Case Study 30

Patient Profile: Patient is 28-year old White Caucasian male.

Chief Complaint: "I have a bad taste in my mouth all the time."

Dental History: The patient has not seen a dentist for 15 years.

Medical History: The patient reports sudden weight loss for no apparent reason and is not under the care of a physician. He acknowledges a history with substance abuse and underwent rehabilitative treatment for 10 months. He reports frequent migraines and is apprehensive about dental work. He currently takes OTC (Acetaminophen, aspirin, caffeine) Excedrin®. Vital signs recorded: Blood Pressure: 130/99; Pulse: 109 BPM; Respiration: 23 Breaths/Minute.

Extraoral Examination:

  • Assessment reported within normal limits.

Supplemental Information:

  • Patient presented with heavy plaque and calculus.
  • Generalized moderate to heavy bleeding upon probing.
  • Suppuration in numerous areas with severe halitosis.
  • Extreme tenderness during probing.
  • Smokes 1 ½ packs of cigarettes daily.

Health Behaviors:

  • Patient brushes with a medium bristled toothbrush 1-2 times per day.
  • The patient has never flossed.
  • Patient uses a phenol mouthrinse several times daily.
  • He is unaware if his toothpaste is fluoridated.

Bleeding Index: 75%

Plaque Free Score: 15%

Social History: The patient has smoked for 10 years and is employed as the assistant manager at a retail department store.

PERIODONTAL CHARTING

case30-peridontal

RADIOGRAPHIC IMAGES

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Case 30 Radiograph
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Intraoral Images

Maxillary Left Posterior Maxillary Left Posterior
Maxillary Right Posterior Maxillary Right Posterior
Maxillary Anterior Maxillary Anterior
Mandibular Anterior Mandibular Anterior
Mandibular Anterior Lingual Mandibular Anterior Lingual

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 radiolucent area on teeth #9, 12, 13, 27 can MOST likely be identified as:
  1. What BEST describes the maxillary right posterior intra-oral image?
  1. Prior to the patient’s scaling and root planing appointments, all of the following are recommended except one.  What is the EXCEPTION?
  1. According to the American Association of Periodontology, what is the classification for the patient’s periodontal status?
  1. Which instrument would be the BEST to initiate scaling in the lower anterior sextant?
  1. The following teeth will MOST likely require an endodontic evaluation:
  1. A local anesthetic is required prior to scaling and root planning.  Which anesthetic would produce the longest duration of action?
  1. All of the following gram negative periodontal pathogens are MOST likely to be elevated in this patient except one.  What is the EXCEPTION?
  1. The patient’s periodontal status exhibits all of the following EXCEPT:
  1. Which of the following nerve block injections are necessary in order to successfully scale, root plane and debride the mandibular right quadrant?