www.deckscorp.com ry TL MOP LEP LI 800.457.7126Acknowledgements ‘The Case Studies in this booklet were used with permission from the following individuals. Case I: Brooke Blicher Harvard School of Dental Medicine, 2007 Case II: Derek Sanders, D.M.D. University of Pennsylvania, School of Dental Medicine, 2006 Case TIT: Owais A. Faroogi, B.D.S, D.D.S. Department of Periodontics University of Tennessee, College of Dentistry Case IV: Dr, Lysa Dul University of Washington, School of Dentistry Case V & Viz Dr. Jennie Gabriela Romero Central University of Venezuela ERTo — Patient Profile Age: 42 Race: Caucasian Sex: Female Height: sit Weight: 110 Ibs. Marital Status: Single Occupation: Self-employed as home heal assistant to a woman with V Medical History General Health: Excellent Current Treatment: She is under the care of a physician tor Bipolar disorder and occasional GERD Diagnosed with bipolar disorder in 1997 after hospitalization due to chronic insomnia & “breakdown 3 further hospitalizations between (997 - 1998 Currently well-controlled with drugs and psychotherap Risperdal 5 mg/day, Citalopram 40 mg/day, Benztropit 2 mg/day, Cimetidine 400 mg/day when needed Hospitalizations/Surgery: Current Medications: Allergies: None Review of Systems: Within normal limits Family History Diabetes: None Hypertension: None Cancer: None Infectious Diseases: None Soclal History Patient smoked 1 pack per day for 20 years, quit in 1995. Walks or tuns everyday Chief Complaints “I need implants. My mouth is always very dry and my tongue burns” Dental History Her last dental visit was about a year ago (recal] and prophylaxis). Prior to that appointmet she had several amalgam restorations placed. In the time period between 1970 and 2004 sh had multiple extractions due to rampant caries. Clinical Examination Vital Signs BP = 105/75 HR = 72 bpm RR=12 Extraoral Exam Head: Within normal limits Muscles: Within normal limits Neck: Within normal limits Intraoral Exam = Soft tissue Oral cancer exam: Within normal limits Lips: Wit normal limits Hard palate: Within normal limits Pharynx & fauces: Within normal limits Soft palate: Within normal limits Tongue: Lobulated and fissured Floor of the mouth: Within normal limits Occlusal Exam Angle Classification: Right Side ~ Canine Class Hl Left Side — Canine Class I ‘TMJ Exam Within normal FimitsAdult Clinical Examinationed Patient Profile Age: 2 Race: African American Male so” 170 tbs. Marital Status: Single Occupation: Not currently working Medical History General Health: Good Current Treatment: He is under the care of a physcian for sickle cell anemi Hospitalizations/Surgery: Last hospitalization was | year ago for sickle crises Current Medications: Folic acid 5 mg/day Allergies: None Review of Systems: Within normal limits Family History Diabetes: None Hypertension: Grandfather died of heart disease Cancer: Grandmother died of lung cancer Infectious Diseases: None Social History Tobacco: 1/3 pack per day, alcohol: socially, marijuana; wwice daily Chief Complaints “[ need a dentist to fix my mouth” “[ hate the way my front tooth looks” “I need you to hook up my grille” Dental History Patient only went to the dentist when he had a toothache. He has had restorative treatment and extractions performed in the past. Clinical Examination Vital Signs BP = 130/ 86 HR = 70 bpm RR= 14 Extraoral Exam Head: Within normal limits Muscles: Within nortaal limits Neck: Within normal limits Intraoral Exam = Soft tissue Oral cancer exam: Within normal limits Lips: Within normal limits Hard palate: Within normal limits Pharynx & fauces: Within normal limits Soft palate: Within normal limits ‘Tongue: Within normal limits Floor of the mouth: Within normal limits Occlusal Exam Angle Classification: Right Side — Full Cusp Canine Class UI Left Side — Full Cusp Canine Class Il Anterior Crossbite Posterior Bite Collapse TMJ Exam