Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Hi Alena ,Thank you for sharing this interesting case with us , and i would like to know wht are ur thoughts about it.Well , i believe nerve tablets are Vit. B12 and i dont knw their relevence to the ttt.I believe as an emergency phase ,i would first prescrible an antiseptic gel (Bonjela) for the large tongue ulcer and refer rightaway for screening at the hospital , also she requires a thorough periodontal ttt .Then going to the main problem ,which is the loose upper denture , i would advice she needs to extract her upper right impacted wisdom tooth and also refer her for surgical ext.We would then do relining or remake the whole upper denture once the wound heals.I would also advice for a lower denture once the periodontal condition is stable and the LL and LR4 are restored also the broken LL1 needs to be restored.Tell me then wht you think.Regards , Hannalla.From: Alena Ozieva <alenaozieva@...>Subject: new DTP case-denture" " < >Date: Wednesday, August 17, 2011, 5:17 AM Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 hey george,i think the candidiasis also needs to be treated in the immediate phaseand i think if the tooth is deeply impacted in bone we shdnt extract it. the guidelines dnt recommend removal of asymptomatic 8s. what do u think?From: george said <georgeeskaros@...> Sent: Wednesday, August 17, 2011 12:46 PMSubject: Re: new DTP case-denture Hi Alena ,Thank you for sharing this interesting case with us , and i would like to know wht are ur thoughts about it.Well , i believe nerve tablets are Vit. B12 and i dont knw their relevence to the ttt.I believe as an emergency phase ,i would first prescrible an antiseptic gel (Bonjela) for the large tongue ulcer and refer rightaway for screening at the hospital , also she requires a thorough periodontal ttt .Then going to the main problem ,which is the loose upper denture , i would advice she needs to extract her upper right impacted wisdom tooth and also refer her for surgical ext.We would then do relining or remake the whole upper denture once the wound heals.I would also advice for a lower denture once the periodontal condition is stable and the LL and LR4 are restored also the broken LL1 needs to be restored.Tell me then wht you think.Regards , Hannalla.From: Alena Ozieva <alenaozieva@...>Subject: new DTP case-denture" " < >Date: Wednesday, August 17, 2011, 5:17 AM Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Hi Neelam ,Yeah i forgot about it,sorry...Well ,this requires a good history taking .I mean ,if the tooth is moving and a bony prominence can be felt on palpation as mentioned, so definitely it needs to be removed ....Regards , .From: Alena Ozieva <alenaozieva@...>Subject: new DTP case-denture" " < >Date: Wednesday, August 17, 2011, 5:17 AM Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 hi, interesting case, here we have to look at the problems in hand 1. upper loose denture and flabby ridge 2. missing lower teeth 3. upper third molar 4. ulcer 5. her concerns about the practice being 'too far' and inability to come. medical concerns.. 1. diabetic patient 2. 'some tablets for nerves' which could be anti-anxiety/ anti-depressants considering her history- death of husband, living alone. the condition of upper ridge is combination syndrome. so simply relining/rebasing denture will not help. my treatment plan would be.. emergency phase- refer for ulcer (even though it is likely to be apthous)/alternatively give tetracycline mouthwash and recall/review after one week. if heels ok. if not refer. also request her to come back with prescription of her medications next time. Primary treatment and stabilisation- treatment options related to dentures- 1.restore lower teeth+ give upper dentures only. 2. restore lower teeth+ give upper and lower dentures for remaining teeth. 3. remove LL1,LL2,LL4,LR1,LR2,LR4 keep lower canines+ give upper denture+ lower overdenture. 4. remove all teeth ( can be done under GA along with the removal of third molar if required) + give U/L complete dentures. maintenance recall and review. personally i would go for overdentures in lower plus upper complete dentures because the reason for the current situation is the presence of lower teeth in relation to an upper denture. also considering the compromised status of these teeth it might be best to extract them. another thing that should be mentioned here if planning for lower dentures is the provision of immediate dentures (as she is concerned about her appearance) because of her diabetic status she should also be warned that her ridges will resorb faster than usual and repeated relining might be required. this fact should also be taken into account while extracting her teeth. thats all i guess. kindly make additions and corrections if required. Regards Smriti. > > From: Alena Ozieva <alenaozieva@...> > Subject: new DTP case-denture > " " < > > Date: Wednesday, August 17, 2011, 5:17 AM > > > > > > > > > > > > > > > > >  > > > > > > > Hello everyoneI brought a new case for the discussion > > Miss son > > DOB; 13/07/1945 > > Actor Scenario Info > > You have gone to see a new dentist for the following reason. > > You think your upper denture “looks horrible†and is “coming looseâ€. You > have never had a lower denture and you don’t think that you could cope with > one. You don’t want to be any trouble and you think you will probably manage > with your denture if the dentist can adjust it. > > Medical history > > You are insulin dependent diabetic. > > Your GP has given you some tablets “for your nervesâ€. You don’t have > them with you and you don’t remember what they are called. > > Dental history > > You have not attend the dentist since your upper teeth were extracted > for your wedding when you were 21 > > You brush your teeth every day > > Social history > > You husband died of cancer last year and you live on your own in a > socially deprived town. > > You have two daughters and one son. > > Attending the surgery is a bit difficult for you. It takes an hour on > the bus, however you are happy to have whatever treatment the dentist deems to > be best. > > Further scenario info for the actor (Only if asked by the candidate) > > You are embarrassed about your dental condition and poor attendance > history. You have not eaten in front of anyone other than your husband for the > past 20 years, not even at your daughter’s wedding reception. Your speech is > also affected. > >  > >  > >  > >  > >  > >  > > Examiner’s Info > > Extra-oral exam > > Nothing abnormal. Decrease in lower face height > > Intra-oral exam > > Soft tissue screening; The mucosa beneath the upper denture is inflamed > with an appearance of chronic candidiasis. There is a large ulcer on the > tongue. The upper anterior ridge is > mobile and “flabby†and when the patient speaks, the upper denture has a > noticeable tendency to drop. > > Bony tissue screening; On palpation, it can be felt that there is a bony > structure under the right posterior side. > > In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > patient was eating a toffee. It is not painful, though. All of the remaining > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically > and occlusaly. > > Occlusion; Appears to be Class III. It is difficult to get the patient > bite in a retruded contact position > > Vitality test; not available > > Generalized alveolar bone loss > > > > > - > > > - > > > - > > > > > - > > > 4 > > > - > > > > > BPE;                                               > >  > >  > > BOP; some > > Grade 1 mobility > > OH; some dental plague is visible. > > Special exam and other props > > Study cast; not available > > Photos; available > > OPG; not available > > Periapicals of the lower anterior teeth and upper right posterior side. > The latter shows an impacted wisdom tooth. > >  > >  > >  > >  Best