibular right first molar extracted one year ago and has received no dental treatment since.

Medical History: The patient had a hysterectomy at age 62. She suffered a mild stroke four years ago, relies solely on a cane in order to walk and occasionally suffers with shortness of breath upon exertion. She recently underwent laser surgery on the retina in her right eye. Daily medications include: 81 mg aspirin, multiple insulin injections, (Omeprazole) Prilosec®, (Lovastatin) Mevacor®, (Atenolol) Tenormin®, (Ramipril) Altace® (Clopidogrel bisulfate) Plavix® and (Risedronate sodium) Actonel®.

Extraoral Examination:

  • A large nevus is present on the left side of her face.
  • All other assessments are within normal limits.

Supplemental Information:

  • Patient is curious about a power brush since her hands are weak.
  • She questions whether a mouthrinse will reduce her bleeding.

Health Behaviors:

  • Patient reports she brushes with a fairly hard manual toothbrush.
  • She does not floss and is uncertain whether she uses a
    fluoridated toothpaste.

Bleeding Index: 55%

Plaque Free Score: 35%

PERIODONTAL CHARTING

Case2-Periodontal

STUDY MODEL

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

RADIOGRAPHIC IMAGES

Click to view a larger image:
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ur_pap
r_bw
lr_pap
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I_c2c
ul_pap
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II_pap
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Intraoral Images

Mandibular Anterior Lingual Mandibular AnteriorLingual
Mandibular Lingual Right Side Mandibular LingualRight Side
Mandibular Lingual Left Side Mandibular Lingual Left Side
Maxillary Palatal Left Side Maxillary PalatalLeft Side
Full Direct Full Direct(Five months post-treatment)
Mandibular Lingual Right Side Mandibular LingualRight 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. According to G.V. Black’s classification of restorations, the classification for tooth #17 is:
  1. All of the following home care regimens would prove beneficial for this patient except one. What is the EXCEPTION?
  1. The left premolar bitewing radiograph lacks diagnostic quality due to:
  1. The vertical linear radiolucency observed in the maxillary central incisor radiographic image is BEST identified as:
  1. According to Angle’s classification of malocclusion, the patient’s centric occlusion can be described as:
  1. Based on the patient’s daily medications, all of the following medical conditions are being treated except one.  What is the EXCEPTION?
  1. All of the following dental hygiene treatment considerations are based on the patient’s medical conditions except one. What is the EXCEPTION?
  1. Based on the patient’s plaque free score and bleeding index, the BEST course of action the dental hygienist should plan is:
  1. (Clopidogrel bisulfate) Plavix® is prescribed for the patient based on what medical condition?
  1. Spacing is observed between the patient’s maxillary anterior teeth which can be attributed to: