Case Study 26

Patient Profile: Patient is a 21-year old White Caucasian female who is overdue for her 6-month prophylactic appointment.

Chief Complaint: "My mouth really hurts and I have a bad taste."

Dental History: The patient was seen regularly by her dentist until this past year.

Medical History: The patient reports a recent illness from mononucleosis and suffers with frequent panic attacks and experiences insomnia. She currently takes (Alprazolam) Xanax®, (Eszopiclone) Lunesta®, (Norgestimate/ethinyl estradiol) Ortho Tri-Cyclen®. Vital signs recorded: Blood Pressure: 108/68; Pulse: 90 BPM; Temperature: 100.7°F; Respiration: 18 Breaths/minute.

Extraoral Examination:

  • She demonstrates bilateral, palpable, tender cervical and submandibular lymph nodes, fetid breath and reports her mouth to be unusually dry.

Supplemental Information:

  • Patient desires information about a mouthrinse that does not burn.
  • She smokes a ½ pack of cigarettes daily.

Health Behaviors:

  • Patient brushes twice daily with a soft manual brush.
  • Patient does not floss because it is too painful.
Gingival Description: Maxillary and mandibular marginal erythema and edema; necrosis of anterior papilla,especially mandibular; bleeds easily upon light pressure.

Bleeding Index: 100% for the first 16 sites probed.

Plaque Free Score: 10%

Social History: The patient is a social drinker and has a diet consisting of carbonated drinks, chips, crackers and chocolate.


Case Study 26 Pictorial Chart


Case 26 Radiograph

Image Source: Langlais, R.P., and Miller C.S. (2003). Color atlas of common oral diseases (3rd edition). Baltimore, MD: Lippincott Williams and Wilkins.


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 patient's vital signs indicate she is experiencing what?
  1. All of the following are characteristics associated with an immunosuppressed condition except one. What is the EXCEPTION?
  1. The virus associated with the patient's recent illness is?
  1. The MOST commonly recognized oral sign associated with the patient's recent illness is:
  1. The intraoral image illustrating the abnormality on the dorsal surface of the patient's tongue is MOST likely:
  1. The etiology of the identified image (answer from #5) is:
  1. What is the radiopacity located inferior to the mandibular central incisors?
  1. The dental hygienist desires to implement a tobacco cessation program for the patient, what is the first step for this proposed initiative?
  1. All of the following require specific planning tailored to address the patient's needs except one. What is the EXCEPTION?
  1. All of the following medications can reduce the efficacy of the patient's oral contraceptive except one. What is the EXCEPTION?