regards > Alena > Ozieva > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 sorry missed the candidiasis.. treatment will be in emergency phase. nyacin application. and regular recall and review. denture making will proceed after the tissue heals. regards smriti > > > > From: Alena Ozieva <alenaozieva@> > > Subject: new DTP case-denture > > " " < > > > Date: Wednesday, August 17, 2011, 5:17 AM > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >  > > > > > > > > > > > > > > Hello everyoneI brought a new case for the discussion > > > > Miss son > > > > DOB; 13/07/1945 > > > > Actor Scenario Info > > > > You have gone to see a new dentist for the following reason. > > > > You think your upper denture “looks horrible†and is “coming looseâ€. You > > have never had a lower denture and you don’t think that you could cope with > > one. You don’t want to be any trouble and you think you will probably manage > > with your denture if the dentist can adjust it. > > > > Medical history > > > > You are insulin dependent diabetic. > > > > Your GP has given you some tablets “for your nervesâ€. You don’t have > > them with you and you don’t remember what they are called. > > > > Dental history > > > > You have not attend the dentist since your upper teeth were extracted > > for your wedding when you were 21 > > > > You brush your teeth every day > > > > Social history > > > > You husband died of cancer last year and you live on your own in a > > socially deprived town. > > > > You have two daughters and one son. > > > > Attending the surgery is a bit difficult for you. It takes an hour on > > the bus, however you are happy to have whatever treatment the dentist deems to > > be best. > > > > Further scenario info for the actor (Only if asked by the candidate) > > > > You are embarrassed about your dental condition and poor attendance > > history. You have not eaten in front of anyone other than your husband for the > > past 20 years, not even at your daughter’s wedding reception. Your speech is > > also affected. > > > >  > > > >  > > > >  > > > >  > > > >  > > > >  > > > > Examiner’s Info > > > > Extra-oral exam > > > > Nothing abnormal. Decrease in lower face height > > > > Intra-oral exam > > > > Soft tissue screening; The mucosa beneath the upper denture is inflamed > > with an appearance of chronic candidiasis. There is a large ulcer on the > > tongue. The upper anterior ridge is > > mobile and “flabby†and when the patient speaks, the upper denture has a > > noticeable tendency to drop. > > > > Bony tissue screening; On palpation, it can be felt that there is a bony > > structure under the right posterior side. > > > > In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > > patient was eating a toffee. It is not painful, though. All of the remaining > > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically > > and occlusaly. > > > > Occlusion; Appears to be Class III. It is difficult to get the patient > > bite in a retruded contact position > > > > Vitality test; not available > > > > Generalized alveolar bone loss > > > > > > > > > > - > > > > > > - > > > > > > - > > > > > > > > > > - > > > > > > 4 > > > > > > - > > > > > > > > > > BPE;                                               > > > >  > > > >  > > > > BOP; some > > > > Grade 1 mobility > > > > OH; some dental plague is visible. > > > > Special exam and other props > > > > Study cast; not available > > > > Photos; available > > > > OPG; not available > > > > Periapicals of the lower anterior teeth and upper right posterior side. > > The latter shows an impacted wisdom tooth. > > > >  > > > >  > > > >  > > > >  Best regards > > Alena > > Ozieva > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Hi Thank you ;-)Ok let me try to do this DTPProblem list:Medical-insulin dependant diabeticTabs from nerves..probably fluoxitine,amitriptilin..eg.antidepressants( side-effect-drawsiness.sedation,xerostomia,blurred vision,nausea)..need to ask her to call back or GP tel number to find out exact name of tabs..Irregular attender,live far away,live in the poor areaLost husband..depressed,how she keep herself busy to askDental-speech affected,flabby ridge,candida,ulcer,caries,poor hygiene,perio,class III maloclusion,etc.I will outline onlyEmergencyidentify problems and explaine to the Pt(resorbtion of jaws)candida+denture HI importance,keep it out overnight etc.PrescNistatin suspension,Smear for Cndida..not sure.Ulcer-chloxehidine+benzydamineask about the denture...is it immediate..?Treatm options for denture..ask why it looks horrible?What she doesnt like?Reline(rebase,copy-not sure because of flubby ridge...may be smone can correct me)Refer to prostho/or maxillofascial surgeon about flabby ridge and wisdom tooth...?Lower jaw-explanation about BPE,ask if she wants to keep her teeth?If so refer to periodonthlogist for a second opinion..and RxPRIMARYReview denture candidosisreview ulcer..if still present..refer to a specialist ..urgently!Explanation of attrition,caries on lower teeth,diet chart,type of toothbrush etc..Reinforcement of oral hygienePlacement temporary fillings on ll1,ll4,lr4Ask what type of denture she wants-upper FUD,implant supported(keep in mind diabetis),overdenture on implants tell abt advant,disadvLower-give options PLD-if teeth present.FLD if notoverdenture,implant supported denture(refer)...what do you think guys cos maloclusion class III do we have to refer to prosthodontist...?SecondaryReview ulcer,replace temporary fillings-give options(if she opt for overdenture-RCT)reinforce OHIease a new upper denture...may beWell it is quite a lot...how to explaine it in 10 mins time!!!please correct me if i am mistaken Best regardsAlenaOzievaFrom: george said <georgeeskaros@...> Sent: Wednesday, August 17, 2011 12:46 PMSubject: Re: new DTP case-denture Hi Alena ,Thank you for sharing this interesting case with us , and i would like to know wht are ur thoughts about it.Well , i believe nerve tablets are Vit. B12 and i dont knw their relevence to the ttt.I believe as an emergency phase ,i would first prescrible an antiseptic gel (Bonjela) for the large tongue ulcer and refer rightaway for screening at the hospital , also she requires a thorough periodontal ttt .Then going to the main problem ,which is the loose upper denture , i would advice she needs to extract her upper right impacted wisdom tooth and also refer her for surgical ext.We would then do relining or remake the whole upper denture once the wound heals.I would also advice for a lower denture once the periodontal condition is stable and the LL and LR4 are restored also the broken LL1 needs to be restored.Tell me then wht you think.Regards , Hannalla.From: Alena Ozieva <alenaozieva@...>Subject: new DTP case-denture" " < >Date: Wednesday, August 17, 2011, 5:17 AM Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Hi SmritiI like yout treatment plan,thank you for sharing it with us Best regardsAlenaOzievaFrom: smriti <doc_smriti@...