Case Study 22

Patient Profile: Patient is a 75-year old White Caucasian female who has been treated in the dental hygiene clinic for several years.

Chief Complaint: At her six month recall/recare appointment, she reported sensitivity between the maxillary right first and second molar.

Dental History:
Two years prior, the patient reported sensitivity around her bridge in the lower left quadrant. She had been receiving regular dental care until her dentist retired and currently does not have a dentist.

Medical History: The patient has suffered from hydronephrosis since her young adult years. She was hospitalized two years ago with bleeding diverticulitis. Seven years ago, polyps were discovered during a routine colonoscopy and a hysterectomy was performed many years prior. She reported no complications from either procedure. Cataract surgeries have been performed on each eye and no complications were reported. The patient suffers with emphysema as a result from smoking two packs of cigarettes daily for fifty-two years. She currently takes (Acetaminophen) Tylenol®, (Omeprazole) Prilosec®, (Methenamine) Urex®, 2 puffs 4 times daily of (Ipratropium bromide) Atrovent® and (Cephalexin) Keflex® as needed for kidney infections. The patient reports frequent arthritic pain. Her blood pressure was recorded at 156/82.

Extraoral Examination:

  • Bilateral crepitus was reported in the TMJ and a large nevus was present on her right cheek.

Supplemental Information:

  • A scrubbing technique was demonstrated throughout the mouth.

Health Behaviors:

  • brushes twice daily but does not floss.
  • Occasionally, a phenol mouthrinse has been used and burning sensations were reported on the inside of the lips, cheeks and tongue after its use.


Case 22 Pictorial Chart


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

Full Direct Full Direct
Mandibular Anterior Mandibular Anterior Lingual
Left Side Left Side
Right Side Right Side
Left Palatal Left Palatal
Right Palatal Right Palatal
Left Lingual Left Lingual
Right Lingual Right 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 clinician’s error resulting in the radiographic image demonstrated in the maxillary right posterior periapical is due to:
  1. What BEST describes the patient's blood pressure recording?
  1. The intraoral image of the mandibular anterior teeth illustrates a condition known as:
  1. The right posterior bitewing radiographs demonstrate radiolucencies on teeth #2, #3 MOST likely identified as:
  1. In reviewing the patient's medical history, nitrous oxide-oxygen conscious sedation will be contraindicated due to:
  1. The restorative materials on the mandibular left posterior periapical radiographs are MOST likely:
  1. The patient's periodontal condition is BEST classified as:
  1. The radiopacity below the apices of the mandibular central incisor’s can be described as:
  1. The BEST instrument of choice to remove calculus from the patient's mandibular anterior lingual surfaces is:
  1. On the maxillary left molar periapical radiograph is a radiopaque U-shaped structure identified as: