Case Study 21

Patient Profile: Patient is a 67-year old White Caucasian female.

Chief Complaint: "I understand my teeth are an important part of my overall health."

Dental History: The patient has had routine dental care for the past 10 years.

Medical History: She had a hysterectomy 15 years ago due to cervical cancer. She currently takes: (Conjugated estrogens tablets) Premarin®, (Conjugated estrogens/Medroxyprogesterone acetate) Provera®, (Verapamil) Calan®, (Quinapril) Accupril®, (Indapamide) Lozol®, (Pentoxifylline) Trental®, (Glipizide) Glucotrol®, (Metformin) Glucophage® daily. Approximately nine months ago, she broke two fingers on her right hand and was in a cast for two months. She has undergone physical therapy since the cast was removed, yet has not regained full use of her dominant right hand. She had smoked for 15 years until recently.

Extraoral Examination:

  • Assessment reported all within normal limits.

Supplemental Information:

  • Patient has a firm nodule on the right side of her upper lip.

Health Behaviors:

  • She brushes twice daily using a scrubbing technique and occasionally flosses.

Social History: Patient smoked for 15 years until recently.


Case 21 Pictorial Chart


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


Click to view a larger image:
Radiographic 1
Radiographic 2
Radiographic 3
Radiographic 4
Radiographic Image 5
Radiographic 6
Radiographic Image 7
Radiographic Image 8

Left Side Left Side
Right Side Right Side
Maxillary Right Molar Maxillary Right Molar
Right Palatal Right Palatal
Full Direct Full Direct


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 maxillary right molar periapical radiograph demonstrates what technique error?
  1. The maxillary left posterior periapical radiographs indicate apical pathology where?
  1. The area representing parallel faint radiopaque lines apical to tooth #31 can be identified as:
  1. A radiolucent image near the apex of tooth #28 is MOST likely what?
  1. What is the technique error demonstrated in the left premolar bitewing radiograph?
  1. What is the technique error demonstrated in the left premolar bitewing radiograph?
  1. The clinician identifies a potential open crown margin with buccal root decay after exploring tooth #5.  Using G.V. Black's classification of dental caries, what is the BEST classification being described
  1. The patient's medications are used to treat all the following conditions except one.  What is the EXCEPTION?
  1. Which of the following oral hygiene aids is the BEST recommendation for this patient?
  1. The tooth with the poorest periodontal prognosis is MOST likely:
  1. The appearance of the gingival tissues around teeth #12, #13 can BEST be characterized as: