My case

CHARTING OF FIRST QUADRENT, SCALEING OF 34 TO 43

he was 64 year old,he had come to the clinic as he received a letter from the hospital,

medical history- had diabetis,blood pressure ,was taking antidepressents, had undergone spine surgery about 8 year ago he told
that he has quit smoking about 20 years ago.

dental history- had last molars removed few years ago also a mandibular anterior tooth was removed

family and social- he had migrated from saudi arabia. he is not aware of his father's teeth but his mother doesn't have periodontal
disease but she has diabetes.
he is not working now and also he is not under any stress

diet and oral hygeine history- ocasionally, consumes wine along with dinner. drinks lemonade sometimes but not regularly. diet
is not much acidic
brushes twice daily, occasionally uses mouth wash

extraoral examination-facial symmetry,TMJ-inspection palpation-NAD, lymhph nodes-not palpable

intraoral examination-soft tissues-linea alba on right and left buccal mucosa, on hard palate there was stomatitis nicotina

hard tissue-32 was missing, ( examiner had told that it doesnt make sense writing class I or clas II occlusion so didn't write it)

perio charting-pocket depth, recession( patient had lots of bleeding so i took more time to record pocket depths and i forgot to
record mobility, there was hardly 10 to 12min for scaleing)

scaleing- there was lots of calculus, so i decided to scale 3 teeth properly and rest 3 teeth i did gross scaleing.
( the female examiner was standing at my cubicle and watching me scaleing)

(they told time up stop scaleing. then i was sent to another cubicle to sit and write the case history.
then i realised i did not record mobility, so how to write the prognosis??? )

investigations-PA for 31,41

vitality testing for 31,41 ( bcoz on OPG i could see slight widening of PDL so i was suspecting endo perio lesion)
diagnosis- i gave it as moderate to severe periodontitis

presumptive etiological factors- local-calculus ( inadequate oral hygiene)

systemic- diabetis,smoking (though patient told that he had quit smoking, i could see nicotina stomatitis on
palate which indicates that he is still smoking)

treatment objectives-educate the patient about etiology and management of periodontal disease and likely treatment outcome. will
discuss the importance of oral hygiene, and effective home care regieme

treatment plan- 1. OHI

2. advice on quiting smoking and importence of blood sugar level
3. scaling of quad1
4. scaling of quad 3
5. scaling of quad 4
6. scaling of quad 2
 7. review

VIVA

i told them that i forgot to record mobility so im unable to write the prognosis, so they told we have recorded and they told grade
I mobility in 16,17, 26,27

1.present your case

ans-started from chief complaint and told all positive findings

2. why have u given this diagnosis, defend your diagnosis

ans-depending on the pocket depth and also recession i decided to give the range of moderate to severe

3.what will be the prognosis

ans- depends on many patient factors like, control of blood sugar level, quiting smoking, though patient said that he has quit
smoking 20 years ago i could see the nicotina stomatitis on palate,i could see orifice of minor salivary gland ducts inflammed,
indicating that he is still smoking. i also feel that he is smoking occasionally as there is so much of bleeding on probing. if he
smoked a lot then bleeding from gingiva would have been less.

prognosis of this patient also improves if he goes to the specialist

4 immediately examiner asked what if u r in a remote place where there is no specialist

ans-either speialist is available or not i have to do the thorough scaling also OHI to the patient and i should insist that patient
should maintain a good level of oral hygiene

5. what interdental aids u will advice for this patient and what OHI
ans- will ask the patient to use interdental brush and before OHI i will ask the patient to show me
how he brushes and then i will ask him to modify rather than change .will tell him that gingival
margin is the niche for micro organism so brush should pass that region too

6.examiner told some name which i didn' know then he told that it is the trade name of
interdental brush

7. so now considering that u have done good scaleing and patient is mainting good oral hygiene
what is the prognosis
ans- though i do good scaling my vision is limited, i may see some subgingival calculus on
radiograph still it is a 2dimenesional view whereas if the specialist opens the flap then he/she
will be able to remove all the calculus which the main etiological factor after which patients
maintaince will surely help in improving prognosis.

also the prognosis in this patient depends on the vitality test of 31,41, if it is an endo perio lesion
then prognosis is poor for those two teeth, if probing depth is more than 7 in some teeth then
prognosis will be poor in those teeth. since i did not probe all the quadrents im not aware of other
quadrents.

8 when will u recall the patient?

usually after three months but this patient i have to recall early as there are more than 16%
bleeding sites

9. how early will u recall?

ans- after 4-6 weeks
8. what r the replacement options for 32?
ans- i cannot give acrylic RPD bcoz it is gumstripper, for chromcoblat RPD so much has to be
comromised just for replacing one tooth, then FPD can't bcoz abutments periodontal health is
questionable, implant is good but again systemically compromised also smoker so have be
cautious before investing in implant...

9. what is the best option in this patient

ans -now the only option left is resin bonded bridge

then examiner was laughing and told yes that is the best option, i was waiting to listen that.

10.can u tell me why this error occured in this OPG (he pointed to the radiolucency beneath the
hardpalate)
ans-it occured bcoz the tongue was not placed against palate when the radiograph was exposed.

11. can u tell me what is this( he pointed to oro-pharengeal region on OPG)

it is oro-pharengeal region

that was the last question, they told me your viva is done