Dental Exam

Clinician Specialty: Prosthodontist RFA: Exam Nurse: Sarah Jenkins CO: - Patient presents with discomfort in the lower left quadrant, particularly when chewing. Reports a history of a fractured molar (tooth 36) approximately 3 months ago, which was initially managed with a temporary filling by a general dentist. Now experiencing increased sensitivity and occasional sharp pain. Expresses concern about aesthetics and function, desiring a long-term solution. - Patient had a history of multiple composite restorations in their youth. Underwent orthodontic treatment 15 years ago. No prior prosthodontic treatments. MH: - Medications: None reported. - Allergies: Penicillin (rash). SH: - Social history: Non-smoker, occasional social alcohol use (1-2 units per week). Maintains good oral hygiene habits. DH: Uses an electric toothbrush twice daily for 2 minutes, interdental brushes once daily. Occasional flossing. Examination: - Extra-oral examination findings: No palpable tenderness in TMJ or muscles of mastication. Facial symmetry is good. Lips appear healthy. No palpable lymphadenopathy. - Soft tissues examination findings: Hard palate, soft palate, buccal mucosa, tongue, and floor of mouth all appear healthy with no abnormal lesions or inflammation. - Dentition: Tooth 36 has a large fractured cusp and a compromised temporary restoration. Deep caries evident on buccal aspect. Tooth 46 has an existing amalgam restoration with marginal breakdown. Generalized mild attrition on occlusal surfaces. No other significant carious lesions noted. - Condition of existing prostheses: No existing prostheses. - Periodontal status: Generalized mild gingivitis, no significant pocketing. - BPE scores: Upper right: 2, Upper anterior: 1, Upper left: 2, Lower right: 1, Lower anterior: 1, Lower left: 3. - Caries risk: High (due to compromised restoration on 36 and marginal breakdown on 46). - Periodontal risk: Low (BPE scores mostly 1 and 2, with one sextant at 3 indicating localized deeper pocketing). - Oral cancer risk: Low (non-smoker, moderate alcohol consumption). Radiographs - Periapical radiograph of 36 shows deep caries extending close to the pulp chamber, with no periapical pathology. Bitewing radiographs reveal recurrent caries under the existing amalgam on 46. Diagnosis - Caries, deep, tooth 36 with pulpal involvement likely. (Reversible pulpitis) - Recurrent caries, tooth 46. - Generalized mild gingivitis. Discussed Dx with patient: Explained the findings for tooth 36, including the deep caries and likely pulpal involvement, necessitating either root canal treatment followed by a crown or extraction. Discussed the recurrent caries on tooth 46 requiring a new restoration. Explained the pros and cons of each treatment option for tooth 36, emphasising the goal of preserving the tooth if possible and restoring function and aesthetics. Patient expressed a preference for preserving tooth 36 if feasible. Plan: - Treatment options for 36: 1) Root canal treatment + full coverage crown (e.g., ceramic or zirconia) or 2) Extraction + implant-supported crown or conventional bridge. For 46: Replacement of existing amalgam with a composite restoration. - Proposed treatment plan: Initiate root canal treatment for tooth 36. Following successful root canal, prepare and place a provisional crown. Once stable, definitive ceramic crown for 36. Replace amalgam on 46 with composite. Review and manage gingivitis. - Referrals to other specialists: Referral to Endodontist for assessment and root canal treatment of tooth 36. - Patient education and counselling provided: Detailed discussion on the importance of maintaining good oral hygiene, the steps involved in root canal treatment and crown placement, and the benefits of timely restoration. Emphasised the role of diet in caries prevention. - Follow-up appointments and any additional instructions: Schedule appointment with Endodontist. Follow-up appointment in 4 weeks post-endodontic treatment for provisional crown placement and assessment of 46. Oral hygiene advice provided, including guidance on brushing along gingival margins and interdental cleaning with interdental brushes, particularly in areas with mild gingivitis. Dietary advice provided, including limiting sugar to meal times only and reducing frequency of sugary snacks and drinks. Next visit: Follow-up in 4 weeks (1 November 2024) for provisional crown placement and review of tooth 46, post-endodontic treatment. Will coordinate with Endodontist for treatment completion.