Case Study 37

Patient Profile: Patient is a 59-year old White Caucasian female.

Chief Complaint: “I have a lump in the roof of my mouth.”

Dental History: The patient is seen every 6 months by her dentist and dental hygienist.

Medical History: The patient has hypothyroidism, Pre-diabetes and occasionally suffers with bronchial asthma and carries a rescue inhaler. She is allergic to latex and sensitive to many aerosols. She has a history of Hepatitis A and a family history of stroke and cardiovascular disease in each first-degree relative. Medications include: (Levothyroxine) Synthroid® and (Albuterol sulfate) Proventil HFA®. Vital signs recorded: Blood Pressure (RAS): 128/88; Heart Rate: 96 BPM; Respiration: 19 Breaths/Minute.

Extraoral Examination:

  • Assessment reported all within normal limits.

Intraoral Examination

  • Hard, bony protuberance in the midline of the maxilla and often tender:

Supplemental Information:

  • She reports grinding and clinching her teeth daily, has sore jaws, burning sensation in the roof of her mouth and occasionally notices ulcerations in the area.

Health Behaviors:

  • She brushes with baking soda and a medium bristled toothbrush, occasionally flosses and uses an interproximal brush if she remembers. She is interested in whitening her teeth, and a mouthwash that will not burn.

Bleeding Index: 35%

Plaque Free Score: 55%

Social History: The patient has a history of smoking.

PERIODONTAL CHARTING

Periodontal Chart - Case 37

RADIOGRAPHIC IMAGES

Click to view a larger image:
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Left Posterior Bitewing - Case 37
Right Premolar Bitewing:large - Case 37
Left Premolar Bitewing - Case 37
Left Posterior Bitewing - Case 37
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Intraoral Images

Full Direct Full Direct - Case 37
Maxillary Palatal Maxillary Palatal - Case 37
Mandibular Lingual Mandibular Lingual - Case 37

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 clinical assessment identifies a hard, bony protuberance in the midline of the palate. This is most likely a:
  1. The patient frequently experiences irritating symptoms in the roof of her mouth. These are most likely due to:
  1. The patient’s pre-diabetic condition indicates lower than normal glucose levels and a confirmed diagnosis for diabetes; however, it can potentially place her at high risk for multiple systemic disorders in the future.
  1. Which of the following teeth are suspicious for caries?
  1. The technique error in the right posterior bite-wing radiograph can be corrected by:
  1. All of the following oral hygiene products can potentially assist in reducing the patient’s gingival bleeding EXCEPT one. Which one is the EXCEPTION?
  1. Which of the following dental materials are radiographically viewed on #30?
  1. The maxillary and mandibular anterior incisal edges demonstrate what similar characteristic?
  1. The furcation charted on #18 can be described as:
  1. All of the following should be avoided when treating this patient EXCEPT one. What is the EXCEPTION?