**Case Presentation** Dr Lyndon P Abbott lyndon.abbott@uwa.edu.au  Dr Lyndon P Abbott lyndon.abbott@uwa.edu.au Clinical photograph of various dental instruments arranged on a white surface. Visible tools include a mouth mirror, excavators, and forceps. The image serves as the background for a slide titled 'Case Presentation' by Dr Lyndon P Abbott. #### Patient Profile and History - **Patient:** 68-year-old male - **Chief Complaint:** Progressive shortness of breath and fatigue over the past three months. - **Medical History:** - Hypertension (controlled with Lisinopril) - Type 2 Diabetes Mellitus (managed with Metformin) - Former smoker (20 pack-year history, quit 10 years ago) #### Clinical Presentation The patient reports a gradual decline in exercise tolerance, now experiencing dyspnea after walking less than one block. He denies chest pain, palpitations, or syncope but notes occasional bilateral lower extremity edema, which is worse in the evenings. #### Physical Examination Findings - **Vital Signs:** - Blood Pressure: 142/88 mmHg - Heart Rate: 82 bpm (regular) - Respiratory Rate: 18 breaths/min - Oxygen Saturation: 94% on room air - **Cardiovascular:** - Jugular venous distention (JVD) present at 4 cm above the sternal angle. - Normal S1 and S2; a faint S3 gallop is audible at the apex. - No murmurs or rubs detected. - **Pulmonary:** - Fine bibasilar crackles noted on auscultation. - **Extremities:** - 1+ pitting edema in bilateral ankles. Case Presentation General Principles * Dr Lyndon P Abbott * Graduated DMD in 2019 * **Current Dental Graduate Officer at UWA**   #### Presenter Profile - Dr Lyndon P Abbott - Graduated DMD in 2019 - Current Dental Graduate Officer at UWA Clinical photo of a dental operatory setup showing a patient chair, overhead lighting and equipment, and cabinetry. Contextual text identifies this as related to Dr Lyndon P Abbott, a Dental Graduate Officer at UWA. Photo of two men standing outdoors near a building with greenery. One man is wearing blue medical scrubs, consistent with the context of a dental graduate or officer mentioned in the slide text. # Case Presentation General Principles * Why is there a case presentation examination? The case presentation exam ensures you are safe to practice ethical, appropriate and evidenced based dentistry   #### Purpose of the Examination Why is there a case presentation examination? The case presentation exam ensures you are safe to practice ethical, appropriate and evidenced based dentistry. Photo of a dog sitting behind a microphone stand, visually representing the concept of 'presentation' in the context of the case presentation examination. Illustration of a smiling tooth wearing a crown, symbolizing dentistry and the outcome of ethical, appropriate, and evidenced-based dental practice mentioned in the text. **The University of Western Australia** # Case Presentation General Principles * Showcase your hard work * Convince the examiners you can practice **ethical, appropriate** and **evidence based** dentistry #### Presentation Objectives - Showcase your hard work - Convince the examiners you can practice ethical, appropriate and evidence based dentistry # Case Presentation General Principles Things you can’t control - Date and time - Venue - Projector, IT - Questions (unyielding) Things you can control - Chosen patient - Examination and diagnosis - Amount of research papers you read - Amount of tutors you talk to - Amount of time spent preparing and rehearsing your case presentation The University of Western Australia   #### Variables in Case Presentation **Things you can’t control** - Date and time - Venue - Projector, IT - Questions (unyielding) **Things you can control** - Chosen patient - Examination and diagnosis - Amount of research papers you read - Amount of tutors you talk to - Amount of time spent preparing and rehearsing your case presentation Cartoon illustration of a sad tooth being attacked by a menacing grey monster with sharp teeth. The tooth has an anxious expression and is sweating, visually representing the 'unyielding' questions mentioned in the text under 'Things you can’t control'. Cartoon illustration of a smiling tooth wearing a red superhero cape and flexing its muscles. This visual represents the positive outcome or confidence gained from the factors listed under 'Things you can control'. # Case Presentation General Principles ## Things you can't control * Date and time * Venue * Projector, IT * Questions ## Things you can control * Chosen patient * Examination and diagnosis * Amount of research papers you read * Amount of tutors you talk to * Amount of time spent preparing and rehearsing your case presentation <br> <img style="display: block; margin: auto;" src="" alt="SUPERHERO TOOTH (Marvel superhero cowl on tooth)" />   #### Preparation Factors **Things you can't control** - Date and time - Venue - Projector, IT - Questions **Things you can control** - Chosen patient - Examination and diagnosis - Amount of research papers you read - Amount of tutors you talk to - Amount of time spent preparing and rehearsing your case presentation Illustration depicting a distressed tooth character with an angry, grey monster cowl on its head. The tooth has a sad expression and red cheeks, visually representing the negative consequences of 'Things you can't control' (Date/time/Venue) in a case presentation. Illustration of a 'SUPERHERO TOOTH' character wearing a red cape and smiling confidently against a blue background. This visual reinforces the positive outcomes achievable by controlling 'Examination and diagnosis', research, and preparation time. # Case Presentation General Principles # Start early.  Start early. Illustration of a yellow duck wearing athletic gear (headband, earphones, sneakers) with the text 'Start early.' to its left. Case presentation General Principles - PLAN - PREPARE - PERFORM The University of Western Australia  #### Core Workflow - PLAN - PREPARE - PERFORM A chalkboard image illustrating a three-step procedure for case presentations. The steps are written in white chalk as 'PLAN', 'PREPARE', and 'PERFORM', each preceded by a checked box symbol. Case presentation General Principles  Case presentation General Principles Chalkboard-style visual diagram listing three general principles for case presentation: PLAN, PREPARE, and PERFORM. Each item is preceded by a checkbox with a checkmark, indicating completion or key steps in the process. Case presentation General Principles • A.Prof Hotinski - Examination and Treatment planning # EXAMINATION AND TREATMENT PLANNING ## Purpose The aim of this Clinical Guideline is to provide advice to OHCWA students and clinicians regarding comprehensive oral exam and treatment planning. Evidence-based clinical guidelines are intended to provide guidance, and are not a standard of care, requirement, or regulation. However, the application of clinical guidelines in publicly-provided oral health services allows for consistency to occur across large patient cohorts with a variety of oral health clinicians. This Clinical Guideline plans to: * Standardise the way in which all patients are assessed * Establish a standardised sequence for a thorough comprehensive examination to reduce overlooking any area to be examined The aim of dental treatment is to assess, restore and maintain the health, function and efficiency of dental and related tissues, and thereby improve the oral, general and psychological health of a patient. Treatment should be designed to prevent further dental disease and to restore lost tissue and function. Patients should be educated to an awareness of the importance of their dental health and how such health may be maintained. #### Clinical Guideline Purpose The aim of this Clinical Guideline is to provide advice to OHCWA students and clinicians regarding comprehensive oral exam and treatment planning. Evidence-based clinical guidelines are intended to provide guidance, and are not a standard of care, requirement, or regulation. However, the application of clinical guidelines in publicly-provided oral health services allows for consistency to occur across large patient cohorts with a variety of oral health clinicians. This Clinical Guideline plans to: - Standardise the way in which all patients are assessed - Establish a standardised sequence for a thorough comprehensive examination to reduce overlooking any area to be examined #### Goals of Dental Treatment The aim of dental treatment is to assess, restore and maintain the health, function and efficiency of dental and related tissues, and thereby improve the oral, general and psychological health of a patient. Treatment should be designed to prevent further dental disease and to restore lost tissue and function. Patients should be educated to an awareness of the importance of their dental health and how such health may be maintained. # Case presentation General Principles ## **Examination template** Guidelines on dental records **Dental Board of Australia** --- 011 **P/C:** - Pain/discomfort: - Loss of function: - Appearance: - Expectations: **HPC:** **MH:** updated, see medical notes - Adverse Drug Reactions: none declared Consent obtained to carry out dental examination **EO:** TMJ, MOM, LN, thyroid, lips – all NAD **IO:** Buccal mucosa, hard palate, soft palate, glossopharyngeal, tongue, FOM – all NAD **Teeth as per odontogram** - TTP: - TT pal: - Mobility: **Occlusion** - OJ: - OB: - Molar class: - Crossbite: - Crowding: - Super-eruption: #### Dental Record Template (011) **Patient Concerns (P/C):** - Pain/discomfort: - Loss of function: - Appearance: - Expectations: **History of Present Complaint (HPC):** **Medical History (MH):** updated, see medical notes - Adverse Drug Reactions: none declared **Consent:** Obtained to carry out dental examination **Extra-oral Examination (EO):** TMJ, MOM, LN, thyroid, lips – all NAD **Intra-oral Examination (IO):** Buccal mucosa, hard palate, soft palate, glossopharyngeal, tongue, FOM – all NAD **Teeth Assessment:** - Odontogram findings - TTP: - TT pal: - Mobility: **Occlusion:** - OJ: - OB: - Molar class: - Crossbite: - Crowding: - Super-eruption: Case presentation General Principles - Patient selection - Multidisciplinary - Select your patients early and treat all patients as possible case presentation patients  #### Patient Selection Strategy - Patient selection - Multidisciplinary - Select your patients early and treat all patients as possible case presentation patients A grid of cartoon teeth icons on a green background. The teeth are stylized with facial expressions and various accessories such as toothbrushes, toothpaste tubes, crowns, graduation caps, shields, and glasses. This visual likely serves as an illustrative or decorative element related to the topic of 'Case presentation General Principles' in dentistry. # Case presentation General Principles * Take photos!!!  