Case Studies

Case Two A 14 year old boy reluctantly attends for an oral health assessment. He has not seen an oral health practitioner since he was 10. He has no pain or discomfort. Medical history: NAD, although there is a family history of Type 2 diabetes. He remembers: “having lots of fillings in my baby teeth – but I haven’t had any fillings for ages” • Boy reluctantly attends assessment – what measures can we take to decrease dental anxiety • How does medical history affect the patient. Family hx of type two diabetes – what is the likelihood of him getting diabetes and how does this affect his risk status for oral cancer, periodontal disease (how does diabetes affect periodontal disease) - (keeping in mind smoking as well) • His assessment reveals: All permanent teeth are present and fully erupted except the 45, 17 and 27 and 3rd molars. The 85 is present and has a moderately sized MO amalgam restoration and a cavitation on the distal surface. There are Class 2 amalgam restorations on the mesio- occlusal surfaces of the 16 and 26. No other restorations are present. 37 and 47 are partially erupted. • What kind of radiograph needed, PA/OPG/BW – what to look for in these radiographs • Treatment options if impaction submergence noticed • How it would affect occlusion and adjacent teeth. The lower incisors are mildly crowded. He has a Class 1 molar relationship, with an overjet of 1mm and an overbite of 20%. • How this affects the dentition, and occlusion of the patient. • Long term effects • Treatment options Fissure sealants are present on all first molars, although some appear deficient. Numerous white spot lesions are evident clinically. • What to do in this case, what kind of treatment needed, ie, removal of sealant to fissure investigate, and treatment of white spot lesion with material of choice – advangatages and disadvantages. A number of C1 and C2 lesions are evident on the bite wing radiographs, his bone levels are normal. • Treatment options for C1 and C2 lesions (restorative and preventative) The 36 mesial has a C4 lesion radiographically which is not evident clinically (borderline C3/C4). • Treatment options for C4 lesions (restorative and preventative) The 46 mesial has a C4 lesion radiographically, which is evident clinically as a discolouration underlying the mesial marginal ridge. • Treatment options (what kind of restorative intervention, and preventative ie fluoride therapy etc, what does discoloration mean. Choices of restorative materials – advantages and disadvantages) The gingivae are generally inflamed and bleed easily when touched. • What does this mean, (gingivitis). How to treat this problem, ie, scale and polish, and treating inflammation with antiinflmmatories such as chlorhexidine mouthwash – how many times a day for how long etc) His plaque control is poor, he brushes once a day with a fluoride toothpaste, (when he remembers), and never uses dental floss. He lives in a fluoridated area. He admits he enjoys fizzy drinks and lollies and has both daily. • What kind of homecare advice would you suggest, what kind of in clinic treatment would you carry out – ie; duraphat fluoride varnish – dosage and duration – recall period) His breath smells strongly of cigarettes, but he hasn’t revealed he is a smoker. • What risk status does this categorize him – periodontal risk, oral cancer risk and caries risk Develop and discuss an oral care plan for this patient. Your care plan should comprehensively address the patient’s presenting oral health condition and risk status and encompass strategies to prevent further disease progression and initiation. Please note: all of the information required to make an accurate diagnosis and assessment of risk may not be provided in the above description of findings. You should state what further information needs to be gathered, and your discussion should address possible diagnoses, risk status and options for care, based on presented and potential findings