Transcript Periodontal Treatment Planning Case

TREATMENT
PLANNING II
STUDENT CASE
BY
SAMUEL J. JASPER, DDS, MS
PERIODONTOLOGY
INSTRUCTIONS

Read and study this case
 Come prepared to discuss the case in
class
 Consider the diagnosis, prognosis and
treatment plan
 Prepare an alternative treatment plan
BIOGRAPHIC DATA
Patient Name:Mrs. T
Marital Status: Married
Age: 57
Occupation: Housewife
Gender: Female Height: 5’3”
Race: Hispanic
Weight: 133 pounds
CHIEF COMPLAINT
“To replace two teeth, get my teeth
cleaned and fillings if they are
needed.”
MEDICAL HISTORY
A standard health questionnaire was completed by Mrs. T.
The questionnaire, covering all organ systems and
conditions, was orally reviewed with the patient by Dr. B.
Mrs. T reports a history of mild anemia during three of her
seven pregnancies for which she received no treatment.
Her only hospitalization, except for deliveries, occurred ten
years ago for a hysterectomy. A heart murmur had been
detected when she was 19 years old and she is
hypertensive. She has yearly physical examinations. She
smokes 1 pack of cigarettes per day. Her current
medications are Indural and Premarin. She is allergic to
penicillin. Her physician is Dr. Fred Jones. Mrs. T’s blood
pressure was 149/91, pulse 64, and respirations 13 at
today’s visit.
ASA ?
DENTAL HISTORY
Mrs. T has visited the dentist approximately once per year for
cleanings and fillings. She has had six extractions. Her
previous dental treatment was performed on various Air
Force bases where her husband was stationed. According
to Mrs. T she was told 6-7 years ago that she needed
periodontal therapy in the lower anterior area and she was
desirous of the treatment. Following this she states that the
only treatment she received was a cleaning. She denies
any history of clenching or bruxing and has no oral habits
other than gum chewing. Mrs. T mentioned that previously
pain occurred in the TMJ area about once per year but this
has not been present in the previous ten years. She also
says that her lower right molar throbs every 3-4 days.
DENTAL HISTORY
Mrs. T brushes once a day with a hard brush using a scrub
motion and flosses once per month. She spends
approximately 1 minute brushing. Her teeth are of minor
importance to her.
SOFT TISSUE
EXAMINATION
A.Extraoral
1.Head - within normal limits
2.Face - within normal limits
3.Neck - within normal limits
B.Intraoral
1.Lips - within normal limits
2.Buccal mucosa - within normal limits
3.Pharynx - within normal limits
4.Tongue - within normal limits
5.Floor of mouth - within normal limits
6.Palate - at the initial exam two 1mm red lesions were
noted on the left side. The patient states these appeared
one day after she ate some corn chips and are getting
better.
SOFT TISSUE
EXAMINATION
7.Gingiva
a.Color - the buccal surface from first premolar to first
premolar is generally pink for papillary and marginal tissue.
Increasing redness is apparent in the interproximal and
marginal tissues of the buccal and lingual surfaces in the
posterior areas and the lingual of the anteriors.
b.Contour - generally scalloped contour except for flat,
shelflike architecture with cratering at area 21-22.
c.Consistency - some loss of resiliency is noted in the
posterior areas. The mandibular anterior tissue can be
reflected slightly.
HARD TISSUE
EXAMINATION
d.Bleeding - present in 88% of the teeth. Refer to clinical
charting.
e.Exudation - none noted
f.Attached gingiva - adequate in all areas
8.Teeth
a.Sensitivity – lower right molar
b.Clinical crown size - normal except in areas of recession
c.Caries – refer to clinical chart
d.Wear facets – noted on all teeth except #12
RADIOGRAPHIC ANALYSIS
A.Overall
1.Trabecular pattern - normal
2.Periapical areas - nutrient canals at 24, 25
B.Individual teeth
1.Apparent loss of density interproximally - 2, 3, 4, 5,
14, 15, 18, 23, 24, 25, 26.
2.Increased width of apical periodontal ligament -31
3.Increased thickness of lamina dura - 18, 30, 31
4.Overhanging restorations - 19 has a severe overhang
on the distal
ANTERIOR
RIGHT SIDE
LEFT SIDE
TREATMENT PLANNING II-C

DIAGNOSIS?
 PROGNOSIS?
 ETIOLOGY?
 TREATMENT PLAN?