Clinical Cases

Be true to your teeth and they won’t be false to you.~ Soupy Sales


The key to maintaining good oral hygiene is to be true to your teeth. We all have jobs, school, and other  issues at hand and we sometimes tend to focus on those things rather than our teeth. Throughout my clinical experience,  I have seen several patients. Some were true to their teeth and some tried to be true to their teeth, but nonetheless, if they showed up to the dental clinic they were concerned about their oral health and they were willing to  improve it.

A while back I came across a 35 year old male with a history of smoking one pack of cigarettes per day for 15 years. He had not been seen in a dental setting for about 6 years. Being that he smoked cigarettes for so long I was expecting fibrotic gingival tissue, little to no bleeding, staining, and significant pocket depths. The patient indeed has fibrotic gingiva, no bleeding upon probing, probing depths that ranged from 1-4 mm, and heavy amounts of supragingival and subgingival calculus. The patient presented with a couple of interesting oral findings as shown below


Hairy Tongue

Upon intraoral examination everything looked fine but a full set of radiographs was exposed on this patient and I found a  periapical pathology localized to the apices of teeth #23 and 24. The patient stated that he was told by a doctor that he had an infection and was prescribed some antibiotics to get rid of it. In order to have a correct diagnosis and treatment of the area, the patient was given a copy of his radiographs, as well as a referral to the oral surgeon and pathologist.


The patient admitted that he had no interest in quitting his long-term smoking habit whatsoever. He also stated that he decided to come to the clinic when he saw brown stains on just about all of his teeth. I reviewed brushing and flossing with the patient due to the amount of staining  and the heavy amounts of calculus he presented with. I decided that it was best to give this patient 3 visits to do some very much needed scaling and root planning as well as air polishing to remove the stain. As for the hairy tongue, I educated the patient about hairy tongue and showed him how to use a tongue scraper to get rid of the brown staining. The results of the scaling and air polishing are shown below

After SRP and air polishing

The patient was very satisfied and appreciative of my work, as was I. I gave the patient a recall of 3 months because I being that he has a history of smoking cigarettes and he had a lot of calculus. About 5 months later the patient returned. His hairy tongue was less pronounced, he was classified as a light having very few areas of subgingival and supragingival calculus, yet he still had staining due to his ongoing smoking habit, which was to be expected. I was very proud of my patient and I praised him for all of the effort he put into maintaining his oral  health. The patient stated that he had not had the time to go see about the pathology around #23 and 24 that was found on his radiographs.  I spoke to the patient about the pathology again and told him that the  lesion could begin to spread and there will be an increased possibility of him losing his teeth if he does not get that area checked out as soon as possible. The patient was very concerned about his teeth and agreed that he would see a pathologist as soon as he could. At this visit he recieved another referral to the pathologist. I am more than sure that the patient will follow through being that he is highly concerned about his teeth.

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