1. TREATMENT PLANNING II STUDENT CASE BY SAMUEL J. JASPER, DDS, MS PERIODONTOLOGY

2. INSTRUCTIONS Read and study this case Read and study this case Come prepared to discuss the case in class Come prepared to discuss the case in class Consider the diagnosis, prognosis and treatment plan Consider the diagnosis, prognosis and treatment plan Prepare an alternative treatment plan Prepare an alternative treatment plan

3. BIOGRAPHIC DATA Patient Name:Mrs. T Marital Status: Married Age: 57 Occupation: Housewife Gender: FemaleHeight: 5’3” Race: HispanicWeight: 133 pounds

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

5. 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. 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.

6. ASA ?

7. 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. 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.

8. 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. 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.

9. SOFT TISSUE EXAMINATION A.Extraoral 1.Head - within normal limits 1.Head - within normal limits 2.Face - within normal limits 3.Neck - within normal limits B.Intraoral 1.Lips - within normal limits 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.

10. 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.

11. 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 a.Sensitivity – lower right molar b.Clinical crown size - normal except in areas of recession b.Clinical crown size - normal except in areas of recession c.Caries – refer to clinical chart c.Caries – refer to clinical chart d.Wear facets – noted on all teeth except #12 d.Wear facets – noted on all teeth except #12

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

15. ANTERIOR

16. RIGHT SIDE

17. LEFT SIDE

40. TREATMENT PLANNING II-C DIAGNOSIS? DIAGNOSIS? PROGNOSIS? PROGNOSIS? ETIOLOGY? ETIOLOGY? TREATMENT PLAN? TREATMENT PLAN?