Case Study 36

Patient Profile: Patient is a 70-year old White Caucasian male.

Chief Complaint: “After all my dental visits, I still have a really dry mouth.”

Dental History: The patient has been receiving regular dental care during the past 18 months.

Medical History: The patient has type 2 diabetes, hypertension, GERD and had a full hip replacement 2 years ago. His orthopedic surgeon request pre-medication prior to any dental work. He is allergic to Penicillin. His A1c value is 7.2%. Daily medications include: (Lisinopril) Zestril®, (Glipizide) Glucotrol®, (Sitagliptin) Januvia®, (Omeprazole) Prilosec®. Vital signs recorded: Blood Pressure (RAS): 139/90; Heart rate: 100 BPM; Respiration: 20 Breaths/Minute.

Extraoral Examination:

  • All assessments within normal limits.

Health Behaviors:

  • Patient brushes with a medium bristled toothbrush and does not floss. Uses a phenol rinse two to three times daily and notes a burning sensation on his tongue and a very dry mouth.

Bleeding Index: 55%

Plaque Free Score: 35%

Social History: He reports a history of smoking.


Periodontal Chart - case 36


Click to view a larger image:
Panoramic Radiograph - case 36

Intraoral Images

Full Direct Full Direct - case 36
Post Extractions Post Extractions - case 36


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. What is MOST likely the reason for the exaggerated “frown” appearance on the panoramic radiograph?
  1. What BEST describes the type of implants this patient has?
  1. What thoroughly describes the osseous defects viewed radiographically on tooth #29?
  1. Which of the following implants has or will potentially have a poor prognosis?
  1. How can the dental hygienist BEST assist with the patient’s chief complaint?
  1. Removing calculus from his implants can be difficult due to the deposits penetration into the implant surface and because moderate to heavy pressure is required, the clinician should not be concerned about the scaling technique.
  1. The patient’s orthopedic surgeon has requested pre-medication prior to any dental procedure. What is most likely the dosing regimen he/she will prescribe?
  1. The patient’s A1c value requires what action, if any?
  1. What air space on the panoramic radiograph is radiolucent and superimposed over the ramus and neck of the mandibular condyle?
  1. What dental index was used to determine the thickness of soft deposits and debris at the gingival margin?