Odell's Clinical Problem Solving in Dentistry E-Book

Edward W Odell, Dr Selvam Thavaraj, Edward W Odell, Dr Selvam Thavaraj

• Publisher: Elsevier
• Year: 2020
• Print ISBN: 9780702077005
• eBook ISBN: 9780702077012
• Edition: 4
• Topic: Medicine
• Subtopic: Dentistry

A step-by-step guide to practical care planning and management of a wide variety of clinical case scenarios encountered in the primary and secondary dental care setting. Covering all the core aspects of oral health care delivery, Clinical Problem Solving in Dentistry 4th edition is a great value resource useful to all general dental practitioners and dental therapists, both qualified and in training, undergraduates or postgraduates alike.

•Explores care planning and treatment alternatives and evaluates their advantages and disadvantages as well as medico-legal implications

•Integrates material from all the dental disciplines in order to cover an extensive range of clinical problems which will be encountered in daily practice

•A practical approach to learning - includes a large number of real-life clinical cases including those relevant to new techniques and issues such as implantology, use of CAD-CAM, CBCT (cone beam computed tomography)

•Designed to help the reader use the knowledge gained in a clinically useful, practically applied format

•Highly visual guide with more than 350 colour illustrations, artwork and tables presenting clinical, diagnostic and practical information in an easy-to-follow structure

Case 1

A High-Caries-Rate/High-Risk Patient

Avijit Banerjee

Summary

A 17-year-old sixth-form college student presents at your general dental practice with several carious lesions, one of which is very large. How should you manage his condition?

Fig. 1.1 The lower right first molar. The gutta percha point indicates a sinus opening.

History

Complaint

He complains that a filling has fallen out of a tooth on the lower right side and has left a sharp edge that irritates his tongue. He is otherwise asymptomatic.

History of Complaint

The filling was placed about a year ago at a casual visit to the dentist precipitated by acute toothache triggered by hot and cold foods and drink. He did not return to complete a course of treatment. He lost contact when he moved house and is not registered currently with a dental practitioner.

Medical History

The patient is otherwise fit and well.

Examination

Extraoral Examination

He is a fit and healthy-looking adolescent. No submental, submandibular or other cervical lymph nodes are palpable and the temporomandibular joints appear normal.

Intraoral Examination

The lower right quadrant is shown in Fig. 1.1 . The oral mucosa is healthy, and the oral hygiene is satisfactory. There is gingivitis in areas, but no calculus is visible, and probing depths are 3 mm or less. The mandibular right first molar is grossly carious, and a sinus is discharging on its buccal aspect. There are no other restorations in any teeth. No teeth have been extracted, and the third molars are not visible. A small cavity is present on the occlusal surface of the mandibular right second molar.

Investigations

What Further Examination Would You Carry Out?

Test of tooth sensibility (vitality) of the teeth in the region of the sinus. Even though the first molar is the most likely cause, the adjacent teeth should be tested because more than one tooth might be nonvital. The results should be compared with those of the teeth on the opposite side. Both hot/cold methods and electric pulp testing could be used because extensive reactionary (tertiary) dentine may moderate the response.

The first molar fails to respond to any test. All other teeth appear vital.

What Radiographs Would You Take? Explain Why Each View is Required

See Table 1.1.

What Problems are Inherent in the Diagnosis of Caries in This Patient?

Occlusal lesions are now the predominant form of caries in adolescents after the reduction in relative caries incidence over the past decades. Occlusal caries may go undetected on visual examination for two reasons. Firstly, it starts on the fissure walls and is obscured by sound superficial enamel, and secondly, lesions tend to cavitate late, if at all, probably because fluoride exposure reinforces the ionic structure of the overlying enamel. Superimposition of sound enamel also masks small- and medium-sized lesions on bitewing radiographs. The small occlusal cavity in the second molar arouses suspicion that other pits and fissures in the molars will be carious. Unless lesions are very large, extending into the middle third of dentine, they may not be detected on bitewing radiographs.

Fig. 1.2 Periapical and bitewing radiographs.

Table 1.1

Useful Radiographs and Their Clinical Benefit

Radiograph	Reason Taken
Bitewing radiographs	Primarily to detect proximal surface caries and, in this case, also required to help detect occlusal caries
Periapical radiograph of the lower right first molar tooth, taken with a paralleling technique	Preoperative assessment for endodontic treatment or for extraction, should it be necessary
Dental panoramic radiograph	Might be useful as a general survey view in a new patient and to determine the presence and position of third molars

The Radiographs are Shown in Fig. 1.2. What Do You See?

