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 stents placed. She has a history of Hepatitis B, smoking, weight control issues, and 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 (RAS): 140/92; Pulse: 105 BPM; Respiration: 19 Breaths/Minute

Extraoral Examination:

  • Several fluid-filled vesicles and crusty skin is noted on the left corner of the lip.

Supplemental Information:

  • Left submandibular and sublingual nodes are tender and palpable.

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 brushes with baking soda.

Bleeding Index: 30%

Plaque Free Score: 65%

Social History: She reports a history of smoking and anxiety 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

Intraoral Images

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 can be associated?
  1. What dental specialist should the patient seek after her initial exam?
  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, what best describes the interarch alignment?
  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. What potential bacteria can be associated with tooth #21?
  1. The (GBI) conducted on the patient provides information about bleeding. The area is observed for 60 seconds and bleeding is scored as either present or absent with the use of an interdental stimulator.
  1. The vesicles noted at the corner of her lip can MOST likely be identified as:
  1. Which of the following contributing factors can be associated with the vesicles on the corner of the lip?