PAE D I AT R I C D E N T I S T R Y

PROFESSIONAL EXAMINATION IV

DATE OF EXAMINATION:

MATRIC NUMBER: 1312896

CASE NUMBER: 1

PATIENT’S INITIALS: A

BACHELOR OF DENTAL SURGERY

KULLIYYAH OF DENTISTRY

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CONTENT:
SECTION 1: CASE SUMMARY PAGE

SECTION 2: CASE PROFILE

Patient details
Presenting complaint
History of complaint
Past medical history
Past dental history
Social history
Oral hygiene regime
Clinical examinations: extra-oral features
Clinical examinations: intra-oral features
Pre-treatment photographs
Investigations
Other special tests/analyses
Diagnosis
Aims and objectives of treatment
Treatment options
Treatment plan

SECTION 3: TREATMENT PROGRESS

Key stages in treatment progress
Mid-treatment photographs/radiographs
Post-treatment photographs/radiographs

SECTION 4: DISCUSSION
 Rationale of treatment
 Critical review

SECTION 5: PROFESSIONAL EXAM NOTE

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SECTION 1. CASE SUMMARY

A, an eight years old Malay girl came to the clinic on 7 th December 2016, complaining of
pain on lower left posterior tooth. Medically she was fit and healthy. She was an irregular attendee
to the dental clinic.

No abnormality was detected extraorally. Intraorally, patient was in mixed dentition, with a
total number of 24 teeth present in the oral cavity. Thick plaque was found covering all surfaces of
the teeth. Generalized inflammation can be seen on upper and lower gingiva.

After further investigation, patient was diagnosed with caries into dentine of tooth 55(MO),
54(DO), 64(MO), 65(D), 26(O), 36(O), 84(DO), 85(O), 46(O&B) and pulpal necrosis of 75, and
mild generalized plaque-induced gingivitis.

Early prophylaxis and topical fluoride application were done to the patient, followed with
restorative treatment of all carious teeth, extraction of 75, stainless steel crown on 54 and final
prophylaxis as well as final topical fluoride application.

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SECTION 2. CASE PROFILE

PATIENT DETAILS

Name :A

Age : 8 years old

Date of birth : 25th March 2008

Gender : Female

Occupation : Primary school student

Date of first visit : 7th December 2016

PRESENTING COMPLAINT

Patient came to the clinic complaining of pain on lower left posterior tooth

HISTORY OF PRESENTING COMPLAINT

The patient complained of pain on lower left back tooth about 1 month ago. It was throbbing in
nature, and no radiation. The pain was aggravated by drinking cold water and eating hard food.
There was no relieving factor, severity was moderate, and the patient denied any history of fever
or swelling

PAST MEDICAL HISTORY

Patient was medically fit and healthy with no known drug or food allergy. Patient had no history of
hospitalization

PAST DENTAL HISTORY

She was an irregular attender. No history of dental trauma.

SOCIAL HISTORY

8 year old girl, Standard 2 student at SK Sungai Talam, the eldest out of three siblings. Father
work as cafe manager, mother work as civil servant at immigrant office. Lives at Taman Mahkota
Emas. History of bottle feeding (sweet drinks). No history of thumb sucking habit.

ORAL HYGIENE REGIME

Regular toothbrushing, unsupervised, using fluoridated toothpaste.

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DIET HISTORY

She frequents sweet drinks.

CLINICAL EXAMINATION: EXTRA-ORAL FEATURES

Face : Symmetrical
Lips : Competent
Eyes : Normal
Lymph nodes : Non-palpable, non-tender
TMJ : No clicking, no pain, deviation to left upon opening
Skin : Normal
Skeletal profile : Class 1

CLINICAL EXAMINATION: INTRA-ORAL FEATURES

Complaint site (if any):

Tooth 75: There was caries on disto-occlusal, the tooth was mobile grade III. Surrounding gingiva
was inflamed. The tooth was non tender upon palpation and percussion.

1. Mucosa: normal

2. Gingiva: mild generalized inflammation

3. Oral hygiene: Poor

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9. General dental condition:

Fig. 1: Dental charting

Symbol Meaning

Caries

.
10. dmft

d 7

m 0

f 0

total 7

Fig.2: dmft

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11. Caries risk assessment: High

INVESTIGATIONS:

Oral pantomogram (OPG) taken on 10th March 2016 displays presence of 20 decidous primary
teeth and the 28 developing permanent teeth. Radiolucency is noted at occlusal 55, distal 54,
occlusal 65, occlusal 75, distal 84 and occlusal 85. For the complaint site (tooth 75), radiolucency
is also noted at the furcation area.

