Patient Scenarios

Patient Scenario 1

An eight-year-old male patient, David, arrives for a new patient appointment accompanied by his mother. Review of the patient’s dental and medical histories are noncontributory. Further discussion with David’s mother indicates that the family lives outside the city limits and drinks non-fluoridated well water. It has been a year or two since her son has seen a dentist due to a new employment opportunity and subsequent family relocation. David has had several new permanent teeth erupt. The mother reports that she had several missing permanent teeth as a child and wonders if her son has any missing permanent teeth. The clinical evaluation of David’s oral cavity demonstrates evidence of poor oral hygiene, occlusal carious lesions in the 1st molar teeth, and marginal gingivitis.

• What positive historical findings were reported?

• What are the clinical signs & symptoms presented in this case?

• What are the risk factors for caries?

• Given the guidelines for a new child patient with a transitional dentition, what radiographic examination is recommended?

Patient Scenario 1 Key

• What positive historical findings were reported? Family history of dental anomalies

• What are the clinical signs & symptoms presented in this case? Marginal gingivitis

• What are the risk factors for caries? Non-fluoridated water, poor oral hygiene, irregular dental care, clinical caries

• Given the guidelines for a new child patient with a transitional dentition, what radiographic examination is recommended? Posterior bitewings with panoramic examination or posterior bitewings and selected periapical images

Patient Scenario 2

Monica, an 18-year-old female patient, arrives for her recall appointment. At her last recall visit one year ago, four bitewings were taken to evaluate for interproximal caries. No clinical or radiographic caries were found at that time and her periodontal status was good. Her chief complaint is discomfort and swelling behind the second molar teeth. The third molars are not erupted but she thinks they might be trying to come in. She is planning to attend an out-of-state college in a few months. Today your patient interview and oral examination reveal excellent general and oral health with the exception of inflammation and slight swelling in the third molar areas. No clinical carious lesions were found.

• What positive historical findings were reported?

• What are the clinical signs & symptoms presented in this case?

• What are the risk factors for caries?

• Given the guidelines for a recall adolescent patient with a permanent dentition, what radiographic examination is recommended?

Patient Scenario 2 Key

• What positive historical findings were reported? No positive historical findings

• What are the clinical signs & symptoms presented in this case? Inflammation and slight swelling in third molar areas

• What are the risk factors for caries? Low caries risk - regular care, no radiographic caries found at last recall one year ago, no clinical caries

• Given the guidelines for a recall adolescent patient with a permanent dentition, what radiographic examination is recommended? Panoramic examination or 4 periapical image examination to evaluate third molars

Patient Scenario 3

A 37-year-old male patient, Raphael, presents as a new adult patient. He has just acquired a new sales position with a local company. During the patient interview and review of his dental/medical history, he reports taking oral medication for diabetes mellitus. He states that it has been several years since his last medical or dental visit. The last dental treatment he received was for a root canal. His job requires a great deal of traveling by car and eating on the go. He is aware that he needs to eat better and brush his teeth more often. Observations from the clinical examination include fair oral hygiene, evidence of periodontitis with generalized mild and localized moderate bone loss, large amalgam restorations in first molar teeth, a crown on tooth 15 and deep occlusal lesions on teeth 12, 18, 29.

• What positive historical findings were reported?

• What are the clinical signs & symptoms presented in this case?

• What are the risk factors for caries?

• Given the guidelines for a new adult dentate patient, what radiographic examination is recommended?

Patient Scenario 3 Key

• What positive historical findings were reported? Previous endodontic treatment

• What are the clinical signs & symptoms presented in this case? Clinical evidence of periodontal disease; large amalgam restorations in 3, 14, 19, 30; deep occlusal carious lesions on 12, 18, 29

• What are the risk factors for caries? Irregular dental care, fair oral hygiene, poor diet, clinical caries present

• Given the guidelines for a new adult dentate patient, what radiographic examination is recommended? Full mouth survey