Case Study 3

Patient Profile: Patient is a 65-year old African-American female, 5’3” and weighs 130 lbs.  She is retired from the school district.

Chief Complaint: “I need my gums treated and teeth cleaned.”

Dental History: Her last dental visit was two years ago.  She reports a history of periodontal disease and several teeth being extracted due to bone loss.

Medical History: The patient had a blood transfusion 42 years ago following a miscarriage.  She reports having surgery on each wrist due to carpal tunnel syndrome and subsequently experiences arthritic pain in her hands.  She suffers from diverticulitis, GERD and stomach ulcers.  Her medications include: (Nizatidine) Axid®, (Acetaminophen) Tylenol®, (Ceterizine) Zyrtec®, (Naprosyn) Naproxen®, (Rosuvastatin calcium) Crestor®, (Metformin hydrochloride) Glucophage® and takes OTC antihistamines as needed.  She reports an occasional reaction to Penicillin.

Extraoral Examination:

  • Submandibular and posterior cervical lymph nodes are palpable.
  • Additional assessments reported to be within normal limits.

Supplemental Information:

  • Patient reports her tissues bleed during brushing and flossing.
  • Food and floss catch between her teeth and some teeth are loose and sensitive.

Health Behaviors:

  • She reports her stomach pain to be intense and she often feels tired.
  • She has not consulted a physician.

Bleeding Index: 60%

Plaque Free Score: 30%


case 3


Mandibular Anterior Lingual-Maxillary Palatal Mandibular Anterior Lingual-Maxillary Palatal
Full Direct Full Direct
Right Side Right Side
Left Side Left Side


Click to view a larger image:
Blank 1
Blank 1
lr pap
u c2c
l c2c
ul pap
Blank 1
ll pap

Full Direct Full Direct
Maxillary Anterior Palatal Maxillary Anterior Palatal
Maxillary Anterior Facial and Palatal Maxillary Anterior-Facial and Palatal
Right Side Right Side


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. Which of the following anatomical structures can be observed in the maxillary left posterior periapical radiograph?
  1. What technique correction would improve the radiographic quality in the mandibular right posterior periapical radiograph?
  1. Based on the patient’s chief complaint, what should the dental hygienist accomplish first?
  1. The MOST likely reason for the patient’s bleeding index to be elevated is the association with:
  1. Which of the following medications is being used to treat the patient’s stomach conditions?
  1. What oral hygiene intervention would BEST address the patient’s plaque free score and reduce the bleeding index?
  1. The BEST description for the furcation involvement in tooth #30 is:
  1. In order to adequately address this patient’s dental hygiene diagnosis and formulate an intervention plan, what phase of therapy should be a priority?
  1. All of the following anatomical landmarks are observed in the maxillary anterior sextant periapical radiographs except one. What is the EXCEPTION?
  1. According to the patient’s periodontal assessment, mobility is noted in the mandibular posterior teeth. What BEST describes the classification of mobility?