> Sent: Wednesday, August 17, 2011 4:20 PMSubject: Re: new DTP case-denture sorry missed the candidiasis.. treatment will be in emergency phase. nyacin application. and regular recall and review. denture making will proceed after the tissue heals. regards smriti > > > > From: Alena Ozieva <alenaozieva@> > > Subject: new DTP case-denture > > " " < > > > Date: Wednesday, August 17, 2011, 5:17 AM > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello everyoneI brought a new case for the discussion > > > > Miss son > > > > DOB; 13/07/1945 > > > > Actor Scenario Info > > > > You have gone to see a new dentist for the following reason. > > > > You think your upper denture “looks horrible†and is “coming looseâ€. You > > have never had a lower denture and you don’t think that you could cope with > > one. You don’t want to be any trouble and you think you will probably manage > > with your denture if the dentist can adjust it. > > > > Medical history > > > > You are insulin dependent diabetic. > > > > Your GP has given you some tablets “for your nervesâ€. You don’t have > > them with you and you don’t remember what they are called. > > > > Dental history > > > > You have not attend the dentist since your upper teeth were extracted > > for your wedding when you were 21 > > > > You brush your teeth every day > > > > Social history > > > > You husband died of cancer last year and you live on your own in a > > socially deprived town. > > > > You have two daughters and one son. > > > > Attending the surgery is a bit difficult for you. It takes an hour on > > the bus, however you are happy to have whatever treatment the dentist deems to > > be best. > > > > Further scenario info for the actor (Only if asked by the candidate) > > > > You are embarrassed about your dental condition and poor attendance > > history. You have not eaten in front of anyone other than your husband for the > > past 20 years, not even at your daughter’s wedding reception. Your speech is > > also affected. > > > > > > > > > > > > > > > > > > > > > > > > > > > > Examiner’s Info > > > > Extra-oral exam > > > > Nothing abnormal. Decrease in lower face height > > > > Intra-oral exam > > > > Soft tissue screening; The mucosa beneath the upper denture is inflamed > > with an appearance of chronic candidiasis. There is a large ulcer on the > > tongue. The upper anterior ridge is > > mobile and “flabby†and when the patient speaks, the upper denture has a > > noticeable tendency to drop. > > > > Bony tissue screening; On palpation, it can be felt that there is a bony > > structure under the right posterior side. > > > > In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > > patient was eating a toffee. It is not painful, though. All of the remaining > > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically > > and occlusaly. > > > > Occlusion; Appears to be Class III. It is difficult to get the patient > > bite in a retruded contact position > > > > Vitality test; not available > > > > Generalized alveolar bone loss > > > > > > > > > > - > > > > > > - > > > > > > - > > > > > > > > > > - > > > > > > 4 > > > > > > - > > > > > > > > > > BPE; > > > > > > > > > > > > BOP; some > > > > Grade 1 mobility > > > > OH; some dental plague is visible. > > > > Special exam and other props > > > > Study cast; not available > > > > Photos; available > > > > OPG; not available > > > > Periapicals of the lower anterior teeth and upper right posterior side. > > The latter shows an impacted wisdom tooth. > > > > > > > > > > > > > > > > Best regards > > Alena > > Ozieva > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Hi Members I am new to this group,looking at your messages I realised how deep your knowledge and how high your standards of treatment of patients. i am going to do the ore1 next year and wish to reach your level of knowledge. which books do i need to read for the exams? All the best and thank you > > > > > > From: Alena Ozieva <alenaozieva@> > > > Subject: new DTP case-denture > > > " " < > > > > Date: Wednesday, August 17, 2011, 5:17 AM > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >  > > > > > > > > > > > > > > > > > > > > > Hello everyoneI brought a new case for the discussion > > > > > > Miss son > > > > > > DOB; 13/07/1945 > > > > > > Actor Scenario Info > > > > > > You have gone to see a new dentist for the following reason. > > > > > > You think your upper denture “looks horrible†and is “coming looseâ€. You > > > have never had a lower denture and you don’t think that you could cope with > > > one. You don’t want to be any trouble and you think you will probably manage > > > with your denture if the dentist can adjust it. > > > > > > Medical history > > > > > > You are insulin dependent diabetic. > > > > > > Your GP has given you some tablets “for your nervesâ€. You don’t have > > > them with you and you don’t remember what they are called. > > > > > > Dental history > > > > > > You have not attend the dentist since your upper teeth were extracted > > > for your wedding when you were 21 > > > > > > You brush your teeth every day > > > > > > Social history > > > > > > You husband died of cancer last year and you live on your own in a > > > socially deprived town. > > > > > > You have two daughters and one son. > > > > > > Attending the surgery is a bit difficult for you. It takes an hour on > > > the bus, however you are happy to have whatever treatment the dentist deems to > > > be best. > > > > > > Further scenario info for the actor (Only if asked by the candidate) > > > > > > You are embarrassed about your dental condition and poor attendance > > > history. You have not eaten in front of anyone other than your husband for the > > > past 20 years, not even at your daughter’s wedding reception. Your speech is > > > also affected. > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > > Examiner’s Info > > > > > > Extra-oral exam > > > > > > Nothing abnormal. Decrease in lower face height > > > > > > Intra-oral exam > > > > > > Soft tissue screening; The mucosa beneath the upper denture is inflamed > > > with an appearance of chronic candidiasis. There is a large ulcer on the > > > tongue. The upper anterior ridge is > > > mobile and “flabby†and when the patient speaks, the upper denture has a > > > noticeable tendency to drop. > > > > > > Bony tissue screening; On palpation, it can be felt that there is a bony > > > structure under the right posterior side. > > > > > > In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > > > patient was eating a toffee. It is not painful, though. All of the remaining > > > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically > > > and occlusaly. > > > > > > Occlusion; Appears to be Class III. It is difficult to get the patient > > > bite in a retruded contact position > > > > > > Vitality test; not available > > > > > > Generalized alveolar bone loss > > > > > > > > > > > > > > > - > > > > > > > > > - > > > > > > > > > - > > > > > > > > > > > > > > > - > > > > > > > > > 4 > > > > > > > > > - > > > > > > > > > > > > > > > BPE;                                               > > > > > >  > > > > > >  > > > > > > BOP; some > > > > > > Grade 1 mobility > > > > > > OH; some dental plague is visible. > > > > > > Special exam and other props > > > > > > Study cast; not available > > > > > > Photos; available > > > > > > OPG; not available > > > > > > Periapicals of the lower anterior teeth and upper right posterior side. > > > The latter shows an impacted wisdom tooth. > > > > > >  > > > > > >  > > > > > >  > > > > > >  Best regards > > > Alena > > > Ozieva > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Hi Alena, Thanks a lot. Hope that we can all help each other get through this exam together. Regards Smriti > > > > > > From: Alena Ozieva <alenaozieva@> > > > Subject: new DTP case-denture > > > " " < > > > > Date: Wednesday, August 17, 2011, 5:17 AM > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >  > > > > > > > > > > > > > > > > > > > > > Hello everyoneI brought a new case for the discussion > > > > > > Miss son > > > > > > DOB; 13/07/1945 > > > > > > Actor Scenario Info > > > > > > You have gone to see a new dentist for the following reason. > > > > > > You think your upper denture “looks horrible†and is “coming looseâ€. You > > > have never had a lower denture and you don’t think that you could cope with > > > one. You don’t want to be any trouble and you think you will probably manage > > > with your denture if the dentist can adjust it. > > > > > > Medical history > > > > > > You are insulin dependent diabetic. > > > > > > Your GP has given you some tablets “for your nervesâ€. You don’t have > > > them with you and you don’t remember what they are called. > > > > > > Dental history > > > > > > You have not