Case Study 33

Patient Profile: Patient is a 52-year old White Caucasian male.

Chief Complaint: “I have a bad taste in my mouth and I have not seen a dentist for at least a year or maybe longer.”

Dental History: The patient has not seen a dentist in 12 months.

Medical History: The patient has type 2 diabetes, hypertension, hypercholesterolemia, depression, and suffered a heart attack at age 41. He experiences frequent asthmatic attacks after exercising and is allergic to latex, dust, pollen and Penicillin. He reports a family history of hypertension, cardiovascular disease, osteoarthritis and COPD. His daily medications include: 81 mg aspirin, (Hydrochlorothiazide) Microzide®, (Lisinopril) Zestril®, (Losartan) Cozaar®, (Venlafaxine) Effexor®, (Duloxetine) Cymbalta®, (Glipizide) Glucotrol®, (Atorvastatin) Lipitor®, (Ipratropium) Atrovent®, (Albuterol) Ventolin®. Vital signs recorded: Blood Pressure (RAS): 142/90; Pulse: 100 BPM; Respiration: 18 Breaths/Minute

Extraoral Examination:

  • Submandibular, sublingual and submental nodes are palpable and tender. All other assessments reported within normal limits.

Supplemental Information:

  • Generalized moderate bleeding upon probing. The maxillary and mandibular anterior sextants exhibit erythema, rounded, and bulbous gingival margins. He is concerned about his dry mouth and bad taste.

Health Behaviors:

  • Patient is unaware of his toothbrush design or brand name of dentifrice.
  • Patient does not floss.
  • Patient uses a phenol mouthrinse several times daily.

Bleeding Index: 60%

Plaque Free Score: 25%

Social History: He reports a history of smoking.

PERIODONTAL CHARTING

Case 33 - Periodontal Chart

RADIOGRAPHIC IMAGES

Click to view a larger image:
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Case 33 - Right Posterior Bitewing
Case 33 - Right Pre-molar Bitewing
Case 33 - Left Pre-molar Bitewing
Case 33 - Left Posterior Bitewing
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Full Direct Case 33- full direct photo
Mandibular Arch Case 33 - Mandibular Arch photo
Maxillary Palatal Case 33 Maxillary Palatal

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 ASA physical status classification for this patient is:
  1. Which teeth require immediate dental treatment?
  1. What type of hypersensitivity reaction can potentially occur if the patient experiences an allergic reaction in the dental chair?
  1. Local anesthesia is necessary in order to effectively scale, root plane and debride the UL quadrant. The following nerves to be anesthetized are:
  1. The patient requires an analgesic post-scaling. What is the best choice for this patient?
  1. What best describes the furcation on #18?
  1. If used safely, can N2O2 sedation be administered to this patient?
  1. What stage of gingivitis is observed in the maxillary and mandibular anterior sextants?
  1. What category does the patient’s anti-depression medication belong?
  1. How was the assessment conducted to determine the inflamed and tender submandibular nodes?