Bilateral clickAdult Clinical Examination CY MD aoa CHET, & OAMe Patient Profile Age: 64 Race: Caucasian Sex: Female Height: 53° Weight: 130 Ibs. Marital Status: Married Occupation: Retired Medical History General Health: Fair Current Treatment: She is under the care of a physician for hypertension, hypercholesteralemia, and postmenopausal osteoporos Hospitalizations/Surgery: Hysterectomy in 1999 Current Medications: Tenormin 10 mg/day. Lipitor 40 mg/day Fosamax 100 mg/day Allergies: None Review of Systems: Within normal limits Family History Diabetes: Grandmother had Type 2 Diabetes Mellitus Hypertension: Father had hypertension Cancer: Mother died of breast cancer Infectious Diseases: None Social History Patient is retired and lives with her husband in an adult community. She is active with the local civie groups. She has never smoked and drinks socially. Chief Complaint “[ want to replace my missing tecth” Dental History Patient had been seeking routine care in the past. Het missing teeth, according to her, wer extracted, due to “gum disease”. Due to financial constraints she could not afford the treatment earlier. But now she is willing to do “anything” to get her teeth fixed. She also reported bleeding from gums sometimes and “unevenness of some teeth”. Clinical Examination Vital Signs Extraoral Exam Head: Within normal limits Muscles: Within normal limits ‘Neck: Within normal limits Intraoral Exam = Soft tissue Oral cancer exam: Within normal limits Lips: Within normal limits Hard palate: Within normal limits Pharynx & fauces: Within normal limits Soft palate: Within normai limits Tongue: Within normal limits Floor of the mouth: Within normal limits Occlusal Exam Angle Classification: Right Side - Canine Class I Left Side — Canine and Molar Class 1 TMJ Exam Within normal limitsAdult Clinical Examination Bi cin nically visable carious lesio i missing Furcationase Patient Profile Medical History General Health: Current Treatment: Hospitalizations/Surgery: Current Medications: Allergies: Review of Systems: Family History Diabetes: Hypertension: Cancer: Infectious Diseases: Social History A 53 Race: Catcasian Sex: Mae Height: 612" Weight: 225 Ibs. Marital Status: Married Occupation: Truck driver Good He is under the care of @ physician for Adult Maturity Onset Diabetes or Non-insulin Dependent Diabetes (NIDDM) None Tolbutamide 1z/day None ‘Within normal limits Mother had Type 2 Diabetes Mellitus. None Father died of a brain tumor None Patient chews tobacco mostly all day and has been for 15 years. He drinks a “few cold ones” every day, Chief Complaint “T need a cleaning” Dental History Patient has his teeth cleaned every year or so. He has had restorative treatment in the past and every dentist tells him he should quit chewing tobacco. Clinical Examination Vital Signs Extraoral Exam Head: Muscles: Neck: Intraoral Exam = Soft tissue BP = 130/82 HR =76 bpm RR = 16 Within normal limits Within normal limits Within normal limits Oral cancer exam: White patch on the right lateral border of tongue Hard palate: Within normal limits Sofi palate: Within normal limits Floor of the mouth: Within norma) limits Occlusal Exam Angle Classification: TMJ Exam Pharynx & fauces: Within normal limits Tongue: Write patch on the right lateral border of tongue Lips: Within normal limits Right Side - Molar Class [II Left Side — Molar Class HI Within normal limits Adult Clinical Examination Slam ai mea RT ee | TES 1 2 3 4 CF 8 Oe 10: 1 2s AS Se: 18 «17 3203 30. 