The periapical radiograph shows the carious lesion in the crown of the lower right first molar to be extensive, involving the pulp. The mesial contact has been completely destroyed, and the molar has tilted mesially. There are periapical radiolucencies at the apices of both roots, that on the mesial root being larger. The radiolucencies are in continuity with the periodontal ligament, and there is loss of most of the lamina dura in the bifurcation and around the root apices.

The bitewing radiographs confirm the carious exposure and reveal occlusal carious lesions in all the maxillary and mandibular molars with the exception of the upper right first molar. No proximal caries is evident.

If Two or More Teeth Were Possible Origins of the Sinus, How Might You Decide Between Them?

A gutta percha point could be inserted into the sinus prior to taking the radiograph, as shown in Fig. 1.1. A medium- or fine-sized point is flexible but resilient enough to pass along the sinus tract if twisted slightly on insertion. Points are radiopaque and can be seen on a radiograph extending to the source of the infection, as shown in a different case in Fig. 1.3.

Fig. 1.3 A different case, showing a gutta percha point inserted through and tracing the path of a sinus.

Diagnosis

What is Your Diagnosis?

The patient has a nonvital lower right first molar with a periapical abscess. In addition, he has a high caries rate in a previously almost caries-free dentition. He is, therefore, classified as ‘high caries risk/susceptibility’ (>2 new/active lesions in 2 years).

...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Preface
• Contributors
• Case 1. A High-Caries-Rate/High-Risk Patient
• Case 2. A Multilocular Radiolucency
• Case 3. An Unpleasant Surprise
• Case 4. Gingival Recession
• Case 5. Multiple Missing Anterior Teeth and a Class III Incisor Relationship
• Case 6. An Unsettled Patient
• Case 7. A Dry Mouth
• Case 8. Painful Trismus
• Case 9. A Deep Carious Lesion
• Case 10. A Lump On the Gingiva
• Case 11. Pain On Biting
• Case 12. CAD/CAM Fixed Prosthodontics
• Case 13. Sudden Collapse
• Case 14. A Difficult Young Child
• Case 15. Pain After Extraction
• Case 16. A Numb Lip
• Case 17. A Loose Anterior Tooth
• Case 18. Oroantral Fistula
• Case 19. Troublesome Mouth Ulcers
• Case 20. A Lump in the Neck
• Case 21. Trauma Causing Displacement of an Upper Central Incisor
• Case 22. Hypoglycaemia
• Case 23. A Tooth Lost At Teatime
• Case 24. A Problem Overdenture
• Case 25. Impacted Lower Third Molars
• Case 26. A Patient Presenting with an Avulsed Central Incisor
• Case 27. Discoloured Anterior Teeth
• Case 28. A Very Painful Mouth
• Case 29. Caution! – X-Rays
• Case 30. Whose Fault is It This Time?
• Case 31. Ouch!
• Case 32. A Swollen Face and Pericoronitis
• Case 33. First Permanent Molars
• Case 34. A Sore Mouth
• Case 35. A Failed Bridge
• Case 36. Skateboarding Accident?
• Case 37. An Adverse Reaction
• Case 38. Advanced Periodontitis
• Case 39. Fractured Incisors
• Case 40. An Anxious Patient
• Case 41. Blisters in the Mouth
• Case 42. Will You See My Son?
• Case 43. Bridge Design
• Case 44. Anticoagulation for a Prosthetic Heart Valve
• Case 45. A White Patch On the Tongue
• Case 46. Another White Patch On the Tongue
• Case 47. Molar Endodontic Treatment
• Case 48. An Endodontic Problem
• Case 49. A Swollen Face
• Case 50. Missing Upper Lateral Incisors
• Case 51. Anterior Crossbite (Class III Malocclusion) with Displacement in the Mixed Dentition
• Case 52. Localized Periodontitis?
• Case 53. Unexpected Findings
• Case 54. A Gap Between the Front Teeth
• Case 55. A Lump in the Palate
• Case 56. Rapid Breakdown of First Permanent Molars (Molar–Incisor Hypomineralization)
• Case 57. Oral Cancer
• Case 58. A Complicated Extraction
• Case 59. Difficulty Opening the Mouth
• Case 60. Erosive Tooth Wear
• Case 61. Worn Front Teeth
• Case 62. A Case of Toothache
• Case 63. A Child with a Swollen Face
• Case 64. Recurrent Neck Swelling
• Case 65. Failed Endodontic Treatment
• Case 66. A Pain in the Head
• Case 67. Aggressive Tooth Decay
• Case 68. Should I Repair or Replace These Restorations? – the ‘5 Rs’
• Case 69. Implant Planning
• Case 70. Domiciliary Care
• Case 71. Managing Complaints
• Case 72. Loose Dentures/Resorbed Ridge Form
• Case 73. ’Invisible Custom-Made Braces’
• Case 74. Swollen Lips
• Case 75. Failing Implant Restoration
• Index