Clinical Case 2 – Ms. Z – Unique Morphology


Case #2: Gemination and Retained Deciduous Teeth

Patient: Ms. Z
24 Year Old Asian Woman
ASA Classification: II

Case Value: Heavy       Perio: Stage I/B     Caries Risk: High

Med Hx: Patient does not have any diagnosed medical or systemic conditions. Not taking any medications or over the counter supplements. Patient does state that she has severe dental anxiety, and that she has never been to a dentist office. Due to dental anxiety, patient was categorized as ASA II.

Initial visit with Ms. Z was on 3/18/2022. According to her dental history, patient had never been to the dentist. Patient presented with no restorations in her mouth, however, she did have clinically present several areas of suspicious carious lesions. She also presented with interesting morphology, and a fractured tooth, #8.

At first glance it appeared that the patient’s mandibular lateral incisors were missing, but also tooth #27 exhibited macrodontia, or it looked like the crowns of two teeth were fused together. The patient stated she never had any teeth extracted. After all assessments, my clinic instructor and I decided that it was best to expose horizontal bitewings and a panoramic x-ray. The HBW showed that the patient had generalized bone loss of up to 15% were seen.  Moderate caries was seen on #30, radiographically.

The panoramic xray was the most telling. It showed us that the patient exhibited oligodontia, and she had gemination of tooth #27, and retained deciduous teeth #O and #P. From the panoramic xray and from the patient stating that she never had any teeth extracted, the determination was made that tooth #17, #23-29, and #32 are congenitally missing.

From the moment that Ms. Z stepped into the clinic and into my operatory, she appeared to be very jumpy and nervous. She mentioned to me that she did have dental anxiety, and she never went to the dentists, either in the US or in China (where she is originally from). She was a patient who really made me use all the calming methods that I’ve learned throughout my semesters and using “tell show do” was helpful with this patient. Even though we had a language barrier (patient did not speak English well). For our appointments, I had to utilize music, “tell show do” during each step of the assessments and used a translator app to communicate with my patient (answer any questions, as well as reassure her that everything was okay, and to explain all assessment findings to her).

Overall, this was a very interesting case, I learned a lot from my patient, and she also helped strengthen my anxiety calming skills when it comes to patient management. I think overall she had a good experience with her cleaning, and I hope that this experience helped to ease a lot of her dental anxiety as well. At the end of our time together, she seemed very motivated to continue with her OHI as well as come back for her RECARE visit.