Take photos!!! A close-up photo of a person taking a picture with a Nikon DSLR camera equipped with a ring light attachment. The image visually supports the text 'Take photos!!!' under 'Case presentation General Principles', demonstrating the importance of photography in case documentation. # Case presentation General Principles * Patient Details * Importance of Social History * Medical History * How does this medical history impact the overall dental management of this patient  #### Patient and Medical Details - **Patient Details:** Importance of Social History - **Medical History:** How does this medical history impact the overall dental management of this patient A four-panel cartoon illustration comparing social platforms using anthropomorphic teeth characters. Top-left panel labeled 'LINKEDIN' shows a tooth with glasses and a bowtie; top-right panel labeled 'FACEBOOK' shows two smiling teeth with hearts in the background; bottom-left panel labeled 'INSTAGRAM' shows a tooth wearing a hat with a suitcase; bottom-right panel labeled 'TINDER' shows a muscular tooth flexing. The visuals relate to the OCR text 'Importance of Social History' under Patient Details. Case presentation General Principles - Clinical diagnosis/Problem list - Have a systematic way of presenting the patient’s examination - Don’t waste time just listing diagnoses but instead use your time to explain the critical thinking underpinning each diagnosis  #### Diagnosis and Problem List - Clinical diagnosis/Problem list - Have a systematic way of presenting the patient’s examination - Don’t waste time just listing diagnoses but instead use your time to explain the critical thinking underpinning each diagnosis Cartoon illustration of a tooth character being examined by a dental mirror. The tooth is anthropomorphized with arms and legs, smiling and waving at the viewer. The mirror reflects an enlarged view of the tooth's surface, highlighting its features. This visual supports the text about clinical diagnosis and problem listing in case presentations. # Case presentation General Principles **The University of Western Australia** * **Treatment Plan** * Discuss the different options * Keep all the dental diagnosis and problem lists in context with the overall patient * Treatment alternative tables * **Delivery of Treatment** <table> <thead> <tr> <th>Problem</th> <th>Treatment options</th> <th>Advantages</th> <th>Disadvantages</th> <th>Rationale</th> </tr> </thead> <tbody> <tr> <td rowspan="2">Retained roots 27, 47<br>Unrestorable caries 26</td> <td>No treatment</td> <td rowspan="2">  • No cost – time or money<br>  • Reduced risk of post-operative complications</td> <td>Doesn’t control disease<br>Fabricating a prosthesis will be less predictable, less stable and require more adjustments</td> <td>Removing teeth with hopeless prognoses, not only removes disease but establishes a sound base to then fabricate a dental prosthesis. This process gives further stability and predictability to the dental prothesis and addresses the patient’s primary concern in the most systematic way.</td> </tr> <tr> <td>Extract retained roots 27, 47 and unrestorable 26</td> <td>  • Controls disease<br>  • Allows a prosthesis to be fabricated on sound tooth structure and adjacent soft tissues</td> <td>iatrogenic complications<br>  • Excessive haemorrhage<br>  • Post-operative pain, swelling, trismus<br>  • Fracture of roots<br>  • Damage to adjacent teeth<br>  • Infection<br>  • Alveolar osteitis<br>  • Peripheral trigeminal nerve injury<br>  • Oral Antrum Communication **(OAC)<sup>33</sup>**<br>After extraction bone resorption occurs which can compromise the fit of a prosthesis</td> </tr> </tbody> </table>  #### Treatment Planning and Delivery - Discuss the different options - Keep all the dental diagnosis and problem lists in context with the overall patient - Treatment alternative tables - Delivery of Treatment #### Treatment Options Table | Problem | Treatment options | Advantages | Disadvantages | Rationale | | :--- | :--- | :--- | :--- | :--- | | Retained roots 27, 47; Unrestorable caries 26 | No treatment | - No cost (time or money)<br>- Reduced risk of post-operative complications | Doesn’t control disease; Fabricating a prosthesis will be less predictable, less stable and require more adjustments | Removing teeth with hopeless prognoses removes disease and establishes a sound base for a prosthesis. | | | Extract retained roots 27, 47 and unrestorable 26 | - Controls disease<br>- Allows prosthesis fabrication on sound structure | Iatrogenic complications (haemorrhage, pain, swelling, fracture, nerve injury, OAC); Bone resorption | Addresses primary concern systematically and improves stability/predictability of the dental prosthesis. | Table titled 'Treatment Alternatives – Oral Surgery Considerations' with columns for Problem, Treatment options, Advantages, Disadvantages, and Rationale. It details the comparison between 'No treatment' and 'Extract retained roots 27, 47 and unrestorable 26', listing specific dental complications and rationales for extraction. **Case presentation General Principles** - **Communication** - Practice makes perfect - Consider writing a script and having things on the slides to help jog your memory - Time yourself - Deep breaths to slow your heart rate The University of Western Australia  #### Communication Skills - Practice makes perfect - Consider writing a script and having things on the slides to help jog your memory - Time yourself - Deep breaths to slow your heart rate Illustration showing two cartoon teeth on a pink background. The tooth on the left holds a red telephone receiver to its ear, while the tooth on the right holds a green telephone receiver to its mouth. A red cord connects the two phones in the shape of a heart. This figure visually demonstrates the concept of 'Communication' mentioned in the text. **Case presentation General Principles** - **Questions** - The questions will be related to your case so prepare answers by researching relevant topics to your patient - See this as an opportunity to demonstrate your breadth of knowledge - The examiners want you to do well ```html <table> <tr> <th> </th> <th> </th> <th> </th> </tr> </table> ```  #### Handling Questions - The questions will be related to your case so prepare answers by researching relevant topics to your patient - See this as an opportunity to demonstrate your breadth of knowledge - The examiners want you to do well A cartoon illustration titled 'Confused Teeth' showing nine anthropomorphic teeth with various expressions of confusion or distress. Each tooth has unique features such as sweat drops, question marks, frowns, and distressed facial expressions, visually representing the concept of being confused. Primary Critical Care. Volume 8 page 510 Disseminated intravascular coagulation is not uncommonly associated with critical illness although spontaneous recovery usually occurs in about 50 to 80 days Disseminated intravascular coagulation is not uncommonly associated with critical illness, although spontaneous recovery usually occurs in about 50 to 80 days.  Clinical facial photographs showing a male patient in frontal and profile views. These images are presented alongside demographic text (Kym Duane Hales) to provide visual identification for the case study. **Medical History** - No current medications - No known allergies - **Hypertension - 150/85** - **Myocardial infarction 2007** - Smokes **20 cigarettes per day for 30 years (30 pack years)** - interested in quitting - Drinks **20 standard alcoholic drinks per week** --- - Virdis A, Giannarelli C, Fritsch Neves M, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong, T.c, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591–599. - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - Interested in quitting - Drinks 20 standard alcoholic drinks per week #### References - Virdis A, Giannarelli C, Fritsch Neves M, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong, T.c, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591–599. **Medical History** * No current medications * No known allergies * **Hypertension** - **150/85** * **Myocardial infarction 2007** * **Smokes 20 cigarettes per day for 30 years (30 pack years)** * interested in quitting * **Drinks 20 standard alcoholic drinks per week** <div style="text-align:left; font-size:0.75em; padding:5px; border-bottom:1px solid #ccc;"> <ul style="margin:0; padding-left:20px;"><li>Viridis A, Giannarelli C, Fritsch Neves M, Todde S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25.</li><li>Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4).</li><li>Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94.</li><li>Wong, Tzic, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591–599.</li></ul> </div>  - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - Interested in quitting - Drinks 20 standard alcoholic drinks per week #### References - Viridis A, Giannarelli C, Fritsch Neves M, Todde S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong, Tzic, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591–599. Clinical photos showing the patient's face from two angles (frontal and profile) to demonstrate physical appearance relevant to the medical history presentation. # Medical History ## No current medications ## No known allergies ## Hypertension - 150/85 ## Myocardial infarction 2007 ## Smokes 20 cigarettes per day for 30 years (30 pack years) ### - interested in quitting ## Drinks 20 standard alcoholic drinks per week - Virdis A, Giannarelli C, Fritsch Neves M, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong Tsc, and Wiesenfeld D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591-599.  Western Australia  - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - Interested in quitting - Drinks 20 standard alcoholic drinks per week #### References - Virdis A, Giannarelli C, Fritsch Neves M, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong Tsc, and Wiesenfeld D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591-599. Western Australia Clinical photograph showing the patient's face (frontal view) and profile (side view). The images correspond to the 'Medical History' slide content, specifically illustrating the patient with a history of hypertension, myocardial infarction, smoking, and alcohol use.  Clinical photos showing a male patient's head and neck from two angles (frontal and profile). These images serve to visually demonstrate the patient's physical presentation relevant to the medical history slide. Team Western Australia Medication History • No current medications • No known allergies • Hypertension - 150/85 • Myocardial infarction 2007 • Smokes 20 cigarettes per day for 30 years (30 pack years) • interested in quitting • Drinks 20 standard alcoholic drinks per week - Virdis A, Gianarelli C, Fritsch Neves M, Taddei S, Ghioadano I. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1:166(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guothmill JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong, Nic, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591-599.  #### Medication History - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - Interested in quitting - Drinks 20 standard alcoholic drinks per week #### References - Virdis A, Gianarelli C, Fritsch Neves M, Taddei S, Ghioadano I. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1:166(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guothmill JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong, Nic, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.51 (2018): 591-599. Clinical photo showing a patient's face from two angles (frontal and profile). Context indicates this is part of a medical history presentation for a male patient with hypertension and smoking history. Medical History - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - interested in quitting - Drinks 20 standard alcoholic drinks per week **Viridis A, Giannarelli C, Fritsch Neves M, Taddei S, Ghisadoni I. Cigarette smoking and hypertension. Current pharmaceutical design, 2010 Aug 1;16(23):2518-25** **Johnson N, Bain C. Tobacco and oral disease. British Dental Journal, 2000 Aug 26;189(4).