TREATMENT TREATMENT PLANNING IIPLANNING II

STUDENT CASESTUDENT CASE

BYBY

SAMUEL J. JASPER, DDS, MSSAMUEL J. JASPER, DDS, MS

PERIODONTOLOGYPERIODONTOLOGY

INSTRUCTIONSINSTRUCTIONS

Read and study this caseRead and study this case Come prepared to discuss the case in Come prepared to discuss the case in

classclass Consider the diagnosis, prognosis and Consider the diagnosis, prognosis and

treatment plantreatment plan Prepare an alternative treatment planPrepare an alternative treatment plan

BIOGRAPHIC DATABIOGRAPHIC DATA

Patient Name:Patient Name: Mrs. TMrs. T

Marital Status: MarriedMarital Status: Married

Age: 57Age: 57

Occupation: HousewifeOccupation: Housewife

Gender: FemaleGender: Female Height: 5’3”Height: 5’3”

Race: HispanicRace: Hispanic Weight: 133 Weight: 133 poundspounds

CHIEF COMPLAINTCHIEF COMPLAINT

““To replace two teeth, get my To replace two teeth, get my teeth cleaned and fillings if teeth cleaned and fillings if they are needed.”they are needed.”

MEDICAL HISTORYMEDICAL HISTORY

A standard health questionnaire was completed by A standard health questionnaire was completed by Mrs. T. The questionnaire, covering all organ Mrs. T. The questionnaire, covering all organ systems and conditions, was orally reviewed with systems and conditions, was orally reviewed with the patient by Dr. B. Mrs. T reports a history of the patient by Dr. B. Mrs. T reports a history of mild anemia during three of her seven pregnancies mild anemia during three of her seven pregnancies for which she received no treatment. Her only for which she received no treatment. Her only hospitalization, except for deliveries, occurred ten hospitalization, except for deliveries, occurred ten years ago for a hysterectomy. A heart murmur had years ago for a hysterectomy. A heart murmur had been detected when she was 19 years old and she is been detected when she was 19 years old and she is hypertensive. She has yearly physical examinations. hypertensive. She has yearly physical examinations. She smokes 1 pack of cigarettes per day. Her She smokes 1 pack of cigarettes per day. Her current medications are Indural and Premarin. She current medications are Indural and Premarin. She is allergic to penicillin. Her physician is Dr. Fred is allergic to penicillin. Her physician is Dr. Fred Jones. Mrs. T’s blood pressure was 149/91, pulse Jones. Mrs. T’s blood pressure was 149/91, pulse 64, and respirations 13 at today’s visit.64, and respirations 13 at today’s visit.

ASA ?ASA ?

DENTAL HISTORYDENTAL HISTORY

Mrs. T has visited the dentist approximately once per Mrs. T has visited the dentist approximately once per year for cleanings and fillings. She has had six year for cleanings and fillings. She has had six extractions. Her previous dental treatment was extractions. Her previous dental treatment was performed on various Air Force bases where her performed on various Air Force bases where her husband was stationed. According to Mrs. T she was husband was stationed. According to Mrs. T she was told 6-7 years ago that she needed periodontal therapy told 6-7 years ago that she needed periodontal therapy in the lower anterior area and she was desirous of the in the lower anterior area and she was desirous of the treatment. Following this she states that the only treatment. Following this she states that the only treatment she received was a cleaning. She denies any treatment she received was a cleaning. She denies any history of clenching or bruxing and has no oral habits history of clenching or bruxing and has no oral habits other than gum chewing. Mrs. T mentioned that other than gum chewing. Mrs. T mentioned that previously pain occurred in the TMJ area about once previously pain occurred in the TMJ area about once per year but this has not been present in the previous per year but this has not been present in the previous ten years. She also says that her lower right molar ten years. She also says that her lower right molar throbs every 3-4 days.throbs every 3-4 days.

DENTAL HISTORYDENTAL HISTORY

Mrs. T brushes once a day with a hard brush using Mrs. T brushes once a day with a hard brush using a scrub motion and flosses once per month. She a scrub motion and flosses once per month. She spends approximately 1 minute brushing. Her spends approximately 1 minute brushing. Her teeth are of minor importance to her.teeth are of minor importance to her.