attend the dentist since your upper teeth were extracted > > > for your wedding when you were 21 > > > > > > You brush your teeth every day > > > > > > Social history > > > > > > You husband died of cancer last year and you live on your own in a > > > socially deprived town. > > > > > > You have two daughters and one son. > > > > > > Attending the surgery is a bit difficult for you. It takes an hour on > > > the bus, however you are happy to have whatever treatment the dentist deems to > > > be best. > > > > > > Further scenario info for the actor (Only if asked by the candidate) > > > > > > You are embarrassed about your dental condition and poor attendance > > > history. You have not eaten in front of anyone other than your husband for the > > > past 20 years, not even at your daughter’s wedding reception. Your speech is > > > also affected. > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > > Examiner’s Info > > > > > > Extra-oral exam > > > > > > Nothing abnormal. Decrease in lower face height > > > > > > Intra-oral exam > > > > > > Soft tissue screening; The mucosa beneath the upper denture is inflamed > > > with an appearance of chronic candidiasis. There is a large ulcer on the > > > tongue. The upper anterior ridge is > > > mobile and “flabby†and when the patient speaks, the upper denture has a > > > noticeable tendency to drop. > > > > > > Bony tissue screening; On palpation, it can be felt that there is a bony > > > structure under the right posterior side. > > > > > > In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > > > patient was eating a toffee. It is not painful, though. All of the remaining > > > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically > > > and occlusaly. > > > > > > Occlusion; Appears to be Class III. It is difficult to get the patient > > > bite in a retruded contact position > > > > > > Vitality test; not available > > > > > > Generalized alveolar bone loss > > > > > > > > > > > > > > > - > > > > > > > > > - > > > > > > > > > - > > > > > > > > > > > > > > > - > > > > > > > > > 4 > > > > > > > > > - > > > > > > > > > > > > > > > BPE;                                               > > > > > >  > > > > > >  > > > > > > BOP; some > > > > > > Grade 1 mobility > > > > > > OH; some dental plague is visible. > > > > > > Special exam and other props > > > > > > Study cast; not available > > > > > > Photos; available > > > > > > OPG; not available > > > > > > Periapicals of the lower anterior teeth and upper right posterior side. > > > The latter shows an impacted wisdom tooth. > > > > > >  > > > > > >  > > > > > >  > > > > > >  Best regards > > > Alena > > > Ozieva > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Dear AllCan anyone criticise my DTP...i personally think it is confusing...maybe even too complex.....?What do you think?Thank you Best regardsAlenaFrom: Alena Ozieva <alenaozieva@...>" " < >Sent: Wednesday, August 17, 2011 5:57 PMSubject: Re: new DTP case-denture Hi SmritiI like yout treatment plan,thank you for sharing it with us Best regardsAlenaOzievaFrom: smriti <doc_smriti@...> Sent: Wednesday, August 17, 2011 4:20 PMSubject: Re: new DTP case-denture sorry missed the candidiasis.. treatment will be in emergency phase. nyacin application. and regular recall and review. denture making will proceed after the tissue heals. regards smriti > > > > From: Alena Ozieva <alenaozieva@> > > Subject: new DTP case-denture > > " " < > > > Date: Wednesday, August 17, 2011, 5:17 AM > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Hello everyoneI brought a new case for the discussion > > > > Miss son > > > > DOB; 13/07/1945 > > > > Actor Scenario Info > > > > You have gone to see a new dentist for the following reason. > > > > You think your upper denture “looks horrible†and is “coming looseâ€. You > > have never had a lower denture and you don’t think that you could cope with > > one. You don’t want to be any trouble and you think you will probably manage > > with your denture if the dentist can adjust it. > > > > Medical history > > > > You are insulin dependent diabetic. > > > > Your GP has given you some tablets “for your nervesâ€. You don’t have > > them with you and you don’t remember what they are called. > > > > Dental history > > > > You have not attend the dentist since your upper teeth were extracted > > for your wedding when you were 21 > > > > You brush your teeth every day > > > > Social history > > > > You husband died of cancer last year and you live on your own in a > > socially deprived town. > > > > You have two daughters and one son. > > > > Attending the surgery is a bit difficult for you. It takes an hour on > > the bus, however you are happy to have whatever treatment the dentist deems to > > be best. > > > > Further scenario info for the actor (Only if asked by the candidate) > > > > You are embarrassed about your dental condition and poor attendance > > history. You have not eaten in front of anyone other than your husband for the > > past 20 years, not even at your daughter’s wedding reception. Your speech is > > also affected. > > > > > > > > > > > > > > > > > > > > > > > > > > > > Examiner’s Info > > > > Extra-oral exam > > > > Nothing abnormal. Decrease in lower face height > > > > Intra-oral exam > > > > Soft tissue screening; The mucosa beneath the upper denture is inflamed > > with an appearance of chronic candidiasis. There is a large ulcer on the > > tongue. The upper anterior ridge is > > mobile and “flabby†and when the patient speaks, the upper denture has a > > noticeable tendency to drop. > > > > Bony tissue screening; On palpation, it can be felt that there is a bony > > structure under the right posterior side. > > > > In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > > patient was eating a toffee. It is not painful, though. All of the remaining > > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically > > and occlusaly. > > > > Occlusion; Appears to be Class III. It is difficult to get the patient > > bite in a retruded contact position > > > > Vitality test; not available > > > > Generalized alveolar bone loss > > > > > > > > > > - > > > > > > - > > > > > > - > > > > > > > > > > - > > > > > > 4 > > > > > > - > > > > > > > > > > BPE; > > > > > > > > > > > > BOP; some > > > > Grade 1 mobility > > > > OH; some dental plague is visible. > > > > Special exam and other props > > > > Study cast; not available > > > > Photos; available > > > > OPG; not available > > > > Periapicals of the lower anterior teeth and upper right posterior side. > > The latter shows an impacted wisdom tooth. > > > > > > > > > > > > > > > > Best regards > > Alena > > Ozieva > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Sorry, thats my treatment plan below Best regardsAlenaOzieva----- Forwarded Message -----From: Alena Ozieva <alenaozieva@...