Case Study 28

Patient Profile: Patient is a 75-year old African-American female.

Chief Complaint: "I am here for my check-up and I have been told I have bad breath."

Dental History: The patient has regular dental appointments every 6 months.

Medical History: The patient suffers with depression, arthritis and type 2 diabetes. Her BMI indicates she is obese. She currently takes OTC Aspirin, (Metformin hydrochloride) Glucophage®, (Amlodipine besylate) Norvasc®, (Paroxetine hydrochloride) Paxil®, (Hydrochlorothiazide) Microzide®. Vital signs recorded: Blood Pressure: 139/89; Pulse: 64 BPM.

Intraoral Examination:

  • Bilateral mandibular tori were noted along with a coated tongue.
  • A fibroma measuring 2mm x 2mm was observed on the attached gingiva between #8 and #9.

Supplemental Information:

  • Patient has poor dexterity in each hand.
  • Patient is curious about a power brush, if it can relieve her hand discomfort while brushing.

Health Behaviors:

  • Patient recently began sucking on mints to alleviate her dry mouth and bad breath.
  • Patient brushes once daily with a manual toothbrush.

Gingival Description: Generalized marginal and papillary erythema and edema. Localized cyanotic tissue around the facial of tooth #5.

Bleeding Index: 20%

Plaque Free Score: 35%

Social History: She plays cards with her friends on Wednesday nights.

PERIODONTAL CHARTING

Case Study 28 Pictorial Chart

RADIOGRAPHIC IMAGES

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Case 28 Radiograph
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Intraoral Images

Full Direct Full Direct
Mandibular Anterior Lingual Mandibular Anterior Lingual(after follow-up appointment)

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 the AAP Classification, what BEST describes the patient's periodontal status?
  1. What phase of therapy will address the patient's dental hygiene diagnosis?
  1. Which of the following oral hygiene aids will BEST assist the patient with plaque removal?
  1. Each of the following medications can potentially increase her xerostomia except one. What is the EXCEPTION?
  1. The patient's hypertensive condition can be risk associated with each of the following except one. What is the EXCEPTION?
  1. What is MOST likely the cause for the technical error illustrated in the panoramic radiograph?
  1. Each of the following can potentially increase her risk for greater periodontal concerns except one. What is the EXCEPTION?
  1. The radiopacity near the apex of tooth #18 is MOST likely:
  1. What BEST describes the positioning of tooth #12?
  1. Specific to the needs of the patient, the implementation phase of care should include all of the following except one. What is the EXCEPTION?