DIAGNOSES
• Caries into dentin : 55, 51, 61, 65
• Dental abscess : 75
• Post-pulp therapy of 85
• Mild generalized plaque-induced gingivitis

AIMS AND OBJECTIVES OF TREATMENT

• To eliminate dental pain
• To prevent orofacial infection
• To improve patient’s oral hygiene
• To restore carious teeth
• To restore optimum function of the teeth
• To prevent development of new carious lesions

TREATMENT OPTIONS

1) To restore carious teeth

 Restoration of 55, 51, 61, 65

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2) To do pulp therapy of tooth with dental abscess

 Pulp therapy of tooth 75

3) To extract tooth with dental abscess

 Extraction of tooth 75

TREATMENT PLAN

• Initial :
i) Oral hygiene instruction/Oral hygiene education :
– brushing using circular technique
– supervised toothbrushing
ii) Diet advice :
– restrict sugary foods/drinks consumptions during heavy meal
time only
iii) Early prophylaxis
iv) Topical fluoride application
v)
 Intermediate :
a. Restorative : 55, 51, 61, 65
b. Extraction : 75 (mother refused pulp therapy)
c. Stainless steel crown : 85
vi) Long term :
a. Final prophylaxis
b. Topical fluoride application
c. Review every 3-monthly

SECTION 3.TREATMENTPROGRESS

KEYSTAGES INTREATMENTPROGRESS

Visit Chief complain Remarks

Date Treatment done
C/C : Pain on lower right and left posterior tooth
1st visit Treatment done: Plaque score :
5/9/16 100%
– Patient was accompanied by his mother during
first visit.
– Examination and diagnosis carried out.
– Full history taking from the mother.

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– Treatment plan constructed and approved by

supervisor, and explained to the mother. Consent
was then obtained.
– Plaque score taken
– Patient was brought to DHE room, and given a
toothbrush and toothpaste.
– Tooth brushing instructions given (circular
technique). The duration and frequency of
brushing was emphasized (2 minutes per each
session, at least twice daily).
– Mother was advised to monitor patient’s sugary
food intake as well as brushing practice.
– Anaelgesic was not prescribed to the patient as the
mother claimed that there was still some leftover
from patient’s previous dental visit.

2nd visit C/C : Swelling at lower left posterior area. Plaque score :
PMH : No new update
19/9/16 69%
E/O : No new update
I/O :
- Presence of swelling at buccal vestibule adjacent to tooth
75.
- Fractured restoration noted at occlusal 75.

Treatment done :
• Extraction was attempted to tooth 75. However, patient
was uncooperative during local anaesthesia
administration, and his mother requested for delayed
extraction of the tooth.
• Another easier treatment was performed: GIC restoration
of tooth 65 (occlusal)
- Tooth isolation with cotton roll
- Removal of caries with high speed handpiece
followed by gentle hand excavation due to poor
patient compliance.
- Soft caries left at pulpal floor due to closeness to pulp
chamber.
- Dentine conditioner was applied for 15s and washed
and dried for 15s
- GIC restoration was placed

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- The restoration was coated with vaseline

- High bite checked with articulating paper - no high
bite noted

3rd visit C/C : NIL

21/9/2016 PMH : No new update Plaque score :
E/O : No new update
I/O : No new update

Treatment done :
a) Composite restoration of 51 & 61 (mesial)
• Tooth isolation with cotton roll
• Caries free
• Bevel of enamel margin
• Etchant was applied for 15s, washed and dry for 15s
• Bonding was applied and light-cured for 20s
• Composite was placed layer by layer and light-cured for
minimum of 20s for each layer
• High bite checked with articulating paper and removed
using white stone bur
b) Amalgam restoration of 55 (occlusal)
• Tooth isolation with cotton roll
• Removal of plaque at previously-dislodged restoration
• GIC lining was applied at the floor of the cavity
• Packing of amalgam
• High bite checked with articulating paper and carved

4th visit C/C : NIL Plaque score :

PMH : No new update
10/10/16 25%
E/O : No new update
I/O : No new update

Treatment done : Stainless steel crown on tooth 85

• Signs & symptoms of previous pulp therapy checked –
tooth 85 had no tenderness to palpation and percussion,
no swelling, no sinus tract and no mobility.
• Infiltration of inferior alveolar nerve and lingual nerve
with ½ catridge of 2.2ml 2% Mepivacaine with
adrenaline.

