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Samantha Greenstein, Amy Seagraves, Danielle Amini-Kern, Xinhong Qiu, Michael Almony, Shariq Khan
Student Worksheet
Patient #: 2
Problem List/Clinical Impressions
Problem List:
CC: “I have a tooth on the upper right side that is really painful, it’s keeping me up at night. Also, I don’t
like the way my teeth look”.
Spontaneous pain post upper right- especially at night.
Swelling around the tooth in pain; no face swelling reported,
Xerostomia
Smoker – 15-20 cigarettes/day
Missing #5, 12, 15, 21, 28 (2nd premolar from ortho treatment – these likely don’t need replaced)
Non-vital #2, 11, 14, 27
Class III occlusion
L posterior cross-bite
Examination
1. Medical Hx: 25 yr old female - Smokes 15-20 cigarettes a day, parents alcoholic, lives with mother,
unemployed
Asthma (since age 8), ADHD (diagnosed age 10),
Bipolar Disorder (diagnosed 3 yrs ago),
Hx of drug and alcohol use (cleanfor one year)
Medications:
Bricanyl, inhaler, daily (asthma);
Flovent, daily (asthma) ;
Quetiapine (Seroquel) 300 mg daily (bipolar);
OTC pain meds (tooth pain)
Has not seen a dentist for 4-5 years. Brushed teeth once a day in the morning.
Bp 120/70, P70
2. Extraoral/ facial: WNL
3. TMJ: WNL
4. Intraoral/soft tissue: WNL
5. Dental/ pulpal: generalized mild gingival inflammation. #2,11,14,27 non vital. #6,10,18 irreversible pulpitis,
#22, 7 sensitive to cold
6. Periodontal: WNL
7. Occlusion: Class 3 molar and canine occlusion. Left post cross-bite.
8. Radiographic interpretation:
#1 occlusal caries #2 large decay DOB PARL, #4 distal lesion, #6 buccal lesion PARL, #7 buccal and
distal caries, #8 buccal caries. #9 buccal caries, #10 Mesio-lingual lesion PARL, #11 buccal lesion, #14 occlusal
decay PARL, #18 mesio-occlusal decay large PDL PARL, #20 distal incipient lesion, #22 recurrent decay, #27
coronal radiolucency, #30 buccal decay, #31 mesial decay, #32 occlusal decay
Diagnoses
Partially edentulous
Irreversible pulpitis #6,10,18
Generalized mild gingival inflammation
Extensive carious lesions.
Non-vital #2,11,14,27.
Xerostomia
Prognosis
General Prognosis: poor
Periodontal Prognosis: good
Treatment Plan
1. Systemic: smoking cessation instruction; med consult with physician (for drug prescriptions)
2. Acute: #2 endodontic therapy or extraction
a. In private practice, could also do a pulpotomy and reevaluate
3. Disease Control: Restorations for -#1,2,4,7,8,9,18,20,22,30,31,32. Scaling and Prophy. EIT. Fluoride
varnish #23,24,25,26.
a. Amalgam restorations for posterior is what we would push for (decrease chances of
secondary caries)
i. Patient will probably want composite for esthetics but push for amalgam
b. Composite for anterior teeth
c. *Note: for the exam, I would specify which surfaces these restorations will be
4. Definitive: RCT+post+core build up+crown or extraction of #6,10,18,11,14,27. Post+Core+Crown
#2
Could do zirconium crowns in posterior because she is in severe group function with the molars
Discuss partial dentures or implant therapy for missing teeth (I don’t think this is necessary for the 2nd
premolars since this space has been closed with ortho). Ortho recommendation for occlusion and
esthetics.
5. Maintenance OHI, 3 month recall, nutritional counselling, smoking cessation counselling.
Recommended Home Care
Brushing (frequency, duration, brush type): instruction on brushing 2x a day, Prevident 5000+ (with
dentifrice)
Interproximal care (frequency, type): floss or proxabrush depending on preference
Other aids: Biotine mouth rise (non-alcohol based) and xylitol gum for the xerostomia