SOFT TISSUE SOFT TISSUE EXAMINATIONEXAMINATION

A.ExtraoralA.Extraoral 1.Head - within normal limits1.Head - within normal limits

2.Face - within normal limits2.Face - within normal limits3.Neck - within normal limits3.Neck - within normal limits

B.IntraoralB.Intraoral 1.Lips - within normal limits1.Lips - within normal limits

2.Buccal mucosa - within normal limits2.Buccal mucosa - within normal limits3.Pharynx - within normal limits3.Pharynx - within normal limits4.Tongue - within normal limits4.Tongue - within normal limits5.Floor of mouth - within normal limits5.Floor of mouth - within normal limits6.Palate - at the initial exam two 1mm red lesions were 6.Palate - at the initial exam two 1mm red lesions were noted on the left side. The patient states these appeared noted on the left side. The patient states these appeared one day after she ate some corn chips and are getting one day after she ate some corn chips and are getting better.better.

SOFT TISSUE SOFT TISSUE EXAMINATIONEXAMINATION

7.Gingiva7.Gingivaa.Color - the buccal surface from first premolar to a.Color - the buccal surface from first premolar to first premolar is generally pink for papillary and first premolar is generally pink for papillary and marginal tissue. Increasing redness is apparent marginal tissue. Increasing redness is apparent in the interproximal and marginal tissues of the in the interproximal and marginal tissues of the buccal and lingual surfaces in the posterior areas buccal and lingual surfaces in the posterior areas and the lingual of the anteriors.and the lingual of the anteriors.b.Contour - generally scalloped contour except for b.Contour - generally scalloped contour except for flat, shelflike architecture with cratering at area flat, shelflike architecture with cratering at area 21-22.21-22.c.Consistency - some loss of resiliency is noted in c.Consistency - some loss of resiliency is noted in the posterior areas. The mandibular anterior the posterior areas. The mandibular anterior tissue can be reflected slightly.tissue can be reflected slightly.

HARD TISSUE HARD TISSUE EXAMINATIONEXAMINATION

d.Bleeding - present in 88% of the teeth. Refer to d.Bleeding - present in 88% of the teeth. Refer to clinical charting.clinical charting.

e.Exudation - none notede.Exudation - none noted

f.Attached gingiva - adequate in all areasf.Attached gingiva - adequate in all areas

8.Teeth8.Teeth

a.Sensitivity – lower right molara.Sensitivity – lower right molar

b.Clinical crown size - normal except in areas of b.Clinical crown size - normal except in areas of recessionrecession

c.Caries – refer to clinical chart c.Caries – refer to clinical chart

d.Wear facets – noted on all teeth except #12d.Wear facets – noted on all teeth except #12

RADIOGRAPHIC ANALYSISRADIOGRAPHIC ANALYSIS

A.OverallA.Overall

1.Trabecular pattern - normal1.Trabecular pattern - normal

2.Periapical areas - nutrient canals at 24, 252.Periapical areas - nutrient canals at 24, 25

B.Individual teethB.Individual teeth

1.Apparent loss of density interproximally - 1.Apparent loss of density interproximally - 2, 3, 4, 5, 2, 3, 4, 5, 14, 15, 18, 23, 24, 25, 26.14, 15, 18, 23, 24, 25, 26.

2.Increased width of apical periodontal 2.Increased width of apical periodontal ligament -31ligament -31

3.Increased thickness of lamina dura - 18, 3.Increased thickness of lamina dura - 18, 30, 3130, 31

4.Overhanging restorations - 19 has a severe 4.Overhanging restorations - 19 has a severe overhang overhang on the distalon the distal

ANTERIORANTERIOR

RIGHT SIDERIGHT SIDE

LEFT SIDELEFT SIDE

TREATMENT PLANNING II-CTREATMENT PLANNING II-C

DIAGNOSIS?DIAGNOSIS? PROGNOSIS?PROGNOSIS? ETIOLOGY?ETIOLOGY? TREATMENT PLAN?TREATMENT PLAN?