Case Study 8

Patient Profile: Patient is a 29-year old African-American female, 5’4” and weighs 150 lbs. Patient reports she has never had her teeth cleaned and is anxious about dental work.

Chief Complaint: “My gums bleed when I brush. I have sensitivity to hot and cold most of the time and I have a sore on my tongue.”

Dental History: Her last dental visit was over ten years ago when she had a wisdom tooth extracted.

Medical History: The patient is not under the care of a physician and is reluctant to have a physical examination. Her family history includes diabetes, hypertension, oral cancer, alcoholism and substance abuse. She currently takes no medications. Her blood pressure was recorded at 138/89.

Extraoral Examination:

  • Assessment reported all within normal limits.

Intraoral Examination:

  • A lesion with soreness was noted on the lateral border of the tongue.

Supplemental Information:

  • Patient rinses with a phenol mouthrinse several times daily.
  • She questions why her tongue has a white spot.

Health Behaviors:

  • Patient uses a medium bristled toothbrush once daily when she remembers.
  • Never flosses and mixes water with her mouthrinse to reduce the burning sensation.
  • She recently started smoking one pack of cigarettes daily.

Bleeding Index: 40%

Plaque Free Score: 30%

PERIODONTAL CHARTING

Case8-Preiodontal

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

Full Direct Full Direct
Mandibular Lingual Left Side Mandibular Lingual Left Side
Maxillary Palatal Maxillary Palatal
Left Side Left Side
Lateral Border of Tongue Lateral Border of Tongue

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 MOST likely is the reason for the gingival appearance around the facial of #10, #11?
  1. What is the BEST definitive method to identify the lesion on the lateral border of the tongue?
  1. What BEST describes the patient’s periodontal classification based on clinical assessments?
  1. To address the patient’s recent behavioral habit, the four A’s designed for a cessation initiative follow what order?
  1. What is the BEST description for the patient’s blood pressure recording?
  1. According to the AAP, what is the patient’s case type classification?
  1. The patient’s dental hygiene care plan should include all of the following except one.  What is the EXCEPTION?
  1. All of the following instruments can effectively scale the maxillary left posterior sextant from the buccal aspect at the distal/distal line angle except one combination.  What is the EXCEPTION?
  1. The following microorganisms will MOST likely be identified in this patient’s microflora except one.  What is the EXCEPTION?
  1. Based on the patient’s diagnosis for periodontitis, her radiographs reveal some minor destructive osseous changes.  This patient’s bone loss is more than likely greater than what the radiographic demonstrates.