>" " < >Sent: Wednesday, August 17, 2011 5:54 PMSubject: Re: new DTP case-dentureHi Thank you ;-)Ok let me try to do this DTPProblem list:Medical-insulin dependant diabeticTabs from nerves..probably fluoxitine,amitriptilin..eg.antidepressants( side-effect-drawsiness.sedation,xerostomia,blurred vision,nausea)..need to ask her to call back or GP tel number to find out exact name of tabs..Irregular attender,live far away,live in the poor areaLost husband..depressed,how she keep herself busy to askDental-speech affected,flabby ridge,candida,ulcer,caries,poor hygiene,perio,class III maloclusion,etc.I will outline onlyEmergencyidentify problems and explaine to the Pt(resorbtion of jaws)candida+denture HI importance,keep it out overnight etc.PrescNistatin suspension,Smear for Cndida..not sure.Ulcer-chloxehidine+benzydamineask about the denture...is it immediate..?Treatm options for denture..ask why it looks horrible?What she doesnt like?Reline(rebase,copy-not sure because of flubby ridge...may be smone can correct me)Refer to prostho/or maxillofascial surgeon about flabby ridge and wisdom tooth...?Lower jaw-explanation about BPE,ask if she wants to keep her teeth?If so refer to periodonthlogist for a second opinion..and RxPRIMARYReview denture candidosisreview ulcer..if still present..refer to a specialist ..urgently!Explanation of attrition,caries on lower teeth,diet chart,type of toothbrush etc..Reinforcement of oral hygienePlacement temporary fillings on ll1,ll4,lr4Ask what type of denture she wants-upper FUD,implant supported(keep in mind diabetis),overdenture on implants tell abt advant,disadvLower-give options PLD-if teeth present.FLD if notoverdenture,implant supported denture(refer)...what do you think guys cos maloclusion class III do we have to refer to prosthodontist...?SecondaryReview ulcer,replace temporary fillings-give options(if she opt for overdenture-RCT)reinforce OHIease a new upper denture...may beWell it is quite a lot...how to explaine it in 10 mins time!!!please correct me if i am mistaken Best regardsAlenaOzievaFrom: george said <georgeeskaros@...> Sent: Wednesday, August 17, 2011 12:46 PMSubject: Re: new DTP case-denture Hi Alena ,Thank you for sharing this interesting case with us , and i would like to know wht are ur thoughts about it.Well , i believe nerve tablets are Vit. B12 and i dont knw their relevence to the ttt.I believe as an emergency phase ,i would first prescrible an antiseptic gel (Bonjela) for the large tongue ulcer and refer rightaway for screening at the hospital , also she requires a thorough periodontal ttt .Then going to the main problem ,which is the loose upper denture , i would advice she needs to extract her upper right impacted wisdom tooth and also refer her for surgical ext.We would then do relining or remake the whole upper denture once the wound heals.I would also advice for a lower denture once the periodontal condition is stable and the LL and LR4 are restored also the broken LL1 needs to be restored.Tell me then wht you think.Regards , Hannalla.From: Alena Ozieva <alenaozieva@...>Subject: new DTP case-denture" " < >Date: Wednesday, August 17, 2011, 5:17 AM Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Thanks for the DTP below. however, i want to share as well. here's mine, please correct me if iam wrong: A) Emergency; 1) tell pt make sure everytime eat ur food & take medication before coming to clinic for precaution of hypoglycemic attack. 2) explain loose UCD bec of flabby ridge, refer to omfs for excesion as even new denture wont fit if flabby still present. 3) explain U mucosa inflammed ( denture stomatitis) as result of poor OH, diabetes, wear denture at night. give Nystatin 100,000 mouthwash for 7 days, review after that if still refer to o medicine specialist for biopsy or systemic antifungal drug. 4) ulcer in tongue might be bec of broke LL1, give benzydamine mouth wash to reduce soreness twice a day for 5 days & smooth LL1. review in 7 days, if the same refer to omfs for biopsy or steriods. Treatment; 5) periodontitis, explain what is it, the causes: poor plaque control, stress, diabetes, age, genetic. mobility grade 1 in L 2,3,4 with poor prognosis. scaling + OHI, refer to periodontist for deep pocket cleaning & consutaltion as may be extraction for L 2,3,4 better. 6) attrition,abration, caries in L teeth. if remain it after consutation with periodontist. put GIC. 7) there's UR8 impacted, check it with omfs for monitoring as there's no problem now, might be need surgical removal in future if pathological problem occur. C) Restoration; 8) after anything is Ok, give options for upper; either complete plastic/metal or implant with overdenture after advice from ur GP if ur diabetes is truly stable as risk of infection. for lower; either fill lower teeth with composit & RPD plastic/metal, RCT of lower teeth + overdenture, or complete plastic/metal with/ without implant. D) Maintanence; 9) review 6 months for checking ..etc Ammar > > > > > > From: Alena Ozieva <alenaozieva@> > > > Subject: new DTP case-denture > > > " " < > > > > Date: Wednesday, August 17, 2011, 5:17 AM > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >  > > > > > > > > > > > > > > > > > > > > > Hello everyoneI brought a new case for the discussion > > > > > > Miss son > > > > > > DOB; 13/07/1945 > > > > > > Actor Scenario Info > > > > > > You have gone to see a new dentist for the following reason. > > > > > > You think your upper denture “looks horrible†and is “coming looseâ€. You > > > have never had a lower denture and you don’t think that you could cope with > > > one. You don’t want to be any trouble and you think you will probably manage > > > with your denture if the dentist can adjust it. > > > > > > Medical history > > > > > > You are insulin dependent diabetic. > > > > > > Your GP has given you some tablets “for your nervesâ€. You don’t have > > > them with you and you don’t remember what they are called. > > > > > > Dental history > > > > > > You have not attend the dentist since your upper teeth were extracted > > > for your wedding when you were 21 > > > > > > You brush your teeth every day > > > > > > Social history > > > > > > You husband died of cancer last year and you live on your own in a > > > socially deprived town. > > > > > > You have two daughters and one son. > > > > > > Attending the surgery is a bit difficult for you. It takes an hour on > > > the bus, however you are happy to have whatever treatment the dentist deems to > > > be best. > > > > > > Further scenario info for the actor (Only if asked by the candidate) > > > > > > You are embarrassed about your dental condition and poor attendance > > > history. You have not eaten in front of anyone other than your husband for the > > > past 20 years, not even at your daughter’s wedding reception. Your speech is > > > also affected. > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > >  > > > > > > Examiner’s Info > > > > > > Extra-oral exam > > > > > > Nothing abnormal. Decrease in lower face height > > > > > > Intra-oral exam > > > > > > Soft tissue screening; The mucosa beneath the upper denture is inflamed > > > with an appearance of chronic candidiasis. There is a large ulcer on the > > > tongue. The upper anterior ridge is > > > mobile and “flabby†and when the patient speaks, the upper denture has a > > > noticeable tendency to drop. > > > > > > Bony tissue screening; On palpation, it can be felt that there is a bony > > > structure under the right posterior side. > > > > > > In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > > > patient was eating a toffee. It is not painful, though. All of the remaining > > > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically > > > and occlusaly. > > > > > > Occlusion; Appears to be Class III. It is difficult to get the patient > > > bite in a retruded contact position > > > > > > Vitality test; not available > > > > > > Generalized alveolar bone loss > > > > > > > > > > > > > > > - > > > > > > > > > - > > > > > > > > > - > > > > > > > > > > > > > > > - > > > > > > > > > 4 > > > > > > > > > - > > > > > > > > > > > > > > > BPE;                                               > > > > > >  > > > > > >  > > > > > > BOP; some > > > > > > Grade 1 mobility > > > > > > OH; some dental plague is visible. > > > > > > Special exam and other props > > > > > > Study cast; not available > > > > > > Photos; available > > > > > > OPG; not available > > > > > > Periapicals of the lower anterior teeth and upper right posterior side. > > > The latter shows an impacted wisdom tooth. > > > > > >  > > > > > >  > > > > > >  > > > > > >  Best regards > > > Alena > > > Ozieva > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 hi geroge , well in case of loose denture is it safe in terms of examination to prescribe patient a fixodent [ its a denture adhesive material] . thanks veenaFrom: Alena Ozieva <alenaozieva@...