** **Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000, 2007 Jun;44(1):178-94** **Wong, Tic, and Wiesenfeld, D, “Oral Cancer” Australian Dental Journal 63:51 (2018): 591-599.**   - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - Interested in quitting - Drinks 20 standard alcoholic drinks per week #### References - Viridis A, Giannarelli C, Fritsch Neves M, Taddei S, Ghisadoni I. Cigarette smoking and hypertension. Current pharmaceutical design, 2010 Aug 1;16(23):2518-25 - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal, 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000, 2007 Jun;44(1):178-94 - Wong, Tic, and Wiesenfeld, D, “Oral Cancer” Australian Dental Journal 63:51 (2018): 591-599. Clinical photo showing the frontal view of a patient's face. This image serves as a visual reference for the medical history slide, likely to illustrate physical features or condition status related to the listed risks such as smoking and hypertension. Clinical photo showing the profile (side) view of the same patient. Presented alongside the frontal view, this image provides a complete facial assessment relevant to the clinical case presentation. # Medical History * No current medications * No known allergies * Hypertension - 150/85 * Myocardial infarction 2007 * Smokes 20 cigarettes per day for 30 years (30 pack years) * interested in quitting * Drinks 20 standard alcoholic drinks per week * Virdis A, Gionnarelli C, Fritsch Neves M, Taddei S, Ghiodoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. * Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). * Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. * Wong, Tsc, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.S1 (2018): S91-S99.  - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - Interested in quitting - Drinks 20 standard alcoholic drinks per week #### References - Virdis A, Gionnarelli C, Fritsch Neves M, Taddei S, Ghiodoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong, Tsc, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63.S1 (2018): S91-S99. Clinical photograph showing a male patient's face from two angles (frontal and profile) to demonstrate physical appearance or dental context relevant to the medical history presentation. **Medical History** - No current medications - No known allergies - **Hypertension - 150/85** - Myocardial infarction 2007 - **Smokes 20 cigarettes per day for 30 years (30 pack years)** - interested in quitting - **Drinks 20 standard alcoholic drinks per week** - Vudis A, Giannarelli C, Fritsch Neves M, Taddai S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. *British Dental Journal*. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. *Periodontology* 2000. 2007 Jun;44(1):178-94. - Wong, Tic, and Wiesenfeld, D. "Oral Cancer." *Australian Dental Journal* 63:51 (2018): 591–599.   - No current medications - No known allergies - Hypertension - 150/85 - Myocardial infarction 2007 - Smokes 20 cigarettes per day for 30 years (30 pack years) - Interested in quitting - Drinks 20 standard alcoholic drinks per week #### References - Vudis A, Giannarelli C, Fritsch Neves M, Taddai S, Ghiadoni L. Cigarette smoking and hypertension. Current pharmaceutical design. 2010 Aug 1;16(23):2518-25. - Johnson N, Bain C. Tobacco and oral disease. British Dental Journal. 2000 Aug 26;189(4). - Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000. 2007 Jun;44(1):178-94. - Wong, Tic, and Wiesenfeld, D. "Oral Cancer." Australian Dental Journal 63:51 (2018): 591–599. Clinical photo showing the frontal view of a male patient's face. This image is presented as part of a 'Medical History' case study to illustrate the physical appearance of a patient with hypertension (150/85), a history of myocardial infarction in 2007, and significant smoking history (30 pack years). Clinical photo showing the profile (side) view of the same male patient. These two images are grouped to provide a complete facial assessment for the medical history presentation. # Presenting complaint, Dental History ## Presenting Complaint * Would like to replace his missing teeth * Trauma – 2013 years ago aluminium flashing hit front teeth * Longstanding dental neglect ## Dental History * Hasn’t visited the dentist in 10 years * No current pain or discomfort from dentition * Lack of function due to multiple missing teeth * Socially, very self conscious and doesn’t like leaving his house * Expectations are to replace his currently missing teeth and improve function Oral Hygiene: Brushes teeth twice per day with manual toothbrush and fluoridated toothpaste. Doesn’t floss or use interdental brushes   #### Patient Concerns and History of Trauma - The patient would like to replace his missing teeth. - History of trauma: In 2013, aluminium flashing hit his front teeth. - Longstanding dental neglect is noted. #### Clinical and Social Dental History - The patient has not visited a dentist in 10 years. - There is no current pain or discomfort reported from the dentition. - There is a significant lack of function due to multiple missing teeth. - Socially, the patient is very self-conscious and does not like leaving his house. - Patient expectations are to replace currently missing teeth and improve overall function. #### Oral Hygiene Habits - Brushing: Twice per day using a manual toothbrush and fluoridated toothpaste. - Interdental Cleaning: Does not floss or use interdental brushes. Clinical photo of the patient's lower lip and chin showing the missing front teeth. Clinical intraoral photo of the patient's mouth showing multiple missing teeth, decayed remaining teeth, and poor oral hygiene. Presenting complaint, Dental History Presenting Complaint * Would like to replace his missing teeth * Trauma – 2013 years ago aluminium flashing hit front teeth * Longstanding dental neglect Dental History * Hasn't visited the dentist in 10 years * No current pain or discomfort from dentition * Lack of function due to multiple missing teeth * Socially, very self conscious and doesn't like leaving his house * Expectations are to replace his currently missing teeth and improve function Oral Hygiene: Brushes teeth twice per day with manual toothbrush and fluoridated toothpaste. Doesn't floss or use interdental brushes   #### Patient Concerns and History of Trauma - The patient would like to replace his missing teeth. - History of trauma: In 2013, aluminium flashing hit his front teeth. - Longstanding dental neglect is noted. #### Clinical and Social Dental History - The patient has not visited a dentist in 10 years. - There is no current pain or discomfort reported from the dentition. - There is a significant lack of function due to multiple missing teeth. - Socially, the patient is very self-conscious and does not like leaving his house. - Patient expectations are to replace currently missing teeth and improve overall function. #### Oral Hygiene Habits - Brushing: Twice per day using a manual toothbrush and fluoridated toothpaste. - Interdental Cleaning: Does not floss or use interdental brushes. Clinical photo showing a close-up of the patient's upper lip and teeth area. The image demonstrates the cosmetic consequence of the presenting complaint: significant spacing between the upper front teeth (diastema) due to missing teeth. Clinical intraoral photograph showing the maxillary arch with multiple missing anterior teeth. This visual supports the 'Dental History' text regarding 'longstanding dental neglect' and 'multiple missing teeth'. Patient Examination and Assessment           Patient Examination and Assessment Clinical photograph of a patient's face showing frontal view with superimposed vertical and horizontal reference lines for facial proportion analysis. Clinical photograph of the same patient in lateral (profile) view with superimposed reference lines to assess profile proportions. Close-up clinical photograph of the patient's lips and chin area, likely assessing soft tissue or lip competence. Close-up clinical photograph of the patient's lower face focusing on the mouth region. Intraoral clinical photograph showing the upper dental arch with visible teeth and gingiva. Intraoral clinical photograph showing the right side of the upper dental arch. Intraoral clinical photograph showing the left side of the upper dental arch. Intraoral clinical photograph showing the right side of the lower dental arch. Intraoral clinical photograph showing the upper palate and posterior teeth. Intraoral clinical photograph showing the lower anterior teeth and gingiva. # Patient Examination and Assessment  Patient Examination and Assessment Clinical presentation slide titled 'Patient Examination and Assessment' displaying a composite of clinical photographs. The left side shows facial views (frontal and profile) with a red arrow indicating the chin area, while the right side displays an array of intraoral close-ups showing teeth, gums, and soft tissue conditions. # Patient Examination and Assessment **WESTERN AUSTRALIA** *The projector screen displays a poster with this title and small images of images that have been were taken to examine the patient's teeth.*    The projector screen displays a poster with this title and small images of images that have been were taken to examine the patient's teeth. Clinical photo showing frontal and lateral views of a patient's face for examination. Close-up clinical photos of the patient's lips and mouth area. Grid of six clinical intraoral photographs displaying various dental conditions including tooth decay, gum recession, and missing teeth from different angles. # Patient Examination and Assessment  Slide titled 'Patient Examination and Assessment' displaying a grid of clinical photographs. Top-left: frontal and lateral facial photos of a male patient. Middle-left: close-up photos of lips/nose area. Bottom-left: occlusal view of upper teeth showing missing molars. Right column: multiple intraoral views showing dental conditions including missing teeth, crowding, and gingival recession. # Patient Examination and Assessment  A composite clinical figure titled 'Patient Examination and Assessment' displaying a grid of patient photos and intraoral images. Left side shows frontal and profile views of a middle-aged male patient's face, plus close-ups of lips/mouth. Right side contains six labeled intraoral photographs showing various dental conditions: upper/lower arches with missing teeth, gingival recession, periodontal disease, and occlusal views. The layout is organized for comparative assessment of facial and oral health. Radiographic Examination     Radiographic Examination Main radiographic image (panoramic dental X-ray) showing the mandible and maxilla with visible teeth. Includes an 'L' marker indicating left side. Intraoral periapical radiograph of posterior teeth, labeled 'a' and dated 8/03/2018. Intraoral periapical radiograph of anterior teeth, labeled 'b' and dated 8/03/2018. Intraoral periapical radiograph of posterior teeth, labeled 'c' and dated 29/03/2018.    