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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