Case Study 29

Patient Profile: Patient is 23-year old White Caucasian male.

Chief Complaint: "I need my front teeth to look good for my wedding pictures."

Dental History: The patient has not seen a dentist for over 10 years.

Medical History: The patient has not seen a physician for many years and appeared agitated when the recommendation was suggested. His family history includes hypertension, alcoholism and substance abuse. He reports a history of cigar and cigarette smoking, frequent stomach indigestion and remarked he is in good health. He currently takes (Lansoprazole) Prevacid® and (Ibuprofen) Advil® as needed. Vital signs recorded Blood Pressure: 142/98; Pulse: 110 BPM; Respiration: 25 Breaths/Minute.

Extraoral Examination:

  • Assessment reported within normal limits.

Supplemental Information:

  • Patient presented with moderate calculus and heavy plaque.
  • Generalized moderate bleeding upon probing with localized heavy bleeding in the maxillary anterior sextant, papillary erythema and edema in the maxillary left posterior region.
  • Smokes 1-3 cigars weekly and 1 pack of cigarettes daily.
  • Lack of interest and motivation to seek additional care.

Health Behaviors:

  • Patient brushes with a hard bristled toothbrush once daily if he remembers.
  • Patient does not floss.
  • Patient uses a phenol mouthrinse several times daily.
  • Drinks cola, high energy drinks and orange juice several times throughout the day.

Bleeding Index: 65%

Plaque Free Score: 30%

Social History: The patient is planning to marry in 3 weeks. He has been smoking cigars for 2 years and has smoked cigarettes for 9 years.

PERIODONTAL CHARTING

Case Study 29 Pictorial Chart

RADIOGRAPHIC IMAGES

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Case 29 Radiograph
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Maxillary Left Maxillary Left
Maxillary Right Maxillary Right
Mandibular Right Mandibular Right
Mandibular Right Mandibular Right
Maxillary Anterior Maxillary Anterior

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. The patient’s blood pressure recording represents what category?
  1. Based on the clinically evident dental findings, all of the following treatment considerations require high priority except one. What is the EXCEPTION?
  1. The radiopacity on tooth #8 is MOST likely:
  1. Which of the following teeth are MOST likely to have a poor prognosis:
  1. When evaluating the patient’s health behaviors, all of the following are appropriate recommendations except one. What is the EXCEPTION?
  1. The gingival tissues around teeth #13-14 can BEST be described as:
  1. All of the following are synergistic destructive factors related to the patient’s treatment outcome except one. What is the EXCEPTION?
  1. According to G.V. Black’s classification of dental caries, what is the classification for #6?
  1. The following daily practices are good recommendations for this patient with erosive challenges except one. What is the EXCEPTION?
  1. When evaluating a patient’s profile for dental erosion, all of the following are risk factors to consider except one. What is the EXCEPTION?