Main panoramic dental radiograph showing the mandible and maxilla with multiple teeth; labeled 'L' on the right side indicating left orientation. Intraoral periapical radiograph dated 8/3/2018, showing anterior teeth and surrounding bone structure. Intraoral periapical radiograph dated 8/3/2018, showing posterior teeth with visible roots and periodontal ligament space. # Radiographic Examination 13/2/2018 | 8/03/2018 | 8/03/2018 | 29/03/2018 | | :--- | :--- | :--- | | (Periapical Image) | (Periapical Image) | (Periapical Image) |     13/2/2018 | 8/03/2018 | 8/03/2018 | 29/03/2018 | | :--- | :--- | :--- | | (Periapical Image) | (Periapical Image) | (Periapical Image) | Radiographic examination image showing a panoramic dental X-ray of the mandible and maxilla. The image displays teeth with varying degrees of visibility and alignment, along with surrounding bone structures. A small 'L' marker is visible in the bottom right corner indicating left side orientation. Periapical radiograph dated 8/03/2018 showing detailed view of lower anterior teeth with visible root structures and surrounding bone density. Periapical radiograph dated 8/03/2018 showing another section of lower teeth with clear visualization of tooth roots and alveolar bone structure. Periapical radiograph dated 29/03/2018 showing posterior teeth region with visible molar roots and periodontal ligament space details. **Patient Examination and Assessment** (Base Charting 8/3/2018) 26 – Distal caries with cavitation, ICDAS 6, not TTP, mobility grade I, unresponsive to CO2 and EPT Pulpal Diagnosis: 26, pulpless and infected root canal system with chronic apical periodontitis caused by caries Abbott PV, Yu C. A clinical classification of the status of the pulp and the root canal system. Australian Dental Journal. 2007 Mar;52:517-81     #### Base Charting (8/3/2018) - **Tooth 26**: Distal caries with cavitation, ICDAS 6, not TTP, mobility grade I, unresponsive to CO2 and EPT. #### Pulpal Diagnosis - **Tooth 26**: Pulpless and infected root canal system with chronic apical periodontitis caused by caries. *Reference: Abbott PV, Yu C. A clinical classification of the status of the pulp and the root canal system. Australian Dental Journal. 2007 Mar;52:517-81* Clinical intraoral photograph showing the maxillary and mandibular dental arches. The image displays significant carious lesions on multiple teeth, particularly in the posterior regions. Clinical intraoral photograph with a cheek retractor applied, exposing the upper and lower anterior dentition. This view demonstrates the patient's smile arc and the condition of the front teeth. Base charting diagram representing tooth positions (labeled 1-8). It includes symbols for specific clinical findings: yellow squares indicating decay, red arrows pointing to specific teeth, and pink outlined boxes highlighting areas of interest or pathology. Detailed base charting data table corresponding to the date 8/3/2018. It lists teeth numbers (e.g., 18, 17... 27, 28) and codes for conditions such as 'ELECT' (electronic pulp testing), 'CO2', and 'MOB' (mobility grade). **Patient Examination and Assessment** **Base Charting** 8/3/2018 **CPITN** - **3** **4*** **3** **4** - Abbott PV, Yu C. A clinical classification of the status of the pulp and the root canal system. Australian Dental Journal. 2007 Mar;52:S17-31    #### Base Charting (8/3/2018) **CPITN** - **3 4*** - **3 4** *Reference: Abbott PV, Yu C. A clinical classification of the status of the pulp and the root canal system. Australian Dental Journal. 2007 Mar;52:S17-31* Clinical intraoral photographs showing the upper and lower dental arches with visible tooth decay and missing teeth. Clinical intraoral photograph of a patient's mouth showing significant dental caries and malocclusion. Base charting diagram illustrating the dental arches and tooth positions, with specific markings for examination findings. Patient Examination and Assessment Gingiva: - Colour: **Erythematous free gingival margin** - Texture: **Oedematous free gingival margin** - Contour: **loss of interdental papilla, blunted** - Biotype: **Normal** Plaque Score 17/4/2018 95% Periodontal Diagnosis: **Generalised periodontitis** **Stage IV, Grade C**   #### Gingival Assessment - **Colour**: Erythematous free gingival margin - **Texture**: Oedematous free gingival margin - **Contour**: Loss of interdental papilla, blunted - **Biotype**: Normal #### Plaque Score (17/4/2018) - 95% #### Periodontal Diagnosis - **Generalised periodontitis**: Stage IV, Grade C Periodontal assessment chart showing multiple rows of grid-based data visualizations with colored bars (red, yellow, green) representing plaque indices or bleeding scores across tooth positions. Includes labeled sections such as 'Probing', 'Plaque Index', and 'Bleeding on Probing Index'. Complementary periodontal assessment chart mirroring the left panel, displaying similar structured grids with color-coded bar indicators for clinical measurements. Labeled sections include 'Probing', 'Plaque Index', and 'Bleeding on Probing Index'. # Patient Level Risk Factors * **Biological** * Normal Salivary flow * Multiple missing teeth * History of trauma * **Behavioral Risk Factors** * Poor oral hygiene * Cariogenic Diet * Smoker * **Financial / Personal Risk Factors** * Motivated for treatment * Understand current situation/need for treatment * Realistic aesthetic expectations * Currently unemployed * **CAMBRA** * High Caries Risk ### Saliva Screening Test 22/3/2018 * pH: 7.0 * Quantity: normal * Buffering capacity: normal ### Diet Analysis Summary * High consumption of simple carbohydrates * Five cups of coffee per day each with 2 teaspoons of sugar * Little to no snacking throughout the day  #### Patient Level Risk Factors - **Biological** - Normal Salivary flow - Multiple missing teeth - History of trauma - **Behavioral Risk Factors** - Poor oral hygiene - Cariogenic Diet - Smoker - **Financial / Personal Risk Factors** - Motivated for treatment - Understand current situation/need for treatment - Realistic aesthetic expectations - Currently unemployed - **CAMBRA** - High Caries Risk #### Saliva Screening Test (22/3/2018) - **pH**: 7.0 - **Quantity**: Normal - **Buffering capacity**: Normal #### Diet Analysis Summary - High consumption of simple carbohydrates - Five cups of coffee per day each with 2 teaspoons of sugar - Little to no snacking throughout the day Clinical data table titled 'Patient Level Risk Factors' containing structured information on Saliva Screening Test results (pH: 7.0, Quantity: normal, Buffering capacity: normal) and Diet Analysis Summary (High consumption of simple carbohydrates, Five cups of coffee per day each with 2 teaspoons of sugar, Little to no snacking throughout the day). The table includes a color-coded column indicating risk levels. <table> <tr> <th colspan="3">Problem List</th> </tr> <tr> <th>Problem List</th> <th>Aetiology</th> <th>Objectives of Treatment Plan</th> </tr> <tr> <td><i>● High blood pressure. Hypert Inferior (2007)</i></td> <td>Environmental & Hereditary factors, Ischaemic heart disease</td> <td>Refer patient to medical practitioner for further investigation.</td> </tr> <tr> <td><i>● Smokes 20 cigarettes per day, drinks 25 standard alcoholic drinks per week</i></td> <td>Personal lifestyle choices.</td> <td>Treat dental abscess, root canal, fillings, extraction, periodontal therapy, teeth whitening.</td> </tr> <tr> <td><i>● Dental neglect, poor oral hygiene, gingival recession, heavy calculus</i></td> <td>Personal lifestyle choices.</td> <td>Educate & motivate patient regarding importance of periodontal hygiene.</td> </tr> <tr> <td><i>Carangoin diet</i></td> <td>Personal lifestyle choices.</td> <td>Dietary advice, nutritional supplementation.</td> </tr> <tr> <td><i>Periodontal disease</i></td> <td>Bacterial colonization of dental plaque & calculus.</td> <td>Provide periodontal maintenance (PMR), debridement of teeth, and regular periodontal review.</td> </tr> <tr> <td><i>Retained roots 27, 47</i></td> <td>Carious, necrotic bacteria, adequate tooth surface, fermented carbohydrates, mercury amalgam, periodontitis.</td> <td>Inform Mr. Hales about risk of malignant lesions before extraction.</td> </tr> <tr> <td><i>Caries 25 Buccal</i></td> <td>Lactose intolerance, formation of tertiary dentine.</td> <td>Monitor or restore teeth with poor prognosis.</td> </tr> <tr> <td><i>Arrested caries 6D Buccal</i></td> <td>Arrested caries.</td> <td>Re-apply fluoride varnish after debridement.</td> </tr> <tr> <td><i>Probable external inflammatory root resorption 31, 21 Mesial</i></td> <td>Bacterial infection of dental tubule causing osteoclastic activity on root surface.</td> <td>Examine after debridement.</td> </tr> <tr> <td><i>Frictional keratosis</i></td> <td>Physical irritation of tooth coming into contact with the mucosa.</td> <td>Monitor mucosa after insertion of prosthesis. Any persistent lesion should be referred to an Oral Medicine/Pathologist specialist for examination.</td> </tr> <tr> <td><i>Missing teeth, partially edentate</i></td> <td>Trauma, dental neglect</td> <td>Replace teeth, restore aesthetics and function.</td> </tr> <tr> <td><i>Very self-conscious about teeth</i></td> <td>Psychosocial implications of multiple missing teeth.</td> <td>Provide dental prosthesis which will restore dental aesthetics and function.</td> </tr> <tr> <td><i>Unruptured 28</i></td> <td>Overcrowding, impaction, severe rotation, trauma.</td> <td>Monitor for any symptoms.</td> </tr> <tr> <td><i>Mate bottom lip RMS</i></td> <td>Occurs when melanocytes grow in clusters. Sun exposure may cause this cancer to progress.</td> <td>Continual monitoring or any changes.</td> </tr> <tr> <td><i>Panoramic radiograph doesn't confirm condyles, TM joint, nasal cavity, mandibular canal, maxillary sinus, not in the focal trough.</i></td> <td>Poor patient positioning during Panoramic Radiograph.</td> <td>Refer to Panoramic Radiograph if necessary.</td> </tr> <tr> <td><i>Skeletal Class II</i></td> <td>Protrusive mandible, lack of space.</td> <td>Create a prosthesis which attempts to compensate for this skeletal relationship.</td> </tr> <tr> <td><i>Low frenal attachments, bilateral mandibular tori</i></td> <td>Genetic, local trauma on mandible.</td> <td>Resect dental prosthesis around tori and root to prevent trauma to tori. Not to cause other effects.</td> </tr> <tr> <td><i>Lisp while prolonging "s" sounds</i></td> <td>Missing maxillary incisors.</td> <td>Create a dental prosthesis that allows Mr. Hales to place his tongue in correct dental prosthesis to correct lisp. Copper can be placed if problem continues. Recommend treatment plan that is appropriate to Mr. Hales' financial situation.</td> </tr> <tr> <td><i>Unemployed - mental considerations</i></td> <td></td> <td>Provide financial assistance to Mr. Hales.