>Subject: new DTP case-denture" " < >Date: Wednesday, August 17, 2011, 5:17 AM Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Hi guysthank you for sharing your treatment plans.I feel that in emergency phase we still need to do reline...even know that there is a flabby ridge.Explain that it is a temporary,and after surgery once mucosa healed make all options above(removable,non-removable)She came with complains of loose denture...we need to do smf about it.Poor fit of denture is a cofactor of candida thrush.Pt needs to know that smf done about it.and of course terat candida,ulcer,referral etc.What do you think guys?SincerelyLyudmylaFrom: Veena B <veena913@...> Sent: Wednesday, 17 August 2011, 22:55Subject: Re: new DTP case-denture hi geroge , well in case of loose denture is it safe in terms of examination to prescribe patient a fixodent [ its a denture adhesive material] . thanks veenaFrom: Alena Ozieva <alenaozieva@...>Subject: new DTP case-denture" " < >Date: Wednesday, August 17, 2011, 5:17 AM Hello everyoneI brought a new case for the discussion Miss son DOB; 13/07/1945 Actor Scenario Info You have gone to see a new dentist for the following reason. You think your upper denture “looks horrible†and is “coming looseâ€. You have never had a lower denture and you don’t think that you could cope with one. You don’t want to be any trouble and you think you will probably manage with your denture if the dentist can adjust it. Medical history You are insulin dependent diabetic. Your GP has given you some tablets “for your nervesâ€. You don’t have them with you and you don’t remember what they are called. Dental history You have not attend the dentist since your upper teeth were extracted for your wedding when you were 21 You brush your teeth every day Social history You husband died of cancer last year and you live on your own in a socially deprived town. You have two daughters and one son. Attending the surgery is a bit difficult for you. It takes an hour on the bus, however you are happy to have whatever treatment the dentist deems to be best. Further scenario info for the actor (Only if asked by the candidate) You are embarrassed about your dental condition and poor attendance history. You have not eaten in front of anyone other than your husband for the past 20 years, not even at your daughter’s wedding reception. Your speech is also affected. Examiner’s Info Extra-oral exam Nothing abnormal. Decrease in lower face height Intra-oral exam Soft tissue screening; The mucosa beneath the upper denture is inflamed with an appearance of chronic candidiasis. There is a large ulcer on the tongue. The upper anterior ridge is mobile and “flabby†and when the patient speaks, the upper denture has a noticeable tendency to drop. Bony tissue screening; On palpation, it can be felt that there is a bony structure under the right posterior side. In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the patient was eating a toffee. It is not painful, though. All of the remaining lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. Occlusion; Appears to be Class III. It is difficult to get the patient bite in a retruded contact position Vitality test; not available Generalized alveolar bone loss - - - - 4 - BPE; BOP; some Grade 1 mobility OH; some dental plague is visible. Special exam and other props Study cast; not available Photos; available OPG; not available Periapicals of the lower anterior teeth and upper right posterior side. The latter shows an impacted wisdom tooth. Best regardsAlenaOzieva Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 hi Lyudmyla, Thanks a lot for adding that very important point here.. you are absolutely right.. we can reline the denture with a tissue conditioner, prescribe anti-fungals, allow tissue to heal and then go for permanent treatment. Kind Regards, Smriti > >> > >> > >>>From: Alena Ozieva <alenaozieva@...> > >>>Subject: new DTP case-denture > >>> " " < > > >>>Date: Wednesday, August 17, 2011, 5:17 AM > >>> > >>> > >>> > >>>Hello everyone > >>>I brought a new case for the discussion > >>>Miss son > >>>DOB; 13/07/1945 > >>>Actor Scenario Info > >>>You have gone to see a new dentist for the following reason. > >>>You think your upper denture “looks horrible†and is “coming looseâ€. You > have never had a lower denture and you don’t think that you could cope with > one. You don’t want to be any trouble and you think you will probably manage > with your denture if the dentist can adjust it. > >>>Medical history > >>>You are insulin dependent diabetic. > >>>Your GP has given you some tablets “for your nervesâ€. You don’t have > them with you and you don’t remember what they are called. > >>>Dental history > >>>You have not attend the dentist since your upper teeth were extracted > for your wedding when you were 21 > >>>You brush your teeth every day > >>>Social history > >>>You husband died of cancer last year and you live on your own in a > socially deprived town. > >>>You have two daughters and one son. > >>>Attending the surgery is a bit difficult for you. It takes an hour on > the bus, however you are happy to have whatever treatment the dentist deems to > be best. > >>>Further scenario info for the actor (Only if asked by the candidate) > >>>You are embarrassed about your dental condition and poor attendance > history. You have not eaten in front of anyone other than your husband for the > past 20 years, not even at your daughter’s wedding reception. Your speech is > also affected. > >>> > >>> > >>> > >>> > >>> > >>> > >>>Examiner’s Info > >>>Extra-oral exam > >>>Nothing abnormal. Decrease in lower face height > >>>Intra-oral exam > >>>Soft tissue screening; The mucosa beneath the upper denture is inflamed > with an appearance of chronic candidiasis. There is a large ulcer on the > tongue. The upper anterior ridge is > mobile and “flabby†and when the patient speaks, the upper denture has a > noticeable tendency to drop. > >>>Bony tissue screening; On palpation, it can be felt that there is a bony > structure under the right posterior side. > >>>In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the > patient was eating a toffee. It is not painful, though. All of the remaining > lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. > >>>Occlusion; Appears to be Class III. It is difficult to get the patient > bite in a retruded contact position > >>>Vitality test; not available > >>>Generalized alveolar bone loss > >>>- - - > >>>- 4 - > >>>BPE;                                               > >>> > >>> > >>>BOP; some > >>>Grade 1 mobility > >>>OH; some dental plague is visible. > >>>Special exam and other props > >>>Study cast; not available > >>>Photos; available > >>>OPG; not available > >>>Periapicals of the lower anterior teeth and upper right posterior side. > The latter shows an impacted wisdom tooth. > >>> > >>> > >>> > >>> > >>>Best regards > >>>Alena > >>>Ozieva > >> > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Hi guys, This is my opinion, First we need to talk about his D.M condition, and need to tell regular meal and insulin intake,and the essential about to bring his insulin with him as an emergency. Second we need to touch the main compln.reason for looseness in very brief and understandable.Then we hv to tell ,pt need to go for new denture,bec his ridge shape has been changed. bec As we all know there is sp mtd of imprsn tech for flappy ridge.I dont think so we need to talk about surgery.I think this is one of the past case,and the exmaminer will expect from us whether we will treat the pt or refr the pt.further more we have to tell the pt bfr going for new denture his candida condition should be treated,for that today i can prescribe cream.futher more we need to talk abt denture hygiene,maintanence,and its essential.defntly in this case pt will keep asking will u treat my condition,and what will u do today.what i think is we need to tell the pt ,ys i can treat u but before that ur infected condn should be treated,and i would like to make u aware of ur denture hygiene. pls correct me if my opinion is wrong. From: smriti <doc_smriti@...