Dental And Oral Health - Case Study 24
Patient History
Patient Profile:
The patient is a 62-year old Caucasian female who is an elementary school teacher. She indicates she loves her career and is not looking forward to retirement as she has no children of her own. She has always taken good care of her teeth but has lost a few due to periodontal disease. She has been on a 3-month periodontal maintenance program for several years. She considers herself in good physical condition and plays tennis twice a week with her husband.
Chief Complaint:
“My bottom teeth seem to be getting longer and my gums seem to be disappearing.”
Medical History:
The patient was diagnosed with type 2 diabetes and hypertension about 10 years ago but feels they are both well-controlled with the medications she takes. She sees her physician annually for a physical examination and measures her blood glucose daily. Her most recent HbA1c value was 6.0%. She reports only one surgery, a hysterectomy 12 years ago. Her daily medications are: (Nisoldipine) Sular®, (Metformin hydrochloride) Glucophage® and 81 mg aspirin. Vital signs recorded: Blood Pressure RAS: 125/78; Pulse: 68 BPM; Respiration: 19 Breaths/Minute.
Dental History:
The patient has received dental care throughout her life and has extensive restorations and one bridge. Since she changed dentists 5 years ago, she had to have several extractions due to periodontal disease and has been on a more stringent periodontal maintenance program since then. She demonstrated how she scrubs twice daily with a manual toothbrush in order for her teeth to be nice and clean and indicates she uses a hard toothbrush. She has considered purchasing an electric toothbrush but has been concerned that it may cause her gums to recede even more. She flosses her teeth only when she gets food stuck in between them. She knows she should be doing it daily, but finds it difficult. She occasionally uses an alcohol-based mouthrinse to eliminate her breath odor.
Extraoral Examination:
The submandibular nodes on the patients right side were tender when palpated but only slightly enlarged. All other extraoral findings were within normal range. No TMJ clicking was noted, her facial features were symmetrical and no lesions were present.
Intraoral Examination:
Using a bi-digital technique, her submandibular and submental nodes were palpated and once again, she experienced tenderness on the right side. All other intraoral tissues including the lips, tongue, floor of the mouth, palate and pharynx were found to be within normal limits. Her gingival tissues from the facial aspects were pale with no redness noted, however gingival margins on several teeth were rolled. Some localized areas of inflammation were noted on the posterior molar facial & lingual margins that also displayed some redness and bulbousness of the interdental papillae. Generalized recession ranging from 2-4mm was noted on all facial surfaces of the teeth.
Bleeding Index:
12%
Plaque Score:
15%
Periodontal Charting
Radiographic Images
Test
Attention Faculty and Students! New Case Study online test feature allows students to complete the tests online and receive an immediate score! Faculty members no longer need to provide the answers.
After evaluating the patient’s medical history, clinical and radiographic findings, how would you classify this patient’s periodontal condition based on the new 2018 AAP guidelines for Periodontal and Peri-implant Diseases?
Under which of the American Society of Anesthesiologists (ASA) categories for physical condition, does this patient fall under?
According to the new blood pressure guidelines published by the AHA/ACC, how would you categorize this patient?
In assessing the radiographic image of tooth # 30, how would you best describe the bone loss and type of pocket that you observe on the distal side of the tooth?
What would improve the diagnostic quality in the left premolar bitewing radiograph?
How would you address her question and concern regarding the purchase of an electric toothbrush?
Which of the following regimens would BEST assist the patient in addressing her chief complaint?
In viewing the radiographic images, which of the following teeth have an overhanging margin on the restoration present?
With generalized recessions visible on the images of the facial surfaces of both maxillary and mandibular teeth spanning from the right premolars to the left premolars, what would be your BEST ESTIMATE for the range of clinical attachment loss (CAL) measurements in these regions.
Since the bleeding on probing was minimal and detected primarily in the posterior molars, what addition to her oral hygiene regimen would you recommend to reduce the inflammation in these areas?