Dental Case Presentation

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Mrs. SL is 41 years old and presented as an emergency patient at the St. David’s Primary Dental Care Unit. She complained of severe pain UL2 that had kept her up the previous night. She was fit and well although reporting a previous medical history of epileptic seizures 5 years ago. Her pain was relieved by draining the abscess through the root canal and prescribing antimicrobials. Subsequently the patient reported dissatisfaction of the appearance of edentulous spaces in the maxillary left and right premolar region. A full history and examination was carried out and an appropriate definitive treatment plan was made which included the construction of two bridges to address the patient’s aesthetic concerns.

Learning outcomes:

History & Examination
Reason for attendance: Pain that had disturbed sleep
Complains of: Severe pain. UL2 is tender to touch. Edentulous spaces in all quadrants History of present complaint:
Patient reports that a filling was replaced in the UL2 one year ago. The tooth has felt ‘numb’ since but dental treatment was not sought. Throbbing pain started two days ago that had kept patient awake at night and UL2 is very tender to touch. Mild pyrexia reported by patient There was also aesthetic concern of two edentulous spaces in the maxillary right and left quadrants where premolars have been previously been extracted due to periradicular pain. Mandibular edentulous spaces were also noted Medical history: Fit and well. Last epileptic seizure 5 years ago with an unknown cause of seizures. Taking no medication Oral health history: Has been treated in the Primary Dental Care Unit over the past year and will look for a General Dental Practitioner once treatment has been completed. Brushes twice daily, no use of mouthwash. Occasionally flosses. Premolars in all quadrants were extracted for orthodontic treatment in her early teens. Has never worn a denture Social History: University lecturer. Never smoked. Drinks 10 units of alcohol per week Diet History: Apparently healthy, no risk factors for caries Extra oral examination: Lymphadenopathy of deep cervical nodes. Slight swelling of lip in region of UL2. No temporomandibular joint problems. Both maxillary premolar spaces visible during speech. The patient’s body temperature measured 38oC Intra-oral examination

Oral hygiene:Good
Soft tissue: Nothing abnormal detected
Caries activity: Low
Gingival condition: Pink, firm stippled gingival tissues
|0 |2 |0 |
|1 |0 |1 |

Basic periodontal examination:

Periodontal assessment: No pocketing, plaques score 10%. bleeding score 10%. 1mm gingival recession LL4 & LL5. UL2 grade I mobile Restorative condition of the teeth: Moderately restored dentition, defective margin of composite UR2, heavily restored UR6 Occlusion: Class I incisal relationship. Over-erupted UR6, LR4, LL4. Canine guidance during left lateral excursion. Mesial drift UR6 reduced space in maxillary right premolar region to 5.5 mm. No significant mesial drift of UL6, the space is a single premolar sized unit. No occlusal trauma. Mesially tilted LR8,LL7 Restorative work:

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Key: Am-amalgam, Co-composite, MCC- metal ceramic crown, RF-root filled Caries risk: Low
Special Investigations:
|Tooth |Percussion |Ethyl chloride |Electric pulp test | |UL2 |Tender to touch |Negative |Negative | |UR6 |Normal | Positive |Positive | |UL6 |Normal | Positive |Positive | |UL3 |Normal | Positive |Positive | |UR3 |Normal | Positive...
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