Case Study 35

Patient Profile: Patient is a 65-year old White Caucasian female.

Chief Complaint: “I have been afraid to revisit my dental office but my tongue is swollen and sensitive and I need to know why.”

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

Medical History: The patient has hypothyroidism, hypertension, hypercholesterolemia, type 2 diabetes, and five years ago had three cardiac stents placed. She has a history of Hepatitis B, smoking, weight control issues, and is allergic to Penicillin. She reports a family history of hypertension and CVD. Her daily medications include: 81 mg aspirin, (Clopidogrel bisulfate) Plavix®, (Rosuvastatin) Crestor®, (Enalapril) Vasotec®, (Levothyroxine) Levoxyl®, (Metformin) Glucophage®. Vital signs recorded: Blood Pressure: 140/92; Pulse: 105 BPM; Respiration: 19 Breaths/Minute

Health Behaviors:

  • Patient brushes with a soft-bristled manual toothbrush. Uses a retail store brand dentifrice and does not floss. She is interested in a power toothbrush and whitening. Occasionally she brushes with baking soda.

Extraoral Examination:

  • Several fluid-filled vesicles and crusty skin is noted on the left corner of the lip.
  • Left submandibular and sublingual nodes are tender and palpable.

Intraoral Examination:

  • Swollen tongue which is sensitive to palpation
  • Bleeding Index: 30%
  • Plaque Score: 35%
  • Some localized areas of redness on the gingival margins
  • Social History: She reports a history of smoking (1/2 pack daily) and anxiety when visiting a dental office


Case 35 - Periodontal Chart


Click to view a larger image:
Case 35 -  Right Posterior Bitewing photo
Case 35 -  Right Pre-molar Bitewing photo
Case 35 - Left Pre-molar Bitewing photo
Case 35 - Left Posterior Bitewing photo

Full Direct Case 35 - Full Direct photo
Mandibular Lingual Case 35 - Mandibular lingual photo
Maxillary Palatal Case 35 - 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 the patient’s chief complaint, what potential nutritional deficiency could this be associated with?
  1. The enlarged left submandibular and sublingual lymph nodes are most likely due to the:
  1. Graves’ disease is the most common cause of hypothyroidism. Medications used to treat Graves’ disease can be either Synthroid® or Levothroid®.
  1. According to Angle’s classification of malocclusion, the patient’s interarch alignment can best be described as:
  1. The restorative material on tooth #4 can be described as:
  1. What is the patient’s blood pressure category and what dental management considerations are BEST for this patient?
  1. Based on the 2019 AAP Classification of Periodontal Diseases, and the clinical findings of this patient, her diagnosis would be:
  1. The Grading in the above diagnosis was based on the:
  1. The patient has inquired about the use of a power toothbrush and whitening; what recommendations would you make regarding her query?
  1. The vesicles noted at the corner of her lip can MOST likely be identified as: