Hello dentistry students and welcome to the beginning of MSO’s clinical case series!
The idea of this case series to invite dental students and graduates form all years and experiences to work together to explore and use our problems solving skills to dissect a series of scenarios based on common clinical scenarios you might/ have encountered during your dental years.
Each month or so,will be writing and uploading a brief introduction/ setting the scenario, possibly a picture if I can and some initial questions to get the ball rolling. These questions may be what diagnostic tests are indicated, what further questions would you ask etc. I hope everyone will drop by, read and contribute/ We can bounce off each other’s comments to continue the discussion and work our way forward. If the discussion is running dry or to make it more interesting, I will step in and add some information/further the scenario, or others can feel free to do the same and make the discussion in another direction.
This is aimed at all dental students, regardless of year/ experience so hopefully the junior students will learning something for more experienced students and senior students/graduates contribute things they have learnt from their own clinical experience. Don’t be afraid to ask questions or contribute ideas! It’s a learning and problem solving activity.
In order to help people gauge an idea of what kind of information/level of knowledge would be useful for the scenario, I will indicate an approximate year level at the beginning of the scenario in which I think it appropriate. That is not to say people who are in the lower years cannot contribute, I would welcome and encourage it.
Lastly, if anyone has any ideas of scenarios that they would like the explore, hit me up with a PM and I’ll see what I can do, or otherwise, write one yourself and send it to me (I would love that more!)
Ok. lets get to it!
Approx year level: ~1-2+
Jason is 19 years old and has attended your practice on a Saturday morning for a check up. He explains he hasn’t been to the dentist for a check up since year 6 when the dentist came to his school to ‘check everyone’s teeth’, but his father has made him come today. When asked is he has any concerns, Jason tells you a lower left filling has fallen out and is cutting and irritating his tongue, otherwise he says he is ok. Upon further questioning, we find out the filling was placed a year ago when he was in a lot of pain due to hot and cold drinks, but never went back to that dentist despite being advised to. Jason has no medical problems that he is aware of.
What further questions would you ask and why?
Jason has areas of moderate gingivitis but no calculus is visible. A perio exam reveals pocketing of ~3mm generally. The lower LHS first molar is grossly carious and cavitated. There is no other restorations present, and Jason has all of his teeth excluding his 3rd molars. You spot some staining on the occlusal surfaces of his molars and premolars. There are some white dull lines around the gingival margins of most of Jason’s posterior teeth. The mucosa seems to be healthy, but there seems to be a pimple of the attached gingiva on the lower left.
What other examination would you do initially?
What further diagnostic tests would you perform and why?
Fig. 1: Jason’s teeth