Focus on Patients
Chapter 1, Case 1:
A patient involved in an automobile accident receives a penetrating wound involving the oral
cavity. The wound enters the alveolar mucosa near the apex of a lower premolar tooth and
extends from the surface mucosa all the way through the tissues to the premolar tooth root.
List periodontal tissues most likely injured by this penetrating wound.
If a patient receives local anesthetic and has a complete loss of sensation in the maxillary molar
tooth and most of the gingival surrounding it there are a couple nerves that were affected. The
Maxillary branch of the Trigeminal nerve breaks down into the Middle superior alveolar and
Posterior superior alveolar nerves. Because the Middle superior alveolar innervates the
mesiobuccal root of the first molar the Posterior superior alveolar innervates the maxillary
molars and buccal gingival it is safe to say they were probably affected. The other nerve that
could have been affected if a palatal injection was given would be the Greater palatine nerve
because it innervates the posterior lingual gingiva.
Chapter 9, Case 2:
Mrs. Smith is a new patient in the dental office. Mrs. Smith is 45 years of age and works as an
accountant. Mrs. Smith had not received regular dental care in the past; however, her new
employer provides dental insurance for his employees. Mrs. Smith has chronic periodontitis.
How will you explain inflammatory periodontal disease to Mrs. Smith?
Mrs. Smith, what we are seeing here in your mouth is a disease called periodontitis. We are
seeing that your bone levels between your teeth are decreased and that your gums around
your teeth are irritated and damaged. Periodontitis or gum disease is similar to cutting your
finger. When you cut your finger germs enter that cut and your body sends special cells to fight
them so that an infection doesn’t occur. The skin around your teeth is just like the skin on your
body and can also become infected by bad bacteria. What we see in your mouth is the result of
a bacterial infection that your body cannot get rid of. The destruction that we see in your
mouth now is irreversible; the bone will not grow back. With routine dental visits and diligent
care at home we can slow the progression and get your gums healthy again. With that said, it’s
going to be a team effort but it is doable!
** I would also have showed her some visual aids such as the flip chart and her current
oral conditions
Chapter 13, Case 1:
A patient new to your dental team has been appointed with you for a dental prophylaxis.
The patient has just relocated to your town. The patient tells you that he saw a dentist just
before moving who told him that he has gingivitis. During your discussion with the patient, he
asks if there is some what he can tell at home if he has gingivitis. How might you reply to this
patient’s question?
To explain to a patient how to look for gingivitis at home, it important that they understand
what healthy tissues look like.
Healthy gums will not bleed and appear light pink (depending on patient’s complexion). They
snuggly hug the tooth all the way around. A few signs to look for at home that might imply that
you have gingivitis are: Do your gums bleed when you brush? Do your gums appear more of a
red color? Does the triangle shape of gum tissue between your teeth look puffy and loose? If
you see any of these things you could have gingivitis but more seriously you may have
periodontitis. The health of your gum tissues can change rapidly so that is why we recommend
regular dental visits. This allows us to monitor the progression or any changes in your gum
tissue.
Chapter 20, Case 1:
Mr. Jones is a new patient in your dental office. He brings with him some recent full-mouth
radiographs that reveal no evidence of alveolar bone loss. While studying a copy of the
patient’s dental chart, you note that there is a diagnosis of chronic periodontitis. How might
you explain the apparent discrepancy between the lack of radiographic evidence of bone loss
and the diagnosis of periodontitis?
There are limited things that we can see on radiographs and they cannot be used solely to
diagnose a periodontal condition. The only way to reliably locate periodontal pockets is to
probe the dentition carefully and accurately. Early signs of periodontitis are not radiographically
evident so it is important to do a thorough periodontal assessment. Before I would make any
assumptions I would gather my own information through the periodontal assessment. Because
of this patients previous diagnosis I would be expecting to find area of periodontal destruction.
Chapter 24, Case 1:
A new patient for your dental team has obvious clinical signs of moderate chronic
periodontitis with generalized dental plaque biofilm and dental calculus deposits. Though the
patient denies having diabetes, the patient does report having several close family members
with this disease. Make a list of steps your dental team might include in an appropriate plan
for nonsurgical periodontal therapy for this new patient.
1. I would start this patient’s therapy out by removing the calculus and plaque biofilm.
With this step of his treatment I would stress the importance of through homecare
in order to prevent progression of this disease.
2. Secondly I would explain to the patient that uncontrolled diabetes does have an
adverse effect on the supporting tissues of the teeth. It would be important for him
to be evaluated by his medical doctor. If he does have uncontrolled diabetes the
outcome of the treatment we perform as a dental hygienist will be unpredictable
and most times will not work.
3. This patient would then be reappointed for a follow up check on the nonsurgical
treatment performed and also on the status of his medical doctors finding.