Case Study 34

Patient Profile: Patient is a 63-year old White Caucasian male.

Chief Complaint: “I have a few sensitive teeth and need my teeth cleaned.”

Dental History: The patient has not seen a dentist in 8 months.

Medical History: The patient has COPD, hypertension and has experienced partial seizures without losing consciousness. He is allergic to cat hair and Penicillin. He reports a family history of hypertension and COPD. His daily medications include: (Diazepam) Valium®, (Divalproex sodium) Depakote®, (Quinapril) Accupril® (Fluticasone/salmeterol) Advair®. Vital signs recorded: Blood Pressure (RAS): 138/89; Pulse: 100 BPM; Respiration: 20 Breaths/Minute

Extraoral Examination:

  • All other assessments reported within normal limits.

Supplemental Information:

  • Scrubbing technique observed in maxillary right and left posterior quadrants, chipped incisal edge #8 and stains in lingual pits.

Health Behaviors:

  • Patient brushes with a medium-bristled toothbrush.
  • Patient does not floss and is unaware if he uses a fluoridated dentifrice.
  • Patient uses a phenol mouthrinse and drinks lemonade and cola daily.

Bleeding Index: 25%

Plaque Free Score: 70%

Social History: He reports a history of smoking.


Case 34 - Periodontal Chart


Click to view a larger image:
Case 34 - Right Posterior Bitewing
Case 34 - Right Pre-molar Bitewing
Case 34 - Left Pre-molar
Case 34 - Left Posterior Bitewing

Full Direct Case 34 - Full direct photo
Mandibular Arch Case 34 - Mandibular arch photo
Maxillary Palatal Case 34 - Maxillary palatal photo


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 G. V. Black’s classification of dental caries, what BEST describes #13 and #30?
  1. The BEST intervention for this patient includes therapeutic approaches that describe what case type?
  1. According to Angle’s classification of malocclusion, what best describes the patient’s centric occlusion?
  1. What best describes the loss of tooth structure observed in this patient?
  1. In reviewing the patient’s medical history, does he pose any contraindication to the elective use of nitrous-oxide-oxygen conscious sedation?
  1. What active ingredient in an OTC dentifrice can most likely reduce the patient’s gingival bleeding, cariogenic bacteria and provide a barrier to acid insults from his favorite beverages?
  1. What best describes tooth #12?
  1. In order to improve the diagnostic quality in the right pre-molar and left posterior bitewing radiographs, the clinician needs to:
  1. Calculus is radiographically noted on teeth:
  1. Which of the medications can potentially create a persistent cough and GI irritation for this patient?