>Subject: Re: new DTP case-denture Date: Thursday, 18 August, 2011, 1:09 hi Lyudmyla, Thanks a lot for adding that very important point here.. you are absolutely right.. we can reline the denture with a tissue conditioner, prescribe anti-fungals, allow tissue to heal and then go for permanent treatment. Kind Regards,Smriti> >>> >>> >>>From: Alena Ozieva <alenaozieva@...>> >>>Subject: new DTP case-denture> >>>" " < >> >>>Date: Wednesday, August 17, 2011, 5:17 AM> >>>> >>>> >>> > >>>Hello everyone> >>>I brought a new case for the discussion> >>>Miss son> >>>DOB; 13/07/1945> >>>Actor Scenario Info> >>>You have gone to see a new dentist for the following reason.> >>>You think your upper denture “looks horrible†and is “coming looseâ€. You> have never had a lower denture and you don’t think that you could cope with> one. You don’t want to be any trouble and you think you will probably manage> with your denture if the dentist can adjust it. > >>>Medical history> >>>You are insulin dependent diabetic. > >>>Your GP has given you some tablets “for your nervesâ€. You don’t have> them with you and you don’t remember what they are called. > >>>Dental history> >>>You have not attend the dentist since your upper teeth were extracted> for your wedding when you were 21> >>>You brush your teeth every day> >>>Social history> >>>You husband died of cancer last year and you live on your own in a> socially deprived town.> >>>You have two daughters and one son. > >>>Attending the surgery is a bit difficult for you. It takes an hour on> the bus, however you are happy to have whatever treatment the dentist deems to> be best. > >>>Further scenario info for the actor (Only if asked by the candidate)> >>>You are embarrassed about your dental condition and poor attendance> history. You have not eaten in front of anyone other than your husband for the> past 20 years, not even at your daughter’s wedding reception. Your speech is> also affected. > >>> > >>> > >>> > >>> > >>> > >>> > >>>Examiner’s Info> >>>Extra-oral exam> >>>Nothing abnormal. Decrease in lower face height> >>>Intra-oral exam> >>>Soft tissue screening; The mucosa beneath the upper denture is inflamed> with an appearance of chronic candidiasis. There is a large ulcer on the> tongue. The upper anterior ridge is> mobile and “flabby†and when the patient speaks, the upper denture has a> noticeable tendency to drop.> >>>Bony tissue screening; On palpation, it can be felt that there is a bony> structure under the right posterior side.> >>>In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the> patient was eating a toffee. It is not painful, though. All of the remaining> lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. > >>>Occlusion; Appears to be Class III. It is difficult to get the patient> bite in a retruded contact position> >>>Vitality test; not available> >>>Generalized alveolar bone loss> >>>- - - > >>>- 4 - > >>>BPE; > >>> > >>> > >>>BOP; some> >>>Grade 1 mobility> >>>OH; some dental plague is visible.> >>>Special exam and other props> >>>Study cast; not available> >>>Photos; available> >>>OPG; not available> >>>Periapicals of the lower anterior teeth and upper right posterior side.> The latter shows an impacted wisdom tooth. > >>> > >>> > >>> > >>> > >>>Best regards> >>>Alena> >>>Ozieva > >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Great point!Surely we need to overcome that...how good when you have different opinions..maybe thats what examiners wanted to hear.Mind you she is from poor area..maybe it is a hint...I ve got some infor on this matterImpression Technique for a Flabby Ridge A flabby ridge is one which becomes displaceable due to fibrous tissue deposition. Most frequently seen in the upper anterior region. Usually occurs when natural teeth oppose an edentulous ridge. A flabby ridge causes instability of the denture. There are a number of different methods to overcome this problem, 3 of which will be discussed. SURGERY This involves removal of the fibrous tissue to leave a firm ridge. However removing the shock absorbing flabby ridge may lead to trauma of the underlying bone, and an increased bulk of denture material. The other technique involves constructing a denture over the flabby ridge. The impression may be either mucostatic or mucodisplacive where a mucostatic impression technique is selected then good retention will be obtain when the teeth are out of occlusion. When the denture is put under load instability may occur. With mucodisplacive impression techniques the denture will only fit well when the denture is under load, it may be unstable when at rest because the flabby ridge tends to recoil back into its original position displacing the denture. WINDOW TECHNIQUE A primary impression is taken in alginate loaded in a stock tray. The impression is then poured and a special tray is constructed on the model. The special tray is close fitting and has a hole or "window" over the area corresponding to the flabby ridge. An impression is taken in impression paste (mucodisplacive). Once this has set it is left in place and impression plaster (mucostatic) is painted over the flabby ridge and allowed to set and removed as one impression. The impression is removed as one, cast and the denture constructed on the resulting model. SELECTIVE DISPLACIVE TECHNIQUE This techniques aims to displace but not distort the flabby ridge as if in function. A primary impression is taken in a mucostatic impression material (e.g. impression plaster or alginate) and cast in stone. A spaced special tray for an impression compound impression is then constructed on this model. The tray is loaded with compound and an impression taken of the model of the patient's mouth. This reduces the risk of displacing the flabby ridge. The tray is then warmed and placed in the patient's mouth. It is adapted and border moulded to the tissues, and should be quite retentive. The impression is removed and warmed all over apart from the flabby ridge area. The impression is retaken, the flabby ridge is compressed but not distorted as the other portions of the impression compound sink into the tissues. The impression is removed inspected and re-tried in the mouth to check that it is stable. If any instability occurs then the impression should be reheated and re-taken. A wash impression may be taken in impression paste to obtain maximum detail and retention and stability. 1) The flabby ridge has been marked on this patient 2) The preliminary cast and a spaced special tray 3) Impression of the cast being taken in impression compound prior to being placed in the mouth 4) Flabby ridge impression after flaming and placing into the patient's mouth The treatment of flabby ridges is controversial and no one treatment stands out against the rest, so it is often the method favoured by the clinician that is used. SincerelyLyudmylaFrom: Latha Santrasegaram <yogan_latha@...> Sent: Thursday, 18 August 2011, 10:34Subject: Re: new DTP case-denture Hi guys, This is my opinion, First we need to talk about his D.M condition, and need to tell regular meal and insulin intake,and the essential about to bring his insulin with him as an emergency. Second we need to touch the main compln.reason for looseness in very brief and understandable.Then we hv to tell ,pt need to go for new denture,bec his ridge shape has been changed. bec As we all know there is sp mtd of imprsn tech for flappy ridge.I dont think so we need to talk about surgery.I think this is one of the past case,and the exmaminer will expect from us whether we will treat the pt or refr the pt.further more we have to tell the pt bfr going for new denture his candida condition should be treated,for that today i can prescribe cream.futher more we need to talk abt denture hygiene,maintanence,and its essential.defntly in this case pt will keep asking will u treat my condition,and what will u do today.what i think is we need to tell the pt ,ys i can treat u but before that ur infected condn should be treated,and i would like to make u aware of ur denture hygiene. pls correct me if my opinion is wrong. From: smriti <doc_smriti@...