</td> </tr> </table>  | Problem List | Aetiology | Objectives of Treatment Plan | | :--- | :--- | :--- | | High blood pressure. Hypert Inferior (2007) | Environmental & Hereditary factors, Ischaemic heart disease | Refer patient to medical practitioner for further investigation. | | Smokes 20 cigarettes per day, drinks 25 standard alcoholic drinks per week | Personal lifestyle choices. | Treat dental abscess, root canal, fillings, extraction, periodontal therapy, teeth whitening. | | Dental neglect, poor oral hygiene, gingival recession, heavy calculus | Personal lifestyle choices. | Educate & motivate patient regarding importance of periodontal hygiene. | | Cariogenic diet | Personal lifestyle choices. | Dietary advice, nutritional supplementation. | | Periodontal disease | Bacterial colonization of dental plaque & calculus. | Provide periodontal maintenance (PMR), debridement of teeth, and regular periodontal review. | | Retained roots 27, 47 | Carious, necrotic bacteria, adequate tooth surface, fermented carbohydrates, mercury amalgam, periodontitis. | Inform Mr. Hales about risk of malignant lesions before extraction. | | Caries 25 Buccal | Lactose intolerance, formation of tertiary dentine. | Monitor or restore teeth with poor prognosis. | | Arrested caries 6D Buccal | Arrested caries. | Re-apply fluoride varnish after debridement. | | Probable external inflammatory root resorption 31, 21 Mesial | Bacterial infection of dental tubule causing osteoclastic activity on root surface. | Examine after debridement. | | Frictional keratosis | Physical irritation of tooth coming into contact with the mucosa. | Monitor mucosa after insertion of prosthesis. Refer persistent lesions to Oral Medicine/Pathologist. | | Missing teeth, partially edentate | Trauma, dental neglect | Replace teeth, restore aesthetics and function. | | Very self-conscious about teeth | Psychosocial implications of multiple missing teeth. | Provide dental prosthesis to restore aesthetics and function. | | Unruptured 28 | Overcrowding, impaction, severe rotation, trauma. | Monitor for any symptoms. | | Mate bottom lip RMS | Melanocyte clusters; sun exposure risk. | Continual monitoring for any changes. | | Panoramic radiograph artifacts (condyles, TMJ, etc. not in focal trough) | Poor patient positioning during Panoramic Radiograph. | Refer to Panoramic Radiograph if necessary. | | Skeletal Class II | Protrusive mandible, lack of space. | Create a prosthesis to compensate for skeletal relationship. | | Low frenal attachments, bilateral mandibular tori | Genetic, local trauma on mandible. | Resect dental prosthesis around tori and root to prevent trauma. | | Lisp while prolonging "s" sounds | Missing maxillary incisors. | Create dental prosthesis to correct tongue placement; recommend treatment appropriate to financial situation. | | Unemployed - mental considerations | | Provide financial assistance to Mr. Hales. | A structured table displayed on a projection screen titled 'Problem List'. The table is organized into three columns: 'Problem List', 'Aetiology' (spelled as Aetiology in the OCR context), and 'Objectives of Treatment Plan'. It details various patient issues such as high blood pressure, smoking habits, dental neglect, caries, and skeletal Class II malocclusion. For each problem, it lists the underlying causes (e.g., environmental factors, bacterial colonization) and specific treatment objectives (e.g., refer to medical practitioner, provide periodontal maintenance, create a prosthesis). The text is presented in rows with alternating background shading for readability. | Problem List | Aetiology | Objectives of Treatment Plan | |------------------------------------------------------------------|---------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------| | High blood pressure, myocardial infarct 2007 | Environmental and heredity factors, ischaemic heart disease | Refer patient to medical practitioner. Keep dental appointments short and relaxed | | Smokes 20 cigarettes per day, drinks 20 standard alcoholic drinks per week | Personal lifestyle choices | Give smoking and alcohol cessation advice, motivational interviewing | | Dental neglect, poor oral hygiene, heavy plaque, heavy calculus | Personal lifestyle choices | Educate and continually motivate regarding oral hygiene, debridement and periodontal reviews | | Carigeneic diet | Personal lifestyle choices | Dietary advice, continual motivation | | Periodontal disease | Complex interplay between bacteria found in dental plaque and both local and systemic factors from the host | Debridement of teeth and regular periodontal reviews | | Retained roots 27, 47 | Caries, cariogenic bacteria, susceptible tooth surface, fermentable | Inform Mr Halles about teeth with hopeless prognoses, explain all associated risks in order to gain informed consent before extraction | | Canines 26 Distal | Saliva re-mineralising teeth, formation of tertiary dentine | Monitor or restore teeth with fair prognosis | | Arrested caries 46 Buccal | Bacteria in pulp and dental tubules triggering osteoclastic activity on root surface | Re-examine after debridement | | Possible external inflammatory root resorption 31 Distal and 32 Mesial | | | | Frictional keratosis | Physical irritation of teeth coming into contact with the mucosa | Monitor mucosa after insertion of prosthesis, any persistent lesion should be urgently referred to an Oral Medicine specialist for biopsy | | Missing teeth, partially dentate | Trauma, dental neglect | Replace teeth, restore aesthetics and function | | Very self-conscious about teeth | Psychosocial implications of multiple missing teeth | Fabricate a dental prosthesis that will restore dental aesthetics | | Unerupted 28 | Lack of space, impaction, severe rotation, trauma | Monitor for any symptoms | | Male bottom lip RIMS | Occurs when melanocytes grow in a cluster. Sun exposure can make this appear darker | Continual monitoring for any changes | | Panoramic - Radiograph doesn't capture condyles, TMJ and nasal cavity, mandibular teeth not in the focal trough | Poor patient positioning during Panoramic Radiograph | Retake Panoramic Radiograph | | Skeletal Class III | Progressive mandible | Create a prosthesis which attempts to compensate for this skeletal relationship | | High frenal attachments, bilateral mandibular tori | Genetic, occlusal forces on the mandible | Relieve dental prosthesis around the frenal attachments and tori to try and prevent denture sore spots | | Lure whilst pronouncing 'S' sounds | Missing maxillary incisors | Create a dental prosthesis that allows Mr Halles to place his tongue against maxillary incisors. Refer to speech pathologist if problem continues | | Unemployed – financial considerations | | Provide a treatment plan that is appropriate to Mr Halles’ financial situation |  | Problem List | Aetiology | Objectives of Treatment Plan | | :--- | :--- | :--- | | High blood pressure, myocardial infarct 2007 | Environmental and heredity factors, ischaemic heart disease | Refer patient to medical practitioner. Keep dental appointments short and relaxed. | | Smokes 20 cigarettes per day, drinks 20 standard alcoholic drinks per week | Personal lifestyle choices | Give smoking and alcohol cessation advice, motivational interviewing. | | Dental neglect, poor oral hygiene, heavy plaque, heavy calculus | Personal lifestyle choices | Educate and continually motivate regarding oral hygiene, debridement and periodontal reviews. | | Cariogenic diet | Personal lifestyle choices | Dietary advice, continual motivation. | | Periodontal disease | Complex interplay between bacteria and host factors | Debridement of teeth and regular periodontal reviews. | | Retained roots 27, 47 | Caries, cariogenic bacteria, susceptible tooth surface | Inform Mr Halles about hopeless prognoses; gain informed consent before extraction. | | Canines 26 Distal | Saliva re-mineralising teeth, formation of tertiary dentine | Monitor or restore teeth with fair prognosis. | | Arrested caries 46 Buccal | Bacteria in pulp and dental tubules triggering osteoclastic activity | Re-examine after debridement. | | Possible external inflammatory root resorption 31 Distal and 32 Mesial | | | | Frictional keratosis | Physical irritation of teeth against mucosa | Monitor mucosa; refer persistent lesions to Oral Medicine specialist for biopsy. | | Missing teeth, partially dentate | Trauma, dental neglect | Replace teeth, restore aesthetics and function. | | Very self-conscious about teeth | Psychosocial implications of missing teeth | Fabricate a dental prosthesis to restore aesthetics. | | Unerupted 28 | Lack of space, impaction, severe rotation, trauma | Monitor for any symptoms. | | Male bottom lip RIMS | Melanocyte clusters; sun exposure risk | Continual monitoring for any changes. | | Panoramic - Radiograph positioning errors | Poor patient positioning | Retake Panoramic Radiograph. | | Skeletal Class III | Progressive mandible | Create a prosthesis to compensate for skeletal relationship. | | High frenal attachments, bilateral mandibular tori | Genetic, occlusal forces on the mandible | Relieve dental prosthesis around attachments and tori to prevent sore spots. | | Lure whilst pronouncing 'S' sounds | Missing maxillary incisors | Create dental prosthesis for tongue placement; refer to speech pathologist if needed. | | Unemployed – financial considerations | | Provide a treatment plan appropriate to financial situation. | A structured table titled 'Problem List' containing three columns: Problem List, Aetiology, and Objectives of Treatment Plan. The table lists various dental and medical conditions (e.g., high blood pressure, periodontal disease, missing teeth) alongside their causes and corresponding treatment objectives.  A structured table titled 'Individual Tooth Assessment – Samet Jotkowicz 2009' displaying a dental prognosis assessment. The table includes columns for Tooth number, Periodontal condition, Restorability, Endodontic Condition, Occlusal factors, Anatomic Irregularities, Iatrogenic Factors, and Overall Prognosis. Rows list specific teeth (e.g., 23, 24, 25) with corresponding clinical statuses such as Questionable, Compromised, or Hopeless. ```html <table> <tr> <th>Individual Tooth Assessment – Samet Jotkowitx 2009</th> </tr> <tr> <th>Tooth</th> <th>Periodontal</th> <th>Restorability</th> <th>Endodontic Condition</th> <th>Occlusal</th> <th>Anatomic Irregularities</th> <th>Iatrogenic Factors</th> <th>Overall Prognosis</th> </tr> <tr> <td>23</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>24</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>25</td> <td>Compromised</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>26</td> <td>Hopeless</td> <td>Hopeless</td> <td>Hopeless</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Hopeless</td> </tr> <tr> <td>27</td> <td>Compromised</td> <td>Hopeless</td> <td>Hopeless</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Hopeless</td> </tr> <tr> <td>33</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>32</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>31</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>41</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>42</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>41</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>45</td> <td>Questionable</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Fair</td> </tr> <tr> <td>46</td> <td>Compromised</td> <td>Good</td> <td>Good</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Questionable</td> </tr> <tr> <td>47</td> <td>Compromised</td> <td>Hopeless</td> <td>Hopeless</td> <td>Fair</td> <td>No</td> <td>No</td> <td>Hopeless</td> </tr> <tr> <td colspan="8"><small>Samet N, Jotkowitx A. Classification and prognosis evaluation of individual teeth—a comprehensive approach. Quintessence international. 2009 May 1:40(5).