EXAMINATION:
EO / ST : NAD
BPE
HISTORY
Patient: Summer Fox
Age: 35
Occupation: Aerobics instructor
MH: NAD
RFA: Routine check-up (6M interval)
PCO: Staining of upper front tooth. Patient reports it had been previously repaired with white filling.
DH: Regular attender
PH: fruit consumption ++
(~8 oranges per day + energy drinks)
Using MagScope
In addition to the control buttons, you can do most of the slide manipulation
with a mouse. Please take a moment to try
these:
MovingYou can use the mouse to drag the slide about (hold the left button down).
Or double-click on a spot - it will centre that spot.
Or double-click on the thumbnal.
Or use the keyboard arrow keys.
Zooming
To magnify, use your mouse wheel.
It magnifies over the bit you are pointing at.
If you have no wheel, hold the L or R button down. After 1 second it will zoom in (or out).
Mac mousepad: use the "two-finger scrape" to zoom.
BrowsersInternet Explorer 6+, Netscape 7+, and Firefox (for Mac & Linux) are recommended.
Safari Opera and Konqueror have slightly limited functionality.
The MagScope viewer was developed by Giles Perryer: Please address any enquiries to d.g.perryer@bham.ac.uk
Before you start, use the Magscope (above) to look around the mouth and examine the teeth of this 26 year old woman.
(Click the help button for Magscope instructions.)
Get a feel for what is going on, and what the main problems might be.
Then go through the programme using the blue buttons, and see if you have thought about the same things as we have...
Q1. Ortho Extractions
This patient had extractions for orthodontic treatment when she was 14. Which teeth were extracted?
• The lower first molars.
• This actually created too much space, causing tilting of the
left 8
, and spacing between
right 3 & 4.
Q2. Lower Left 8
Describe the Left 8
• Buccal and Occlusal amalgam restorations present.
• The occlusal restoration shows some marginal ditching, but is otherwise sound.
• The buccal restoration has secondary caries: note the creamy colour of the enamel in this region.
Q3. Lower Left 8
What treatment should be provided for Left 8?
• First, find out the aetiology of the caries by investigating the diet, and address this.
• Both amalgams should be removed, caries removed or treated, and the tooth restored.
Q4. Lower Left 7
Describe the Left 7.
• It has an occlusal amalgam restoration that shows some marginal ditching, but is otherwise sound.
• It has a buccal crack, and two distal cracks.
• There is staining of the buccal fissure.
Q5. Lower Left 7
The patient reports she gets an occasional sharp pain of short duration when she bites on this tooth.
It is not sensitive to hot or cold.
What is the most likely cause of the pain?
• Cracked tooth syndrome
Q6.
The patient reports she gets an occasional sharp pain of short duration when she bites on this tooth.
It is not sensitive to hot or cold.
How might you confirm your provisional diagnosis of cracked tooth syndrome?
• By using a bite stick or "tooth sleuth" on each cusp in turn, until you find the cusp that elicits the pain.
• The disto-buccal cusp is the most likely candidate.
Search the ecourse for cracked tooth to find out more about this common condition.
Q7. Lower Left 5
Describe the Left 5. Would you treat it?
• The tooth is unrestored.
• It has a black stained central fissure. The adjacent enamel looks normal. The central fissure
does not require treatment.
• The enamel around the distal fissure is discoloured grey/blue. In view of the active caries in the Left 8,
many clinicians might biopsy this fissure, then seal it or provide a PRR.
Search the ecourse for PRR for more information.
Q8. Lower Left 4
Describe the Left 4. Would you treat it?
• The tooth is unrestored.
• It has black stained fissures. The adjacent enamel looks normal.
• A crack is visible bucally.
• The tooth does not require treatment.
Q9. Lower Left Sextant
Have you noticed the enamel of the teeth inspected so far has a smooth, glassy, semi-transparent appearance?
What is the probable cause of this?
• Tooth surface loss due to acid erosion.
• When directly and sensitively questioned, this patient reported she had bulimia when younger.
Both gastric acid and dietary acid had contributed to the erosion.
• She assures us that she now has a mostly non-acidic diet, and is no longer bulimic.
Q10. Lower Anteriors
Describe the lower anterior teeth.
• Wear facets are present, especially on the incisors.
• The facets are flat - dentine has not been exposed by wear.
• They are probably due to attrition, with a minor erosion component.
• There is staining present, and calculus.
Q11. Lower Anteriors
What does the staining tell you about whether the patient may still be bulimic?
• Patients with active acid erosion tend not to have surface stains on the teeth, as the acid dissolves it away
with the enamel. So it is probable that the patient is telling the truth.
See Here for a programme on acid erosion.
Summary
Now use the magscope to inspect the rest of the teeth yourself. Try to decide whether fissures need intervention or not.
Look for amalgam ditching and/or corrosion: how bad should it be before you refill a tooth?
We hope you have enjoyed working with this "Virtual Patient".
You may not agree with the way we would manage this patient, but if not, we hope it has got you
thinking about alternative approaches.
Thanks for using the programme
Giles Perryer
Back to top
|
Index
