Case Study 9

Patient Profile: Patient is 57-year old White Caucasian male, 6’1” and weighs 190 lbs. He is currently in an alcohol rehabilitation program.

Chief Complaint: “I have bad breath and a dry mouth with a bad taste all the time. My partial denture does not fit.”

Dental History: His last dental appointment was to fabricate a mandibular removable partial denture. He has not had his teeth cleaned in the past 6 years. After completing his dental work, he lost interest in maintaining his teeth.

Medical History: Patient was diagnosed with prostate cancer 5 years ago and underwent chemotherapy and radiation treatments lasting 9 months. He has a family history of cancer, hypertension, depression, cardiovascular disease and alcoholism. He has numerous allergies to pollen, dust, bee stings, cats, shellfish and Penicillin. He was recently diagnosed with gout and arthritis in each knee. He experiences frequent asthmatic attacks. His daily medications are: 81 mg aspirin, (Fluoxetine hydrochloride) Prozac®, (Aripiprazole) Abilify®, (Dutasteride) Avodart®, (Aloprim) Allopurinol®, (Naproxen) Aleve®, (Valsartan) Diovan®, (Lovastatin) Mevacor®, (Indomethacin) Indocin®, (Albuterol sulfate) Proventil®, (Ipratropium bromide) Atrovent®. His blood pressure was recorded at 155/95.

Extraoral Examination:

  • Submandibular, sublingual, and cervical lymph nodes are palpable and tender.

Supplemental Information:

  • Patient questions why he consistently has a bad taste and a dry mouth.

Health Behaviors:

  • Patient brushes with a hard bristled toothbrush once daily and is uncertain whether he uses a fluoridated toothpaste.
  • He has never used floss.
  • He has rinsed with a phenol mouthrinse daily for several years.

Bleeding Index: 35%

Plaque Free Score: 40%

PERIODONTAL CHARTING

Case9_Periodontalchart

RADIOGRAPHIC IMAGES

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Case 9 Radiograph
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Intraoral Images

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Maxillary Palatal Maxillary Palatal
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Full Direct Full Direct(Post-treatment)

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 of the following appear radiolucent in the split image panoramic radiograph?
  1. Which of the following dental prostheses has been surgically placed and used as prosthodontic abutments in this patient?
  1. All of the following are home care devices essential for properly maintaining the mandibular arch except one. What is the EXCEPTION?
  1. This patient experiences xerostomia as a result from what?
  1. Which of the following medications is used to treat the patient’s gout?
  1. What is LEAST effective in controlling plaque in the maxillary anterior sextant?
  1. What phase of care will BEST address this patient’s health behavior?
  1. In reviewing the health history, what condition can potentially pose as a risk should long dental procedures become necessary?
  1. Which of the patient’s combined medications are often contraindicated?
  1. Based on the patient’s assessment, the following vitamins are MOST likely deficient except one. What is the EXCEPTION?