Case Study 7

Patient Profile: Patient is a 42-year old African-American female, 5’8” and weighs 175 lbs. She has not received regular dental care and reports her teeth need to be cleaned.

Chief Complaint: “I am concerned that I have gum disease. I have bad breath and my gums bleed when I brush.”

Dental History: The patient only visits the dental office when in pain.

Medical History: The patient does not receive annual physical examinations. She has a family history of hypertension, diabetes type 1, depression and cancer. She is allergic to sulfa medications and Penicillin. She currently takes: (Omeprazole) Prilosec®, (Acetaminophen) Tylenol®, (Levothyroxine) Levoxyl® and (Venlafaxine HCL) Effexor®. Her blood pressure was recorded at 160/110.

Extraoral Examination:

  • Assessment reported all within normal limits.

Supplemental Information:

  • Patient questions why her gums bleed and her mouth is always dry.
  • She uses a phenol mouthrinse several times daily.

Health Behaviors:

  • Patient uses a medium bristled manual toothbrush once daily.
  • Never flosses unless something is lodged between her teeth.

Bleeding Index: 55%

Plaque Free Score: 35%

PERIODONTAL CHARTING

Study7-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

Maxillary Palatal Maxillary Palatal
Mandibular Lingual Right Side Mandibular Lingual Right Side
Maxillary Palatal Right Side Maxillary Palatal Right 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. The patient's blood pressure recording can be classified as which of the following?
  1. What protocol should be followed for this patient's dental treatment based on the blood pressure recording?
  1. Which of the following radiograph(s) exhibit potential pathology?
  1. Which of the patient’s medications does not have an association with her family history?
  1. What is required to improve the diagnostic quality in the mandibular right posterior periapical radiograph?
  1. Which of the patient’s medications can potentially intensify her xerostomic conditions?
  1. What is the BEST dental index to determine the patient’s bleeding score?
  1. Which phase of dental care would BEST address the patient’s chief complaint?
  1. Based on Maslow’s hierarchy of needs, what level does this patient most likely exhibit?
  1. What anatomical landmark(s) is/are observed in the mandibular left molar periapical radiograph?