Case Study 6

Patient Profile: Patient is a 70-year old White Caucasian male, 5’8” and weighs 200 lbs. He is a retired life insurance salesman.

Chief Complaint: “I am way overdue for my dental check-up.”

Dental History: In previous years he received regular dental care and was on a 6 month recare appointment interval.

Medical History: He reports a history of cigar smoking, hypothyroidism, Parkinson’s disease, frequent bronchitis, GERD and occasional angina. Five years ago he had a basal cell carcinoma removed from under his right eye. His daily medications are: (Simvastatin) Zocor®, (Metoprolol succinate) Toprol®, (Levothyroxine) Synthroid®, (Lisinopril) Zestril®, (Levodopa) Sinemet® and 81 mg aspirin. His blood pressure was recorded at 138/88.

Extraoral Examination:

  • Clicking and popping was noted in each TMJ.
  • Mild and inconsistent facial tremors occurred.
  • Areas of tenderness were noted in the submental, submandibular and deep cervical chain nodes.

Supplemental Information:

  • Generalized plaque with bleeding upon probing in most areas.
  • Moderate to heavy stains and calculus deposits.
  • Sensitivity on palatal surfaces.
  • Burning dry mouth.

Health Behaviors:

  • Brushes twice daily with a medium bristled toothbrush.
  • Seldom flosses unless food is trapped.
  • Burning sensation from his daily mouthrinse.

Bleeding Index: 55%

Plaque Free Score: 35%

Social History: Smoked cigars weekly for 20 years and now smokes 1 pack of cigarettes weekly.

PERIODONTAL CHARTING

Case6-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
Maxillary Posterior Periapicals
Posterior Bitewings
Mandibular Posterior Periapicals
Maxillary Anterior Sextant Periapicals (canine-to-canine)
Maxillary Posterior Periapicals
Posterior Bitewings
Mandibular Posterior Periapicals
Mandibular Anterior Sextant Periapicals (canine-to-canine)
L

Intraoral Images

Full Direct Full Direct_1
Full Direct Full Direct_2(Six week post-treatment)
Mandibular Anterior Lingual Mandibular Anterior Lingual_1
Mandibular Anterior Lingual Mandibular Anterior Lingual_2(Six week post-treatment)
Maxillary Anterior Palatal Maxillary Anterior Palatal_1
Maxillary Anterior Palatal Maxillary Anterior Palatal_2(Six week post-treatment)
Maxillary Left Palatal Maxillary Left Palatal

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 mobility noted in the patient’s assessment?
  1. What is the deficiency within the brain associated with muscle rigidity and tremors observed in Parkinson’s disease?
  1. The U-shaped radiopaque landmark on the maxillary left posterior periapical radiograph is:
  1. What BEST describes the osseous defect in the mandibular anterior periapical radiograph?
  1. What gingival characteristic BEST describes the interdental papillae between #8 and #9?
  1. Which of the following teeth require Phase II dental care planning?
  1. Which of the patient’s medical conditions can be associated with the maxillary anterior palatal surfaces?
  1. All of the following home care devices will reduce the patient’s bleeding index and improve his plaque free score except one.  What is the EXCEPTION?
  1. Which of the patient’s medications can increase his xerostomia?
  1. What MOST likely is the radiopacity observed near the occlusal surfaces in the maxillary left posterior periapical radiograph?