Case Study 40

Patient Profile: Patient is a 67-year old White Caucasian male.

Chief Complaint: “ I have a broken tooth and really itchy gums.”

Dental History: The patient had his teeth cleaned 16 months ago and saw his dentist at that time.

Medical History: The patient has type 2 diabetes, hypertension, early dementia, and Parkinson’s disease. He is allergic to penicillin. Medications include: (Lisinopril) Prinivil®, (Glipizide) Glucotrol®, (Carbidopa/Levodopa) Sinemet®, (Escitalopram) Lexapro®. Vital signs recorded: Blood Pressure (RAS): 130/88; Heart Rate: 100 BPM; Respiration: 20 Breaths/Minute.

Extraoral Examination:

  • Assessment reported all within normal limits.

Intraoral Examination

  • Tenderness reported in maxillary left quadrant.

Supplemental Information:

  • He experiences tremors in his hands, stiffness in his joints and an impaired balance. He is a mouth breather.

Health Behaviors:

  • He brushes with a hard bristled toothbrush once daily, does not floss, and rinses with a phenol mouthwash and hydrogen peroxide daily.

Bleeding Index: 65%

Gingivitis Index: Moderate inflammation

Plaque Free Score: 365%

PERIODONTAL CHARTING

Periodontal Chart - case 40

RADIOGRAPHIC IMAGES

Click to view a larger image:
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Panoramic Radiograph - Case study 40
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Full Direct Full Direct - Case study 40
Maxillary Left Side Maxillary Left Side - Case study 40
Maxillary Palatal Maxillary Palatal - Case study 40
Mandibular Arch Mandibular Arch - Case study 40

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 is MOST likely the reason for the radiopacities distal to #6?
  1. What BEST describes the patient’s centric occlusion?
  1. The (GI) reports moderate inflammation referring to redness, edema and bleeding on probing. The (GI) score was within the range 2.1-4.0 indicating the classification as moderate inflammation.
  1. In order to effectively scale, root plane and debride the maxillary anterior sextant, the patient requires local anesthesia. Which anesthetic will provide the best duration?
  1. The landmark on the panoramic radiograph appearing as a small radiolucent circle directly inferior to the mandibular central incisors is:
  1. What is the patient’s ASA physical status classification category?
  1. What phase of dental care planning will BEST address the patient’s needs?
  1. What landmark on the panoramic radiograph can appear as a U, V, or J shaped radiopaque line superior to the maxillary first and second molar?
  1. Which of his medical conditions can affect gait, speech and difficulty swallowing?
  1. What dental assessment can be determined from viewing the maxillary anterior sextant?