Case Study

This patient presented with a check-up and pain from both upper and lower right quadrants. She had not been for 2 years due to having problems in finding an NHS practice who would accept her. The patient's personal details and medical history was checked. A dental history was taken which revealed that the patient attendance was also due to a fear of treatment as a result of the school dentist many years ago. An extraoral examination, soft tissue check, mouth cancer screening, charting, occlusal examination, periodontal assessment including BPE scores, and oral hygiene assessment was recorded. Bitewing radiographs and periapicals of the molars in the right hand side were taken. Their justification and grading were recorded. Film holders were used for her bitewing radiographs but not for two periapicals. Dr Zaman did try to but the patient who is very nervous found it hard to tolerate. The radiographs were reported which included root caries in UR7, root caries in LR5 distal, root caries in LR6 and extensive caries in LR7 and LR8. A diagnosis
was recorded and a suitable treatment plan made. This was agreed with the patient and included a discussion of all options including no treatment and advantages and disadvantages of possible solutions. The patient consented for the extraction of UR7, LR5, LR6, LR7 and LR8 which all had a poor prognosis. In view of the patients nervous disposition and multiple teeth that needed extractions, the patient requested this under sedation. The patient was given all options including their disadvantages and advantages including sedation or LA alone. Opportunity to ask further questions was given and a referral was made. In view of these multiple carious cavities, Dr Zaman also explored further the cause of these and gave appropriate prevention advice such as in relation to diet, sugar, oral hygiene and use of fluoride toothpastes. She was extremely pleased with her care that she received from us and referred the rest of her family to us also.