29° «28 «27-26 25 24 23 22 21 20 «19 LL gt " GU) THT AY S<> yO \ ot (Tae Teen Tae Tons [ze J sr2 [ose s20for2] 32a] 23 [ze [933 [434 Po B Clinically vieablo carious lesion i Clinically missing tooth A Furcation 4A “Trough and through” furcationll Patient Profile in American Female 47” 120 Ibs. Marital Status: Married Occupation: Secretary Medical History General Health: Fair Current Treatment: She is under the care of a physician for Bronchial Asth and High Blood Pressure Hospitalizations/Surgery: 2 Heart attacks (most recent | year ago) Current Medications: Albuteral inhaler prn, Toprol-XL 250 mg/day Coumadin 5 mg/day, Aspirin 325 mg tablet per day Allergies None Review of Systems: Within normal limits Family History Diabetes: Mother died from Type I Diabetes Mellitus Hypertension: Father died from a heart attack Cancer: None Infectious Diseases: None Social History Patient does not smoke or drink Chief Complaint “I.came because my teeth appearance worries me. especially my black front tooth, and als the tooth I lost. [ would also like te change the silver fillings to white ones.” Dental History Her first dental visit was when she was 13 years old and had a wisdom tooth extracted (#1 Over the next 7 ~ 8 years she had a couple of root canals and a couple more teeth extractes For the last 20 years she has had periodic appointments for scaling and prophylaxis. Clinical Examination Vital Signs Extraoral Exam Head: Within normal limits Muscles: Pain in the masseter, temporalis, medial pterygoid, late pterygoid, and sternocleidomastoid muscl Neck: Within normal limits Intraoral Exam = Soft tissue Oral cancer exam: Within normal limits Lips: Within normal limits Hard palate: Within normal limits Pharynx & fauces: Within normal limits Soft palate: Within normal limits Tongue: Within normal limits Floor of the mouth: Within normal limits Occlusal Exam Angle Classification: Right Side — Molar Class IT Left Side — Molar Class IL TMJ Exam Bilateral clickAdult Clinical Examination lag OM VN VY) v1) OX ( y BION" [=< >< 32 318029 BOTs «2G 25 24-23-22 21 20 «19 «18 = 17 Minawase A (\ yy aD SDS > moa OO A | ae utcation A Throws igh and through’ furcation(shaadi Patient Profile Age: 49 Race: Caucasian Sex Female Height: SDP: Weight: 115 tbs. Marital Status: Married Occupation: Medical History General Health: Current Treatment: Hospitalizations/Surgery: Current Medications Allergies. Review of Systems: Family History Diabetes: Hypertension: Cancer: Infectious Diseases: Social History She does not smoke and drinks soci grandchildren. Chief Complaint Cashier at a local food store Good She is under the care of a physician for Rheumatoid Arthritis She had benign fibromas remove from her uterus in 199 and a hysterectomy in 2001 Naproxen 250 mg/twice a day None Mitral valve prolapse Father died from Type I Diabetes Mellitus None Mother died of breast cancer ‘None ally. She enjays spending her spare time with her “[ do not want to cover my mouth when I smile anymore, and [ also want to take eare of thi painful spot on the inside of my lower lip” Dental History Her family could never afford dentistry and she only went when she had a toothache and m of the time the tooth was extracted, Clinical Examination Vital Signs BP = 130/86 HR = 72 bpm RR = 12 raoral Exam Head: Within normal limits Muscles: Within normal limits Neck: ‘Within normal limits Intraoral Exam = Soft tissue Oral cancer exam: Within normal limits Hard palate: Within normal limits Soft palate: Within normal limits Floor of the mouth: Within normal limits ***Uleer on inside of lower lip Occlusal Exam Angle Classification: Lips: Within normal limits Pharynx & fauoes: Within normal limits Tongue: Within normal li Right side: unable to determing due to missing teeth Left side: unable to determine due to missing teeth (MJ Exam Within normal limitsAdult Clinical Examination Mandibular Right Maxillary LeftOe ee TO CASE STUDIES 7. The eal treatment plan for this patient will involve th placernent of endosseus implants in the maillary right left posterior quadrans, An endasseus dental implant, between the bone anc implant, a fan) 1 This patient's parhally edentulous maxillary arch woutd he A. Periodontal ligament classified as B, Per-implant ligament © Epithelial ligament A. Kennedy