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• Tooth isolation with cotton roll

• Interproximal, buccal, lingual and occlusal reduction was
done until size #5 crown fit.
• Patient’s tooth dried using triple airway syringe
• Crown was cemented to the tooth using GIC luting
cement
• Patient was asked to bite on the gauze
• Syrup Paracetamol 250mg TDS (PRN) x 1/7 was
prescribed to the patient.
• Patient was advised to contact the operator should any
problem arise.

5th visit C/C: NIL Plaque score:

5/12/16 PMH : No new update
E/O : No new update
I/O : No new update

Treatment done: Extraction of necrotic pulp of 75

• Topical LA was applied to buccal and lingual mucosa of
tooth 75
• Infiltration of inferior alveolar nerve and lingual nerve
with 1 catridge of 2.2ml 2% Mepivacaine with
adrenaline.
• Extraction of tooth 75 with lower primary molar
universal forceps.
• Anaelgesic was not prescribed to the patient as the
mother claimed that there was still some leftover from
patient’s previous dental visit.

6th visit C/C : Pain on lower right posterior tooth when eating Plaque score :
food since 3 days prior to the appointment.
12/12/16
History of presenting complaint: Patient claimed of pain
at lower left posterior tooth since 3 days prior to the
appointment when eating foods. However, it did not
disturb patient’s sleep.

E/O : NAD

I/O : At the site of complaint, dislodged GIC restoration

found at distal 84. Adjacent 85 was restored with SSC.

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Pain felt both upon palpation and percussion on both 84

and 85. No pus discharge, no inflamed gingiva & no sinus
tract noted.

Treatment done:
- PA radiograph of 84 and 85 was indicated to confirm
which tooth was involved in the complaint. However, it
was scheduled on next visit due to patient’s poor
compliance.
- No treatment done for the complaint area.
- Oral prophylaxis was done to the patient.
- Application of fluoride varnish containing 22600 ppm
Acidulated Phosphate Fluoride (Duraphat)

7th visit C/C : NIL

19/12/16 PMH : No new update Plaque score :
I/O examination :
• New caries found on 54 (D) and 65 (buccal)
• Swelling noted on buccal gingiva of tooth 84. Dislodged
distal restoration of 84 was also noted. This confirmed
that the complaint from previous visit was associated with
tooth 84.
• Treatment option for tooth 84 was discussed with the
mother. His mother refused for extraction and opted for
pulp therapy at a later date.
- Treatment done : Class ii composite restoration on 54 (D)
• Tooth isolation with cotton roll
• Caries free
• Dycal application
• GIC lining application
• Matrix band placement
• Etching (15s)
• Bonding (curing 20s)
• Composite restoration (curing 40s)
• High bite checked with articulating paper and polished

C/C : NIL
8th visit PMH : No new update Plaque score :
E/O : No new update
28/12/16
I/O : No new update

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Treatment done : Composite restoration of tooth 55 (M) & 65

(buccal)
• Caries free
• Etching (15s)
• Bonding (curing for 20s)
• Composite restoration (curing 40s)
• Occlusion checked and high bite was polished

9th visit Plaque score :

2/1/2017 C/C : NIL
PMH : No new update
E/O : No new update
I/O : No new update
Soft tissue : No abnormality detected
Oral hygiene : Poor

Treatment done:
• Re-charting of the teeth
• Final prophylaxis
• Fluoride varnish application with duraphat containing
226000 ppm Acidulated Phosphate Fluoride
• After discussion and agreement with supervisor, patient
was referred to specialist for pulp therapy of 84 due to
poor compliance.
• Treatment under student was completed.

POST-TREATMENT PHOTOGRAPHS/ RADIOHRAPHS:

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SECTION 4. DISCUSSION

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SECTION 5. PROFESSIONAL EXAM NOTE

a. Case reports submission verification (to be filled on the day of case report submission)

Case report Dateline of submission Date and time submitted by students

no.
(Before 5 pm) Advisor’s name & signature

No 1

No 1

(Re-submit)

No 2

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b. Advisor’s marking report (to be filled when the report has been marked)

Date / time Advisor’s name & signature Comments if any

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