>Subject: Re: new DTP case-denture Date: Thursday, 18 August, 2011, 1:09 hi Lyudmyla, Thanks a lot for adding that very important point here.. you are absolutely right.. we can reline the denture with a tissue conditioner, prescribe anti-fungals, allow tissue to heal and then go for permanent treatment. Kind Regards,Smriti> >>> >>> >>>From: Alena Ozieva <alenaozieva@...>> >>>Subject: new DTP case-denture> >>>" " < >> >>>Date: Wednesday, August 17, 2011, 5:17 AM> >>>> >>>> >>> > >>>Hello everyone> >>>I brought a new case for the discussion> >>>Miss son> >>>DOB; 13/07/1945> >>>Actor Scenario Info> >>>You have gone to see a new dentist for the following reason.> >>>You think your upper denture “looks horrible†and is “coming looseâ€. You> have never had a lower denture and you don’t think that you could cope with> one. You don’t want to be any trouble and you think you will probably manage> with your denture if the dentist can adjust it. > >>>Medical history> >>>You are insulin dependent diabetic. > >>>Your GP has given you some tablets “for your nervesâ€. You don’t have> them with you and you don’t remember what they are called. > >>>Dental history> >>>You have not attend the dentist since your upper teeth were extracted> for your wedding when you were 21> >>>You brush your teeth every day> >>>Social history> >>>You husband died of cancer last year and you live on your own in a> socially deprived town.> >>>You have two daughters and one son. > >>>Attending the surgery is a bit difficult for you. It takes an hour on> the bus, however you are happy to have whatever treatment the dentist deems to> be best. > >>>Further scenario info for the actor (Only if asked by the candidate)> >>>You are embarrassed about your dental condition and poor attendance> history. You have not eaten in front of anyone other than your husband for the> past 20 years, not even at your daughter’s wedding reception. Your speech is> also affected. > >>> > >>> > >>> > >>> > >>> > >>> > >>>Examiner’s Info> >>>Extra-oral exam> >>>Nothing abnormal. Decrease in lower face height> >>>Intra-oral exam> >>>Soft tissue screening; The mucosa beneath the upper denture is inflamed> with an appearance of chronic candidiasis. There is a large ulcer on the> tongue. The upper anterior ridge is> mobile and “flabby†and when the patient speaks, the upper denture has a> noticeable tendency to drop.> >>>Bony tissue screening; On palpation, it can be felt that there is a bony> structure under the right posterior side.> >>>In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the> patient was eating a toffee. It is not painful, though. All of the remaining> lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. > >>>Occlusion; Appears to be Class III. It is difficult to get the patient> bite in a retruded contact position> >>>Vitality test; not available> >>>Generalized alveolar bone loss> >>>- - - > >>>- 4 - > >>>BPE; > >>> > >>> > >>>BOP; some> >>>Grade 1 mobility> >>>OH; some dental plague is visible.> >>>Special exam and other props> >>>Study cast; not available> >>>Photos; available> >>>OPG; not available> >>>Periapicals of the lower anterior teeth and upper right posterior side.> The latter shows an impacted wisdom tooth. > >>> > >>> > >>> > >>> > >>>Best regards> >>>Alena> >>>Ozieva > >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2011 Report Share Posted August 19, 2011 Thanks Lyu for sharing useful informationI guess we have to use tissue conditioner+crash tablets nistatin etc etc,review in a week then we can take impressions(below)because we need the inflammation to be gone...or ask if she wants to be referred to MFS...It looks like that two treatment planning sorted by the group.It is good to put these all messages on microsoft word and apload in the file section so newcommers will have an easy access,rather going thru messages... From: smriti <doc_smriti@...>Subject: Re: new DTP case-denture Date: Thursday, 18 August, 2011, 1:09 hi Lyudmyla, Thanks a lot for adding that very important point here.. you are absolutely right.. we can reline the denture with a tissue conditioner, prescribe anti-fungals, allow tissue to heal and then go for permanent treatment. Kind Regards,Smriti> >>> >>> >>>From: Alena Ozieva <alenaozieva@...>> >>>Subject: new DTP case-denture> >>>" " < >> >>>Date: Wednesday, August 17, 2011, 5:17 AM> >>>> >>>> >>> > >>>Hello everyone> >>>I brought a new case for the discussion> >>>Miss son> >>>DOB; 13/07/1945> >>>Actor Scenario Info> >>>You have gone to see a new dentist for the following reason.> >>>You think your upper denture “looks horrible†and is “coming looseâ€. You> have never had a lower denture and you don’t think that you could cope with> one. You don’t want to be any trouble and you think you will probably manage> with your denture if the dentist can adjust it. > >>>Medical history> >>>You are insulin dependent diabetic. > >>>Your GP has given you some tablets “for your nervesâ€. You don’t have> them with you and you don’t remember what they are called. > >>>Dental history> >>>You have not attend the dentist since your upper teeth were extracted> for your wedding when you were 21> >>>You brush your teeth every day> >>>Social history> >>>You husband died of cancer last year and you live on your own in a> socially deprived town.> >>>You have two daughters and one son. > >>>Attending the surgery is a bit difficult for you. It takes an hour on> the bus, however you are happy to have whatever treatment the dentist deems to> be best. > >>>Further scenario info for the actor (Only if asked by the candidate)> >>>You are embarrassed about your dental condition and poor attendance> history. You have not eaten in front of anyone other than your husband for the> past 20 years, not even at your daughter’s wedding reception. Your speech is> also affected. > >>> > >>> > >>> > >>> > >>> > >>> > >>>Examiner’s Info> >>>Extra-oral exam> >>>Nothing abnormal. Decrease in lower face height> >>>Intra-oral exam> >>>Soft tissue screening; The mucosa beneath the upper denture is inflamed> with an appearance of chronic candidiasis. There is a large ulcer on the> tongue. The upper anterior ridge is> mobile and “flabby†and when the patient speaks, the upper denture has a> noticeable tendency to drop.> >>>Bony tissue screening; On palpation, it can be felt that there is a bony> structure under the right posterior side.> >>>In the lower jaw, there are incisors, canines and first premolars. The LL1 broke about 2 weeks ago when the> patient was eating a toffee. It is not painful, though. All of the remaining> lower teeth have abrasion cavities and LL4 and LR4 are carious, both cervically and occlusaly. > >>>Occlusion; Appears to be Class III. It is difficult to get the patient> bite in a retruded contact position> >>>Vitality test; not available> >>>Generalized alveolar bone loss> >>>- - - > >>>- 4 - > >>>BPE; > >>> > >>> > >>>BOP; some> >>>Grade 1 mobility> >>>OH; some dental plague is visible.> >>>Special exam and other props> >>>Study cast; not available> >>>Photos; available> >>>OPG; not available> >>>Periapicals of the lower anterior teeth and upper right posterior side.> The latter shows an impacted wisdom tooth. > >>> > >>> > >>> > >>> > >>>Best regards> >>>Alena> >>>Ozieva > >>> >>> Quote Link to comment Share on other sites More sharing options...
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