Class f D Abone-implant interface 8. Kennedy Class I C Kennedy Class fll 8. The histologic definition of osseointegration is best D Kennedy Class IV described by which of the following: ‘A. Diet connection between living bone and land-bes endosseous implant atthe light microscopic level 2. A significant side effect of Risperdal iy A. Arthralgio B. Tissue to implan} contact with healthy dense collag 8 Tinnitus tise between the implant and bene C. Xerostomia C. Fibrous integration with development of a perindon D Bone pain igamentlke structure D. None of the above 3. Based on the radiographs and probe readings of this pater what would be the periodontal diagnosis? A. Type F Gingivitis B Type Il: Early Pencdontts C. Type IT Moderate Penodonans D.Tpped¥s Advanced Penodantits 9. Based on the radiographs and probe seadings of eis pi what would be the peredontal diagnos? 4. Radiographic findings to the correct answer above may en e include al ofthe following. except: A Type E Ginguis B Type Il Early Penodoniis a Heizantal type of bone loss C Type lll: Moderate Penodontus B. Slight loss of interdental sepium C, Alveolar bone [evel 1s 3 t04 mmi from the CES area D Crown to root ratio is 2.1 or more D Type LV: Advanced Penodontius LU, Based on the radrographs. residual root ups are found assoctated with which of the following teeth? All of the following hactena would mosi likely be found in a subgingival plaque sainple taken Irom a periodontal pocket A214 19 and 31 of chis patient, excepts B. 19 and 30 | . ©. 14,19, and 30 A, Actinobacillus etinomycetemcomitans D.3. 19, and 31 B. Porphyromonas gingrvalis C. Staphylococcus aureus D. Prevotella intermedia E, Eikenella corrodens . Sickle-cell anemia is a hereditary typeof chvonic hemo aatemia Its caused by: F. Fusobacterium nucleatum ‘A. Blood group incosnpaibilay between mother and ba B, Abnormal hemoglebin 6, The mest common disease causing sevostomia ts: C Abnormal red howe cell membraves Al] of the abo A. Sarcoidosis D. All of the above B. Amsloidosis C. Sjogren's syndrome D. Rheumatoid anhntisChole (Coit) 12. Folic acid is. A. Also called nicotnie acid B A water-soluble vitamun in the B-complex group € A fat-soluble vitamin D_ Involved inthe normal production of sound dentin and enamel 13. Which ofthe following is the most likely diag condition associated with teeth 9 and 107 A, Fusion B.Concreseence Bons invaginatus D. Gerningtion 14, In the condition abave which of the followang ss true” A. Division 1s usually incomplete and results in a large tooth crown that has single roct and single canal B, Division is usually incomplete an resulls in a lurge tooth crown that has two roots and 1wo canals . Division 1s usually complete and results in large tooth craven that has single root and nwo canals D Division is usvally complete and resus in large toh croysn that bas to roots and a single canal 1S While excavating the gmss caries on tooth #3, you decide to perform an indirect pulp cap. The caries near the pulp s left in place to avoid pulp tissue eaposuce and is most often covered seth A Calcium hydroxide B. Composite resin C. cat D. Amalgam Case III 16, Based on the clinical pictures and radiographs. the periodontal status ofthis patent can be categorized as A. Chronic generalized moderae fo severe penodantius B. Chronic generalized mild to moderate periodontitis . Chante generalized mild periodontitis . Cannot be determine! froma the available information 1D 0G, BOGE ee A. Vibrios, spirochetes, and other gram-negstive organisms B Gram-positive cocei © Rods and filamentous forms D Gram-negative, motile spirochetes and mds Which instruntent is mest appropriate for use when root planing the distal surfaces of this patients molars and premolars? A. Gracey 9110 curet B. Gracey’ [72 curet C. Gracey 13/14 curet D, Gracey 3/4 curet Fosamax: A Binds with stereospecific receptors at many