CASE PRES Flashcards
Number
2102646424
Initial exam summary
C/O – infection and pain in front teeth
HPC – referred by GDP 15th January 2024
S – upper left central and lateral incisor
O – December 2023
C – dull pain
R – no radiation
A – no associated symptoms
T – constant
E – no painkillers, antibiotics helped pain S – 4/10
PMH – fit and well, no medications, no allergies
PDH – regular attender at GDP
– brushes twice daily with ETB
– flosses once daily
SH – non-smoker
– drinks alcohol occasionally
– works as medical secretary at QEUH (4 days)
E/O
- Lymph nodes, glands, MOM, asymmetry - NAD - TMJ – click LHS, no pain associated
I/O
- Mucosa, palate, tongue, FOM – NAD
- OH inadequate, gingival inflammation - Grade 1 mobility – 16, 48
Special investigations
Radiographs
- Right and left BWs
- PA of 12, 11, 21, 22, 15
Clinical photographs
MPBS – Plaque 64%, Bleeding 46%
Sensibility test - 15
Radiograph report
Radiographs are diagnostically acceptable.
Bone levels
- Generalised horizontal bone loss 20-50%
- Worst site at 16d – 50%
Restorations
As seen clinically, with the following additions;
- 12 cast post MCC with RCT (inadequate)
- 11 screw post MCC with RCT (adequate)
- 21 cast post MCC with RCT (inadequate)
- 22 screw post MCC with RCT (inadequate)
Pathology
15 – deep caries into inner third of dentine
21 – periapical radiolucency and widening of PDL, inadequate RCT
22 – periapical radiolucency and widening of PDL, inadequate RCT
25 – mesial overhang
48 – buccal caries
11 – deficient, carious crown margin
21 – query carious crown margin (mesial)
Diagnoses
Generalised periodontitis stage 3 grade B currently unstable, no known risk factors
Caries – 11 crown margin, 15do, 48b
11 – previously treated, normal apical tissues
21 – previously treated, symptomatic periapical periodontitis
22 – previously treated, symptomatic periapical periodontitis
Tx plan
Immediate
Nil
Initial
1. Step 1 BSP S3 guidelines
a. OHI and education
b. Supragingival PMPR
c. Adjustmentof25mesialoverhang
2. Step 2 BSP S3 guidelines a. Subgingival PMPR
3. Caries removal and restoration of 48 4. Caries removal and restoration of 15 Re-evaluation
5. Review periodontal condition
a. 6PPC of quadrants scoring BPE 3 Reconstructive
6. Construct temporary prosthesis for 21, 22 ± 11 7. Post removal and re-RCT 21
8. Post removal and re-RCT 22
9. Post placement and crown 21
10.Post placement and crown 22
Maintenance
11. Review periodontal condition and SPT
Antibiotics
- Dental abscesses are usually streptococci or gram-negative bacteria
- Local measures should be used in the first instance
- Amoxicillin 500mg TID for 5 days
Systems enquiry
- CV
- Resp
- GI
- Neuro
- Liver and kidneys
- MSK and skin
- Endocrine
- Blood
- Allergies
TMJ click
- Click is due to discoordination of condyle and articular disc
- Condyle has to overcome mechanical obstruction (disc) before full range of movement achieved
- Disc displaces anteriorly by the condyle, disc then reduces = click and full movement
TMJ tx
- If pain – counsel, jaw rest, bite raising appliance, surgery if severe
- Michigan splint = Full coverage splint for either jaw - Hard PMMA
- BRAs stabilise occlusion and improve function of masticatory muscles, which decreases parafunction
Mobility
- Tooth mobility is described is relation to the bucco-lingual movement observed, detected using a finger and instrument either side of the tooth
- Grade 1 = <1mm but more than physiological movement
- Grade 2 = 1-2mm
- Grade 3 = >2mm ± rotation or depression
BSP stage
- Stage = site of worst bone loss
- 1 = <15%
- 2 = coronal third of root
- 3 = middle third of root
- 4 = apical third of root
BSP grade
- Describes the patient’s susceptibility to the disease
- A = slow progression, bone loss < ½ patient’s age
- B = moderate progression, ½ patient’s age < bone loss < patient’s age
- C = rapid progression, bone loss > patient’s age
BSP distribution
- Distribution = how many teeth affected
- <30% = localised
- > 30% = generalised
- Molar/incisor pattern
BSP stability
- Stable = BOP <10%, PPD 4mm, no BOP at 4mm sites
- Remission = BOP >/= 10%, PPD </= 4mm, no BOP at 4mm sites
- Unstable = PPD >/= 5mm or BOP at sites of 4mm
