Case Study 25

Patient Profile: Patient is a 64-year old African-American male.

Chief Complaint: "I really want to get my partial but I was told I need to get a dental check-up and have my teeth cleaned and have some teeth removed before I can get it."

Dental History: It has been more than 10 years since the patient received dental care.

Medical History: His daily medications include: (Metformin hydrochloride) Glucophage®, (Clonazepam) Klonopin®, OTC Aspirin, (Nifedipine) Procardia®, (Valsartan) Diovan®, (Losartan potassium) Cozaar®, (Atorvastatin calcium) Lipitor®, (Aledronate sodium) Fosamax®, (Benazepril hydrochloride) Lotensin® and (Rosiglitazone maleate) Avandia®. Vital signs recorded: Blood Pressure RAS: 142/71; Pulse: 73 BPM.

Extraoral Examination:

  • Assessment reported within normal limits.

Supplemental Information:

  • The patient is a former boxer with partial numbness in his mandible.
  • The patient is tired of taking so many medications.

Health Behaviors:

  • a retail store brand dentifrice and brushes once daily with a hard bristled manual toothbrush.
  • Uses a phenol mouthrinse twice daily for 1 minute each rinse.
  • Exercises on a regular basis training upcoming boxers.
  • Drinks diet soda once daily with lunch and coffee once daily with 1 teaspoon sugar.
Gingival Description: Generalized edematous tissue on maxillary and mandibular arches. Localized fibrotic tissue in the UR quadrant.

Bleeding Index: 68%

Plaque Free Score: 32%

Social History: Patient used spit tobacco for 10 years. He currently does not use any tobacco product and has not for 33 years.

PERIODONTAL CHARTING

Case Study 25 pictorial Chart

RADIOGRAPHIC IMAGES

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Case 25 Radiograph
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Intraoral Images

Maxillary Occlusal Maxillary Occlusal
Right Side Right 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. All of the following medical conditions are represented in the patient's profile except one. What is the EXCEPTION?
  1. The discoloration on the palatal tissue bordering areas #12 and #13 is MOST likely attributed to:
  1. What is the BEST protocol to follow based on the patient's blood pressure recording?
  1. After reviewing the intraoral images, what tooth has been extracted since the panoramic image?
  1. The MOST obvious technique error illustrated in the panoramic image is:
  1. In reviewing the patient's medical history, what medication cannot be tolerated if drinking alcohol?
  1. In order to provide a dental hygiene care plan tailored with oral hygiene interventions, all of the following should be addressed EXCEPT:
  1. Deep subgingival calculus is detected on teeth #3, #7 and anesthesia is required in order to thoroughly scale and debride the areas.  The following nerves to be anesthetized are:
  1. While scaling subgingivally on the distobuccal root of tooth #14, the dental hygienist breaks the instrument at the shank, what should he/she NOT do?
  1. What BEST describes the clustered-like projections observed diagonally between areas #6, #11 and extending into the vault of the hard palate?