</small></td> </tr> </table> ```  #### Individual Tooth Assessment (Samet Jotkowitx 2009) | Tooth | Periodontal | Restorability | Endodontic Condition | Occlusal | Anatomic Irregularities | Iatrogenic Factors | Overall Prognosis | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | 23 | Questionable | Good | Good | Fair | No | No | Fair | | 24 | Questionable | Good | Good | Fair | No | No | Fair | | 25 | Compromised | Good | Good | Fair | No | No | Fair | | 26 | Hopeless | Hopeless | Hopeless | Fair | No | No | Hopeless | | 27 | Compromised | Hopeless | Hopeless | Fair | No | No | Hopeless | | 33 | Questionable | Good | Good | Fair | No | No | Fair | | 32 | Questionable | Good | Good | Fair | No | No | Fair | | 31 | Questionable | Good | Good | Fair | No | No | Fair | | 41 | Questionable | Good | Good | Fair | No | No | Fair | | 42 | Questionable | Good | Good | Fair | No | No | Fair | | 41 | Questionable | Good | Good | Fair | No | No | Fair | | 45 | Questionable | Good | Good | Fair | No | No | Fair | | 46 | Compromised | Good | Good | Fair | No | No | Questionable | | 47 | Compromised | Hopeless | Hopeless | Fair | No | No | Hopeless | *Reference: Samet N, Jotkowitx A. Classification and prognosis evaluation of individual teeth—a comprehensive approach. Quintessence international. 2009 May 1:40(5).* Table titled 'Individual Tooth Assessment – Samet Jotkowitx 2009' with columns for Tooth, Periodontal, Restorability, Endodontic Condition, Occlusal, Anatomic Irregularities, Iatrogenic Factors, and Overall Prognosis. Rows list assessments for teeth 23 through 47, including prognostic categories such as Questionable, Compromised, Hopeless, Good, Fair, and No. # Treatment Alternatives **Periodontal Considerations** * Diagnosis: Generalised Periodontitis Stage IV, Grade C * Options: * No treatment * Advantages * Disadvantages * Periodontal Debridement of teeth * Advantages * Disadvantages * Rationale *Lotheef P, Sirajuddin S, et al. Suppl 1: M7: Iatrogenic Damage to the Periodontium Caused by Periodontal Treatment Procedures. The open dentistry journal. 2015;9:203.* #### Clinical Assessment - **Diagnosis:** Generalised Periodontitis Stage IV, Grade C #### Management Options 1. **No treatment** - Advantages - Disadvantages 2. **Periodontal Debridement of teeth** - Advantages - Disadvantages #### Rationale - Rationale for selected approach provided based on clinical findings. *Reference: Lotheef P, Sirajuddin S, et al. Suppl 1: M7: Iatrogenic Damage to the Periodontium Caused by Periodontal Treatment Procedures. The open dentistry journal. 2015;9:203.* **Treatment Alternatives** Periodontal Considerations - **Diagnosis:** Generalized Periodontitis Stage IV, Grade C - **Options:** - No treatment - **Advantages** - **Disadvantages** - Periodontal Debridement of teeth - **Advantages** - **Disadvantages** - **Rationale** Latheef P. Sirajuddin S., et al. Suppl 1: M7. Iatrogenic Damage to the Periodontium Caused by Periodontal Treatment Procedures. *The open dentistry journal*. 2015,9:203.  #### Clinical Assessment - **Diagnosis:** Generalized Periodontitis Stage IV, Grade C #### Management Options 1. **No treatment** - Advantages - Disadvantages 2. **Periodontal Debridement of teeth** - Advantages - Disadvantages #### Rationale - Rationale for selected approach provided based on clinical findings. *Reference: Latheef P. Sirajuddin S., et al. Suppl 1: M7. Iatrogenic Damage to the Periodontium Caused by Periodontal Treatment Procedures. The open dentistry journal. 2015,9:203.* Photo of a presentation slide titled 'Treatment Alternatives'. The slide details Periodontal Considerations for a diagnosis of Generalised Periodontitis Stage IV, Grade C. It outlines two options: No treatment and Periodontal Debridement of teeth, listing Advantages and Disadvantages for each, followed by a Rationale section. **Treatment Alternatives** Periodontal Considerations • Diagnosis: Generalised Periodontitis Stage IV, Grade C • Options: • No treatment • Advantages • Disadvantages • Periodontal Debridement of teeth • Advantages • Disadvantages • Rationale LaTheef P, Sirajuddin S, et al. Suppl 1: M7: Iatrogenic Damage to the Periodontium Caused by Periodontal Treatment Procedures. The open dentistry journal. 2015;9:201 Western Australia #### Clinical Assessment - **Diagnosis:** Generalised Periodontitis Stage IV, Grade C #### Management Options 1. **No treatment** - Advantages - Disadvantages 2. **Periodontal Debridement of teeth** - Advantages - Disadvantages #### Rationale - Rationale for selected approach provided based on clinical findings. *Reference: LaTheef P, Sirajuddin S, et al. Suppl 1: M7: Iatrogenic Damage to the Periodontium Caused by Periodontal Treatment Procedures. The open dentistry journal. 2015;9:201* # Treatment Alternatives ## Oral Surgery Considerations ### Problem: - Retained roots 27, 47 - Unrestorable 26 ### Options: - No treatment - Advantages - Disadvantages - Extraction of 26, 27 and 46 - Advantages - Disadvantages - Rationale ### Problem: - Retained unerupted 28 ### Options: - No treatment - Advantages - Disadvantages - Extraction of 28 - Advantages - Disadvantages - Rationale --- **Steed MB. The indications for third-molar extractions. The Journal of the American Dental Association. 2014 Jun 1;145(6):570-3.** #### Clinical Problem: Retained Roots and Unrestorable Teeth - **Findings:** Retained roots 27, 47; Unrestorable 26 - **Options:** - **No treatment** - Advantages - Disadvantages - **Extraction of 26, 27 and 46** - Advantages - Disadvantages - **Rationale** #### Clinical Problem: Impacted Dentition - **Findings:** Retained unerupted 28 - **Options:** - **No treatment** - Advantages - Disadvantages - **Extraction of 28** - Advantages - Disadvantages - **Rationale** *Reference: Steed MB. The indications for third-molar extractions. The Journal of the American Dental Association. 2014 Jun 1;145(6):570-3.* # Treatment Alternatives **Western Australia** Oral Surgery Considerations * **Problem:** retained roots 27, 47, unrestorable 26 * **Options:** * **No treatment** * Advantages * Disadvantages * **Extraction of 26, 27 and 46** * Advantages * Disadvantages * **Rationale** Problem: retained unerupted 28 Options: * **No treatment** * Advantages * Disadvantages * **Extraction of 28** * Advantages * Disadvantages * **Rationale** Steed MB: The indications for third-molar extractions: The Journal of the American Dental Association: 2014 Jun 1;145(6):570-3. #### Clinical Problem: Retained Roots and Unrestorable Teeth - **Findings:** Retained roots 27, 47; Unrestorable 26 - **Options:** - **No treatment** - Advantages - Disadvantages - **Extraction of 26, 27 and 46** - Advantages - Disadvantages - **Rationale** #### Clinical Problem: Impacted Dentition - **Findings:** Retained unerupted 28 - **Options:** - **No treatment** - Advantages - Disadvantages - **Extraction of 28** - Advantages - Disadvantages - **Rationale** *Reference: Steed MB: The indications for third-molar extractions: The Journal of the American Dental Association: 2014 Jun 1;145(6):570-3.* Prostodontic Considerations **Problem:** Missing teeth, partially dentate **Options:** * No treatment * Partial acrylic maxillary and mandibular dentures * Full maxillary acrylic denture and partial acrylic mandibular denture * Partial Co/Cr maxillary and mandibular denture * Implant supported removable or fixed prosthesis **Advantages** **Disadvantages** **Rationale** *Swural P, Singh AK, Ayer A, Roy DK, Roy RH. Cast Partial Denture versus Acrylic Partial Denture for Replacement of Missing Teeth in Partially Edentulous Patients. *Journal of Dental Materials and Techniques*. 2017 Mar 1;6(1):27-34. McCord J, Smiles R. *Oval diagnosis and treatment planning, part 7: Treatment planning for missing teeth*. *British dental journal*. 2012 Oct;213(7):341. Petrisili H, Hempton T. *Periodontal considerations in removable partial denture treatment: a review of the literature*. *The international journal of prosthodontics*. 2001;14(2):164-72. **"Whatever treatment mode is selected should minimize the long-term biological and soft tissue costs to the dental patient"** **-McCord on Smiles 2012** #### Clinical Problem: Edentulism - **Status:** Missing teeth, partially dentate #### Prosthetic Options - No treatment - Partial acrylic maxillary and mandibular dentures - Full maxillary acrylic denture and partial acrylic mandibular denture - Partial Co/Cr maxillary and mandibular denture - Implant supported removable or fixed prosthesis #### Evaluation - **Advantages** - **Disadvantages** - **Rationale** #### Clinical Principles - "Whatever treatment mode is selected should minimize the long-term biological and soft tissue costs to the dental patient" — McCord on Smiles 2012 #### References - Suwal P, Singh AK, Ayer A, Roy DK, Roy RH. Cast Partial Denture versus Acrylic Partial Denture for Replacement of Missing Teeth in Partially Edentulous Patients. *Journal of Dental Materials and Techniques*. 2017 Mar 1;6(1):27-34. - McCord J, Smiles R. *Oral diagnosis and treatment planning, part 7: Treatment planning for missing teeth*. *British dental journal*. 2012 Oct;213(7):341. - Petrisili H, Hempton T. *Periodontal considerations in removable partial denture treatment: a review of the literature*. *The international journal of prosthodontics*. 2001;14(2):164-72. # Treatment Alternatives ## Prosthodontic Considerations - Problem: Missing teeth, partially dentate - Options: - No treatment - Partial acrylic maxillary and mandibular dentures - Full maxillary acrylic denture and partial acrylic mandibular denture - Partial Co/Cr maxillary and mandibular denture - Implant supported removable or fixed prosthesis - Advantages - Disadvantages - Rationale "Whatever treatment mode is selected should minimize the long-term biological and soft tissue costs to the patient" -MCCord, Smalies 2012 - Suwal P, Singh RK, Ayer A, Roy DK, Roy RK. Cast Partial Denture versus Ayclic Partial Denture for Replacement of Missing Teeth in Partially Edentulous Patients. Journal of Dental Materials and Techniques. 2017 Mar 1;6(1):27-34. - MeCord P, Smalies R. Oral diagnosis and treatment planning: part 7. Treatment planning for missing teeth. British Dental Journal. 2012 Oct;213(7):341. - Petralis H, Hempton Y. Periodontal considerations in removable partial denture treatment: a review of the literature. The International Journal of Prosthodontics. 2001;14(2):164-72. #### Clinical Problem: Edentulism - **Status:** Missing teeth, partially dentate #### Prosthetic Options - No treatment - Partial acrylic maxillary and mandibular dentures - Full maxillary acrylic denture and partial acrylic mandibular denture - Partial Co/Cr maxillary and mandibular denture - Implant supported removable or fixed prosthesis #### Evaluation - Advantages - Disadvantages - Rationale #### Clinical Principles - "Whatever treatment mode is selected should minimize the long-term biological and soft tissue costs to the patient" — McCord, Smalies 2012 #### References - Suwal P, Singh RK, Ayer A, Roy DK, Roy RK. Cast Partial Denture versus Ayclic Partial Denture for Replacement of Missing Teeth in Partially Edentulous Patients. Journal of Dental Materials and Techniques. 2017 Mar 1;6(1):27-34. - MeCord P, Smalies R. Oral diagnosis and treatment planning: part 7. Treatment planning for missing teeth. British Dental Journal. 2012 Oct;213(7):341. - Petralis H, Hempton Y. Periodontal considerations in removable partial denture treatment: a review of the literature. The International Journal of Prosthodontics. 2001;14(2):164-72. <img>A man in blue scrubs is lecturing in front of a projection screen displaying a presentation slide. The slide is titled 'Treatment Alternatives' under the category 'Prosthodontic Considerations'. The text lists options for replacing missing teeth, including various types of dentures and implants, and cites three references from the *Journal of Dental Materials and Techniques*, *British dental journal*, and *The international journal of prosthodontics*. The University of Western Australia logo is visible in the top right corner.<img>  A man in blue scrubs is lecturing in front of a projection screen displaying a presentation slide. The slide is titled 'Treatment Alternatives' under the category 'Prosthodontic Considerations'. The text lists options for replacing missing teeth, including various types of dentures and implants, and cites three references from the Journal of Dental Materials and Techniques, British dental journal, and The international journal of prosthodontics. Photo of a presentation slide titled 'Treatment Alternatives' displayed on a projector screen. The slide contains text under 'Prosthodontic Considerations' listing options for missing teeth such as partial acrylic dentures and implant-supported prostheses. A man in blue scrubs stands to the right of the screen lecturing. **Con** **t** **r** **o** **l** **P** **h** **a** **s** **e** **Delivery of Treatment** * 8/3/2018 * Referral to medical practitioner * 10/4/2018 * Informed consent to carry out treatment plan * Extraction 26, 27 and 47 * 17/4/2018 * Review of extraction sockets * Periodontal Debridement * 30/4/2018 * PA: 25 distal arrested caries * 8/5/2018 * Dietary advice * Oral Hygiene instruction * Fluoride application * Motivational interviewing for smoking and alcohol cessation    #### Clinical Procedures and Timeline - **8/3/2018** - Referral to medical practitioner - **10/4/2018** - Informed consent to carry out treatment plan - Extraction 26, 27 and 47 - **17/4/2018** - Review of extraction sockets - Periodontal Debridement - **30/4/2018** - PA: 25 distal arrested caries - **8/5/2018** - Dietary advice - Oral Hygiene instruction - Fluoride application - Motivational interviewing for smoking and alcohol cessation Clinical radiograph (labeled 'a') showing the extraction sockets of teeth 26, 27, and 47. Caption below reads '30/4/2018'. Clinical intraoral photo of the lower anterior teeth showing extraction sites following removal of teeth 26, 27, and 47. Caption below reads '17/4/2018'. Clinical intraoral photo of the lower dentition showing a full arch with visible carious lesions on tooth 25. This image corresponds to the 'PA: 25 distal arrested caries' note dated 30/4/2018. Hold Phase Delivery of Treatment - 23/5/2018 - Periodontal review - PA: 41 31 for possible external inflammatory resorption - Plaque score: 50% - Oral hygiene instruction - Periodontal debridement - 13/7/2018 - Diagnostic base and rim - 26/7/2018 - 46 BUC composite - Pulp testing to reassess abutment teeth - 31/7/2018 - Panoramic Radiograph    #### Clinical Procedures and Timeline - **23/5/2018** - Periodontal review - PA: 41 31 for possible external inflammatory resorption - Plaque score: 50% - Oral hygiene instruction - Periodontal debridement - **13/7/2018** - Diagnostic base and rim - **26/7/2018** - 46 BUC composite - Pulp testing to reassess abutment teeth - **31/7/2018** - Panoramic Radiograph Panoramic radiograph of the mandible and maxilla showing teeth alignment and bone structure. Dated '31/7/2018' in bottom right corner. Close-up intraoral photograph showing tooth #41 (mandibular left first molar) with visible root structure. Dated '23/5/2018' below image. Intraoral clinical photographs showing dental impression or temporary restoration on upper molars. Dated '13/7/2018' below images. **Delivery of Treatment** **Holding Phase** **Holding Stage Review** 31/7/2018      #### Holding Stage Review 31/7/2018 Clinical photo of a maxillary lateral view showing teeth and gingival tissue during the holding phase. Clinical photo of a mandibular lateral view showing teeth alignment during the holding stage review dated 31/7/2018. Clinical photo of an occlusal view of the mandible showing multiple missing teeth and remaining dentition during the holding stage review. Clinical photo of an occlusal view of the maxilla showing the dental arch during the holding phase. Clinical photo of an occlusal view of the mandible showing the dental arch during the holding stage review. **Delivery of Treatment** **Holding Stage Review** **Holding Phase** **31/7/2018**  #### Holding Stage Review 31/7/2018 Clinical dental photographs labeled 'Holding Stage Review' dated 31/7/2018, showing intraoral views of a patient's teeth during treatment. The images include frontal and lateral perspectives of the upper and lower arches, with visible dental work in progress. **Delivery of Treatment** R e c o n s t r u c t i v e - **22/7/2018** - Denture design sign off - **31/7/2018** - Secondary impressions - Face-bow - **15/8/2018** - MMR - **5/9/2018** - Anterior tooth set up - **14/9/2018** - Posterior tooth set up - **3/10/2018** - Insertion of P/P acrylic denture Davenport JC, Basker RM, et al. Prosthetics: A system of design. Britsh dental journal. 2000 Dec;189(11):586.    #### Clinical Procedures and Timeline - **22/7/2018** - Denture design sign off - **31/7/2018** - Secondary impressions - Face-bow - **15/8/2018** - MMR - **5/9/2018** - Anterior tooth set up - **14/9/2018** - Posterior tooth set up - **3/10/2018** - Insertion of P/P acrylic denture #### References Davenport JC, Basker RM, et al. Prosthetics: A system of design. Britsh dental journal. 2000 Dec;189(11):586. Labeled diagram of denture design showing upper and lower arches with tooth placement annotations. Includes date '22/7/2018' at top right. Clinical photo showing pink secondary impression trays or bite registration material in upper and lower jaw impressions. Captioned '31/7/2018' below. Clinical photo showing anterior teeth set up on a dental cast or model, demonstrating tooth alignment and occlusion. Captioned '15/8/2018' below. Delivery of Treatment Reconstructive Insertion of Acrylic P/P 3/10/2018      #### Insertion of Acrylic P/P 3/10/2018 Clinical photo of an upper dental arch showing the placement of an acrylic partial denture (P/P), with visible teeth and gum tissue. Clinical photo of a lower dental arch showing the fit of an acrylic partial denture within the oral cavity. Frontal intraoral view labeled 'Insertion of Acrylic P/P' dated '3/10/2018', demonstrating the alignment and insertion of an acrylic partial prosthesis in both upper and lower jaws. Lateral intraoral photo showing the occlusion and fit of the acrylic partial denture from a side angle. Lateral intraoral photo from the opposite side showing the acrylic partial denture's integration with natural teeth and soft tissue. # Delivery of Treatment R e c o n s t r u c t i v e ### Insertion of Acrylic P/P 3/10/2018      #### Insertion of Acrylic P/P 3/10/2018 Clinical photo showing an occlusal view of the maxillary dental arch with a pink acrylic prosthesis (P/P) in place, demonstrating fit and coverage. Clinical photo showing an occlusal view of the mandibular dental arch with a pink acrylic prosthesis (P/P), illustrating the lower denture's fit. Clinical photo showing a frontal intraoral view of both upper and lower jaws with acrylic partial prostheses inserted, dated 3/10/2018. Clinical photo showing a right lateral intraoral view of the teeth and gums with the acrylic prosthesis fitted. Clinical photo showing a left lateral intraoral view of the teeth and gums with the acrylic prosthesis fitted. **Delivery of Treatment** **Maintenance** * 10/10/2018 * Denture review * 19/10/2018 * Denture review 2 * 21/1/2019 * Periodic oral examination * Plaque score 30% * CPITN * 2 2 * 2 - * Debridement * Fluoride application * 6/6/2019 * Periodic oral examination * Full periodontal chart * Debridement * Refer to oral surgery * 5/7/2019 * Oral hygiene review * Removal of calculus * subsequent visit * Fluoride application * 13/11/2019 * Periodic oral examination * Full periodontal chart * 19/11/2019 * Debridement * Motivation for oral and denture hygiene #### Clinical Procedures and Timeline - **10/10/2018** - Denture review - **19/10/2018** - Denture review 2 - **21/1/2019** - Periodic oral examination - Plaque score 30% - CPITN - 2 2 - 2 - - Debridement - Fluoride application - **6/6/2019** - Periodic oral examination - Full periodontal chart - Debridement - Refer to oral surgery - **5/7/2019** - Oral hygiene review - Removal of calculus (subsequent visit) - Fluoride application - **13/11/2019** - Periodic oral examination - Full periodontal chart - **19/11/2019** - Debridement - Motivation for oral and denture hygiene # Delivery of Treatment Maintenance ## Review appointment 6/6/2019 Denture in situ  #### Review Appointment 6/6/2019 Denture in situ Clinical photo series showing a patient's face with denture in situ from multiple angles (frontal, left profile, right profile, and close-up frontal view), displayed as part of a 'Delivery of Treatment' presentation slide for a review appointment on 6/6/2019. **Delivery of Treatment** Maintenance Review appointment 6/6/2019 Denture in situ Western Australia  #### Review Appointment 6/6/2019 Denture in situ Western Australia Clinical photo series showing a patient's facial features from frontal and profile views with a denture in situ. The images include four panels: two frontal views (one slightly angled), one side profile view, and one full frontal smile view. Green horizontal lines are overlaid on the images to indicate reference planes for dental or orthodontic analysis. # Delivery of Treatment <br> # Periodontal Diagnosis: Generalised periodontitis Stage IV, Grade C  #### Periodontal Diagnosis Generalised periodontitis: Stage IV, Grade C Slide titled 'Delivery of Treatment' containing a structured periodontal diagnostic table for 'Generalised periodontitis Stage IV, Grade C'. The table includes columns for Periodontitis (Stage I–IV), Severity (Interdental CAL, Attachment Loss, Tooth Loss), Complexity (Max probing depth, Radiographic bone loss, etc.), Extent and distribution (% teeth involved), Progression (Primary criteria: Rapid progression vs Slow rate), and Grade modifiers. Rows are organized by clinical parameters with stage-specific descriptors and highlighted yellow cells indicating key findings or classifications relevant to the diagnosis. # Complications/Issues arising from treatment - After the 26 was extracted arrested caries was detected on 25 Distal - PA - Fluoride - Monitor - Secondary impressions - Overfilled the maxillary special tray with PVS - Oral Hygiene - Continual motivation - Maxillary midline during anterior tooth set up - Partially erupted 28 Evans RW, Pokaman A, Dennison P, Howe EL. The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for adults. Australian dental journal. 