sites within the CNS. nereasing the pain threshold for patients with osteoporosis 8 (sa bisphonate which tnhibits bone resomption via actions ‘on asteaclasts or on osteoclast precursons C Is a competitive inhibitor of angiotensin-converting enzyme (ACE) and prevents the conversion of angiotensin [to angiotensin II, potent vasoconstrictor D. 1s from 3: new class of drugs called Selecuve Estrogen Receptor Modulators (SERMSs) that appear to prevent boone loss athe spine hip, and total body With regards to this pauen's periodontal satus A. Patient tceds thorough scaling and root planing only and re-evaluation B Periodontal flap surgery is needed in all quadrants i order to fully assess the prognosis C. Bone gralting in the regions of horizontal bone loss should be attempted immediately D Connective tssue grafts should be pesformed for teeth £1, 3. and 116 where tissue loss is severe ‘The perapical radtogrephs of the mandibular anienor eth. A, Siow early signs of periapical cemental dysplasia B. Show that the bone has some suspicious radiopacies mos likely due to an adverse effect of medicstion the patient is taking C Show nonmal hone trabeculations D None of the above Jn what position woutd you place this patient in the event of vasovagal syncope? A Semiupnght B Trendelenburg C. Supine D Standing ase 23. Which of the [ollowing desenbes Tolbutamide's mechanism of action? A Itacis exclusively on the digestive tube by partially blocking the digestion of complex sugars B. It reduces the production of glucose by’the live in which ‘tis sored It stimulates insulin release from the pancreatic beta cells D. Iv increases tne use of glucose by the musele and se reduces the level of glucose in the blood 24. Whict ofthe following should bx used with caution in palients taking Tolhutamnide due (0 potential increased hypo- slyeoma A. Aspirin B. Ibuprofen © Naproxen D Nahumetone, 25 Noninsulin dependent diabetes should he A Limited to the number of teeth treated at each visit B. Appointed for dental treatment in the momming in order co minimize the chance of stress-induced hypoglycemia C. Allowed to have shont appointments for stress management 1D. All of the above: 26 Hased on the radingrapks and probe readings ofthis patient whit Would be the periodontal diagnosis? A Typed: Gingrvtis B. Type tl: Early Penodontns C. Type lll: Moderate Periodontitis D. Typo IV: Advaticed Periodomitis ‘The caries on the factal surface of tooth #5 is most likely asvoriated with: A. Actinomyces ‘iscosus. B. Filamentous rods C. Lactobacillus specien D Streptovaceus mutans 25) The white patch on the right lateral border of the tongue can rete be scraped off nor classified as any other diagrosable slisgase, What isthe most likely diagnosis?” A. Lichen planus B. Leukoplakia C, Leukoedema D. White sponge nevus u 3 4 A Tobacco use B Alcohol use © Ultraviutet radiation D Microorganssms & Traum ‘The treatment for the condition above ts: A. Observe every 6 months B. Radiation C. Biopsy D. No treatment is necessary as this is a benign condi Case V ‘When using local anesthesia on this patient, what 1s the concern” A, Tne amount of lidocaine used per visit 8. The amount of epinephrine used per visit C. Avotding the use of topical anesthesia du to possib allergic reaction D. None of the ove (there should be no concern} The maximal dose of epirephnne recommended for ad {ration to the cardioc-rish patient at one appointment is A OG mg B 002 mg €. 004 me D 006 mg Tuprol-XL (Metoprolol) su fan} A Loup diureic B Nonselective beta-blocker C. Alpha-blocker D Cardioselecnve beta-blocker ‘Which of the flowing can occur when epinephrine or tevonordephiin in local anesthetic solutions is adminis 1o patents taking alpa-blockers? A, Hypertension and brady cardia B. Hypotension and tachycardit C. Decreased cleerance of injected local arestheties tro peripheral circulation D. Bid retention