Case Study 2 :  Supernumerary tooth.

Demographics:

A.A, Male ,35 year old Asian, Heavy/ Stage 2 grade B.

Assessment:
CC: “ I have pain on my right side all the way in the back.”
Patients significant findings in medical history

  • Patient is ASA 1
  • Vital signs- Blood Pressure :121/80 with Pulse: 85
  • Non-social drinker, no pre-medication needed, and, no systemic conditions presen

Oral Pathology

EO: WNL

IO: Bilateral linea alba, scalloped lateral border.

Dentition

Bilateral Class Right:1. Left: 2 Occlusion.

  • 5mm overjet
  • 40% overbite
  • Localized attrition on #5-12, #22-27.
  • PD 5mm/limited probing due to calculus.
  • Patient has active caries lesions on #2O and #31D
  •  #16 2/3 of the crown is fractured and has active caries.


Periodontal 

  • Patient has generalized 3-4mm probing depths with localized 5-7 mm on premolar and molar regions.
  • Generalized moderate bleeding upon probing on all surfaces.

Gingival Assessment: Generalized red inflamed gingiva with localized bulbous interdental papilla on lower anteriors and localized rolled gingival margins on molars. Generalized heavy biofilm.

Oral Hygiene 

Patient initial plaque score was 1.8- Poor. This patient had heavy sub and supra calculus especially on lingual of lower anteriors. From clinical findings I figured this patient would benefit from power toothbrush. My plan was to demonstrate power toothbrush on a typodont, teach him how to floss and recommended him to use Listerine Antiseptic mouthwash 2x a day.

Radiographs

Patient was exposed for HBWs and Panoramic to check for PAP on #16, 3rd molars, active caries lesions and to confirm periodontal conditions. Patient was given Referal to DDS for active caries and evaluation of 3rdmolars and supernumerary tooth.

 

        

 

Radiographic findings: About 25% molar incisor bone loss pattern. Supernumerary tooth 1A exists. #17 horizontally impacted. #32 mesially impacted and it has damaged #31D.

Treatment Management 

Initial visit

Did all the recare assessments, exposed BWs and Panoramic image. Went over OHI. Hand scaled quadrant four, used 20% Benzocaine topical gel and Oraqix (Prilocaine & Lidocaine) for pain management.

Visit 2

Reviewed his medical history and intraoral examination again- within normal limits. Recorded plaque score .9-Fair. Patient bought power toothbrush and was compliant with brushing method, disclosing solution has showed his improvement. For interdental aid Waterpik was introduced: since patient has 5-7mm pockets it is beneficial for him to keep up with her homecare. Hand scaled quadrants two and three to completion. used 20% Benzocaine topical gel and Oraqix (Prilocaine & Lidocaine) for pain management.

 

Visit 3

Plaque score .7 fair , Introduced second aid of flossing, re-scales on quadrant two and scaled quadrant one. Less bleeding was noted after this visit compared to the first visit. Polished with medium grit paste. Applied Varnish 5% NaF, post op instructions given. Next recare will be in 3mo.

Evaluation

Initially the patient came in with pain in UL and did not have any knowledge on what was happing in the oral cavity. However after showing him his radiographs and periodontal charting and radiographic bone loss he had more interest on taking care of his teeth. Explained the importance of visiting the dentist and taking care of his cavitied before it reaches the nerve. Patient became more aware and acknowledged his dental condition and asked for list of dental facilities.

Reflection 

I believe I accomplished everything I had in my treatment plan. I educated my patient and stressed the importance of oral hygiene and reglar dental visitations for professional cleaning. My patient was satisfied with the service and left with bright smile.