Case Study 4

Patient Profile: Patient is a 48-year old White Caucasian male, 5’9” and weighs 175 lbs. He is employed at an industrial warehouse.

Chief Complaint: “Tartar builds up on my bridge and my gums bleed when I brush. You will have a difficult time cleaning my teeth.”

Dental History: Patient was diagnosed with periodontal disease and teeth #23-26 were extracted and replaced with a fixed bridge several years ago. He does not follow recommended recare appointment intervals.

Medical History: The patient has recently been under the care of a physician for a right shoulder injury. He was diagnosed with Hepatitis A over 30 years ago. He has an occasional outbreak of genital herpes. His current medications include: (Enalapril maleate) Vasotec®, (Valsartan) Diovan®, (Paroxetine hydrochloride) Paxil®, (Lorazepam) Ativan®, (Valacyclovir hydrochloride) Valtrex®, 81 mg daily aspirin and (Naproxen) Aleve® as needed. His blood pressure was recorded at 155/98.

Extraoral Examination:

  • Assessment reported all within normal limits.

Supplemental Information:

  • He reports sensitivity to cold water and air.
  • Patient rinses daily with a phenol rinse.

Health Behaviors:

  • He demonstrated a fast “scrub” motion technique.
  • Patient remarked he flosses daily yet does not floss the bridge area.
  • He sometimes will brush two times daily using a hard bristled toothbrush.

Bleeding Index: 45%

Plaque Free Score: 30%

Social History: He smoked for 15 years and quit about 5 years ago.

PERIODONTAL CHARTING

Case4-Periodontal

STUDY MODEL

Mandibular Anterior Lingual/Maxillary Palatal Mandibular Anterior Lingual/Maxillary Palatal
Full Direct Full Direct
Right Side Right Side
Left Side Left Side

RADIOGRAPHIC IMAGES

Click to view a larger image:
R
ur_pap
r_bw
Ir_pap
U-c2c
I_c2c
ul_pap
I_bw
II_pap
L

Full Direct Full Direct
Mandibular Anterior Lingual Mandibular Anterior Lingual
Maxillary Palatal Maxillary Palatal
Left Side Left Side

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. Which instrument(s) is/are BEST for scaling, root planning and debriding the osseous defects observed in the maxillary left posterior periapical radiographs?
  1. What is the BEST clinical feature for identifying the patient’s periodontal status?
  1. The patient’s Hepatitis A represents what mode of transmission?
  1. According to Angle’s classification of malocclusion, what BEST describes the patient’s occlusion?
  1. What type of restorative material has been used to fabricate the mandibular anterior crowns?
  1. What is the BEST classification for the patient’s periodontal disease progression?
  1. What MOST likely will correct the technique error observed in the mandibular left molar periapical radiographic image?
  1. After evaluating the patient’s radiographs and periodontal charting, which sextant demonstrates the poorest prognosis?
  1. In order to effectively scale, root plane and debride #14 and #15, which of the following nerves will require local anesthesia?
  1. According to G.V. Black’s classification of caries, what is the BEST classification describing #18?