Case Study 39

Patient Profile: Patient is a 66-year old White Caucasian female.

Chief Complaint: “I have a sore in my mouth, bad taste and my gums bleed every day.”

Dental History: The patient had her teeth cleaned 9 months ago.

Medical History: The patient has type 2 diabetes, hypertension, osteoarthritis, hypothyroidism, rheumatoid arthritis and is recovering from a stroke 8 months ago. She is allergic to penicillin, cephalosporins and latex. Her medications include: (Lisinopril) Prinivil®, (Rosuvastatin) Crestor®, (Apixaban) Eliquis®, (Levothyroxine) Levoxyl®, (Glipizide) Glucotrol®, (Adalimumab) Humira®, (Naproxen) Aleve®, (Prednisolone) Omnipred®. Vital signs recorded: Blood Pressure (RAS): 130/90; Heart Rate: 94 BPM; Respiration: 19 Breaths/Minute.

Extraoral Examination:

  • Assessment reported all within normal limits.

Intraoral Examination

  • Tenderness in the maxillary left anterior sextant with exudate present.

Supplemental Information:

  • The patient reports a sore throat and a consistent dry cough. She experienced physical deficits post stroke and needs personalized oral hygiene recommendations.

Health Behaviors:

  • She brushes with a medium toothbrush once daily, does not floss, uses an interdental brush where it fits and rinses with a phenol mouthrinse daily.

Bleeding Index: 65%

Plaque Free Score: 25%

Social History: She reports a history of smoking.

PERIODONTAL CHARTING

Periodontal Charting - case 39

RADIOGRAPHIC IMAGES

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Radiographs - case 39
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Intraoral Images

Full Direct Full direct - case 39
Maxillary Palatal Maxillary palatal - case 39
Mandibular Arch Mandibular arch - case 39

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. What best describes the radiopaque image between #10 and #11?
  1. Which of the medications requires TB testing before she starts the prescribed dosing?
  1. What gingival characteristics are observed in the maxillary anterior sextant?
  1. All of the following oral hygiene recommendations can benefit this patient EXCEPT one, what is the EXCEPTION?
  1. What best describes the stage of peri-implantitis in tooth #10?
  1. In order to correct the radiographic error(s) in the maxillary anterior periapical, the clinician needs to:
  1. What should be avoided or reconsidered when using a local anesthetic on this patient?
  1. The patient’s consistent dry cough can most likely be an adverse reaction associated with what medication?
  1. Based on the patient’s (GBI) score, what is the best antimicrobial rinse recommendation?
  1. Which teeth most likely demonstrate a poor prognosis?