2008 Mar;53(1):83-92 8/5/2018  #### Clinical Findings and Management - **Caries Management (Tooth 25)**: After the 26 was extracted, arrested caries was detected on the distal aspect of 25. Management plan includes: - Periapical radiograph (PA) - Fluoride application - Continued monitoring - **Prosthodontic Procedures**: - Secondary impressions: Overfilled the maxillary special tray with PVS. - Maxillary midline: Considerations during anterior tooth set-up. - **Patient Education**: - Oral Hygiene: Requirement for continual motivation. - **Other Observations**: - Partially erupted tooth 28. Clinical radiograph showing the maxillary posterior dentition, specifically highlighting the region of tooth #25. The image serves as visual evidence for the 'arrested caries detected on 25 Distal' mentioned in the slide text. Complications/Issues arising from treatment After the 26 was extracted arrested caries was detected on 25 Distal PA Fluoride Monitor Secondary impressions Overfilled the maxillary special tray with PVS Oral Hygiene Continual motivation Maxillary midline during anterior tooth set up Partially erupted 28  #### Clinical Findings and Management - **Caries Management (Tooth 25)**: After the 26 was extracted, arrested caries was detected on the distal aspect of 25. Management plan includes: - Periapical radiograph (PA) - Fluoride application - Continued monitoring - **Prosthodontic Procedures**: - Secondary impressions: Overfilled the maxillary special tray with PVS. - Maxillary midline: Considerations during anterior tooth set-up. - **Patient Education**: - Oral Hygiene: Requirement for continual motivation. - **Other Observations**: - Partially erupted tooth 28. Clinical photograph showing a dental radiograph or X-ray image. It displays the roots of teeth, specifically focusing on the area where tooth 25 is located, consistent with the slide's mention of detecting arrested caries on the distal surface of tooth 25. # Prognosis - Periodontal **Dependent of the ability of the patient to maintain their oral environment** - **Buchmann, Nunn 2002** - 95% success rate after five years - **Bouziane, Benrachadi 2014** - Baseline 7.94mm - Re-evaluation 4.33mm - Post-treatment 3.54mm - Inflammation was resolved and angular bone defects were repaired in all cases **Boxplot showing Mean PPD for Initial PD, PD at re-evaluation, and PD at post treatment. The mean at all stages is lower in Group G2.** - **Smoking showed a 3.8 times increase in non-responding patients – Hughes, Syed 2006** - **Smokers had a 0.7mm less reduction in pocket depths – Darby, Hodge 2005** - Buchmann R, Nunn ME, et al. Aggressive periodontitis: 5-year follow-up of treatment. Journal of Periodontology. 2002 Jun;73(6):675-83. - Bouziane A, Benrachadi L, et al. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. Journal of periodontal & implant science. 2014 Aug;1:44(4):201-6. - Hughes FJ, Syed M, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome. Journal of clinical periodontology. 2006 Sep;33(9):671-6. - Darby IB, Hodge PI, et al. Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. Journal of clinical periodontology. 2005 Feb;32(2):200-6.  The prognosis is dependent on the ability of the patient to maintain their oral environment. #### Clinical Success and Outcomes - **Buchmann, Nunn 2002**: 95% success rate after five years. - **Bouziane, Benrachadi 2014**: - Baseline: 7.94mm - Re-evaluation: 4.33mm - Post-treatment: 3.54mm - Inflammation was resolved and angular bone defects were repaired in all cases. #### Impact of Smoking - Smoking showed a 3.8 times increase in non-responding patients (Hughes, Syed 2006). - Smokers had a 0.7mm less reduction in pocket depths (Darby, Hodge 2005). #### Data Analysis - Boxplot showing Mean PPD for Initial PD, PD at re-evaluation, and PD at post treatment. The mean at all stages is lower in Group G2. #### References - Buchmann R, Nunn ME, et al. Aggressive periodontitis: 5-year follow-up of treatment. Journal of Periodontology. 2002 Jun;73(6):675-83. - Bouziane A, Benrachadi L, et al. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. Journal of periodontal & implant science. 2014 Aug;1:44(4):201-6. - Hughes FJ, Syed M, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome. Journal of clinical periodontology. 2006 Sep;33(9):671-6. - Darby IB, Hodge PI, et al. Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. Journal of clinical periodontology. 2005 Feb;32(2):200-6. Boxplot showing Mean PPD for Initial PD, PD at re-evaluation, and PD at post treatment. The mean at all stages is lower in Group G2. # Prognosis - Periodontal - Dependent of the ability of the patient to maintain their oral environment - Buchmann, Nunn 2002 - 95% success rate after five years - Bouziane, Benrachadi 2014 - Baseline 7.94mm - Re-evaluation 4.33mm - Post-treatment 3.54mm - Inflammation was resolved and angular bone defects were repaired in all cases - Smoking showed a 3.8 times increase in non-responding patients – Hughes, Syed 2006 - Smokers had a 0.7mm less reduction in pocket depths – Darby, Hodge 2005 - Buchmann R, Nunn ME, et al. Aggressive periodontitis: 5-year follow-up of treatment. Journal of Periodontology. 2002 Jun;73(6):675-83. - Bouziane A, Benrachadi L, et al. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. Journal of periodontal & implant science. 2014 Aug 1;44(4):201-6. - Hughes FI, Syed M, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome. Journal of clinical periodontology. 2006 Sep;33(9):671-6. - Darby IB, Hodge PI, et al. Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. Journal of clinical periodontology. 2005 Feb;32(2):200-6.  Prognosis is dependent on the ability of the patient to maintain their oral environment. #### Clinical Success and Outcomes - **Buchmann, Nunn 2002**: 95% success rate after five years. - **Bouziane, Benrachadi 2014**: - Baseline: 7.94mm - Re-evaluation: 4.33mm - Post-treatment: 3.54mm - Inflammation was resolved and angular bone defects were repaired in all cases. #### Impact of Smoking - Smoking showed a 3.8 times increase in non-responding patients (Hughes, Syed 2006). - Smokers had a 0.7mm less reduction in pocket depths (Darby, Hodge 2005). #### References - Buchmann R, Nunn ME, et al. Aggressive periodontitis: 5-year follow-up of treatment. Journal of Periodontology. 2002 Jun;73(6):675-83. - Bouziane A, Benrachadi L, et al. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. Journal of periodontal & implant science. 2014 Aug 1;44(4):201-6. - Hughes FI, Syed M, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome. Journal of clinical periodontology. 2006 Sep;33(9):671-6. - Darby IB, Hodge PI, et al. Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. Journal of clinical periodontology. 2005 Feb;32(2):200-6. Box plot chart titled 'Bouziane et al. 2014' comparing 'Pocket depth (mm)' across three categories: 'Initial PD', 'PD at re-evaluation', and 'PD at post-treatment'. The chart visually demonstrates a significant decrease in pocket depth from baseline to post-treatment, supporting the slide's text stating a reduction from 7.94mm to 3.54mm. # Prognosis - Periodontal - **Dependent of the ability of the patient to maintain their oral environment** - **Buchman, Nunn 2002** - **95% success rate after five years** - **Bouziane, Benrachadi 2014** - **Baseline 7.94mm** - **Re-evaluation 4.33mm** - **Post-treatment 3.54mm** - **Inflammation was resolved and angular bone defects were repaired in all cases** - **Smoking showed a 3.8 times increase in non-responding patients – Hughes, Syed 2006** - **Smokers had a 0.7mm less reduction in pocket depths – Darby, Hodge 2005** - **Buchman R, Nunn ME, et al. Aggressive periodontitis: 5-year follow-up of treatment. Journal of Periodontology. 2002 Jun;73(6):675-83.** - **Bouziane A, Benrachadi L, et al. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. Journal of periodontal practice & implant science. 2014 Jun;14(4):201-6. - **Hughes FI, Syed M, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome. Journal of clinical periodontology. 2006 Sep;33(9):671-6. - **Darby IB, Hodge PI, et al. Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. Journal of clinical periodontology. 2005 Feb;32(2):200-5.</div>  Prognosis is dependent on the ability of the patient to maintain their oral environment. #### Clinical Success and Outcomes - **Buchman, Nunn 2002**: 95% success rate after five years. - **Bouziane, Benrachadi 2014**: - Baseline: 7.94mm - Re-evaluation: 4.33mm - Post-treatment: 3.54mm - Inflammation was resolved and angular bone defects were repaired in all cases. #### Impact of Smoking - Smoking showed a 3.8 times increase in non-responding patients (Hughes, Syed 2006). - Smokers had a 0.7mm less reduction in pocket depths (Darby, Hodge 2005). #### References - Buchman R, Nunn ME, et al. Aggressive periodontitis: 5-year follow-up of treatment. Journal of Periodontology. 2002 Jun;73(6):675-83. - Bouziane A, Benrachadi L, et al. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. Journal of periodontal practice & implant science. 2014 Jun;14(4):201-6. - Hughes FI, Syed M, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome. Journal of clinical periodontology. 2006 Sep;33(9):671-6. - Darby IB, Hodge PI, et al. Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. Journal of clinical periodontology. 2005 Feb;32(2):200-5. Box plot chart titled 'Bouziane et al. 2014' showing 'Pocket depth (mm)' on the y-axis ranging from 2 to 10. The x-axis displays three categories: 'Initial PD', 'PD at re-evaluation', and 'PD at post-treatment'. Each category has a vertical box-and-whisker plot indicating data distribution. The chart visually supports the OCR text stating baseline 7.94mm, re-evaluation 4.33mm, and post-treatment 3.54mm, demonstrating significant reduction in pocket depths. ## Prognosis - Prosthodontic Partial maxillary and mandibular acrylic denture * Survival after five years 86.3 - 100% - **Canadian Agency for Drugs and Technologies in Health 2015** * Survival after ten years 33.3 - 100% - **Canadian Agency for Drugs and Technologies in Health 2015** * Survival after ten years 50% - McCord, Smales 2012 **Carlsson et al. 1962** RPDs can increase occurrence of: * **Caries** * **Damage to the periodontium** * **Increase the amount of trauma on natural teeth** "Hussain et al. 2015" * RPDs can increase dental plaque retention: * **periodontitis** * **gingival recession** * **root caries** * **Increased mobility** "Removable partial dentures requires regular patient recall and high maintenance" -McCord, Smales 2012 #### Partial Maxillary and Mandibular Acrylic Denture Survival - Survival after five years: 86.3 - 100% (Canadian Agency for Drugs and Technologies in Health 2015). - Survival after ten years: 33.3 - 100% (Canadian Agency for Drugs and Technologies in Health 2015). - Survival after ten years: 50% (McCord, Smales 2012). #### Risks Associated with RPDs (Carlsson et al. 1962) RPDs can increase occurrence of: - Caries - Damage to the periodontium - Increase the amount of trauma on natural teeth #### Plaque Retention and Maintenance (Hussain et al. 2015) RPDs can increase dental plaque retention, leading to: - Periodontitis - Gingival recession - Root caries - Increased mobility #### Maintenance Requirements "Removable partial dentures requires regular patient recall and high maintenance" - McCord, Smales 2012 # Prognosis - Prosthodontic ### Partial maxillary and mandibular acrylic denture * Survival after five years 86.3 – 100% - *Canadian Agency for Drugs and Technologies in Health 2015* * Survival after ten years 33.3 – 100% - *Canadian Agency for Drugs and Technologies in Health 2015* * Survival after ten years 50% – *McCord, Smales 2012* #### Carlsson et al. 1962 RPDs can increase occurrence of: * Caries * Damage to the periodontium * Increase the amount of trauma on natural teeth #### Hussain et al. 2015 * RPDs can increase dental plaque retention: * periodontitis * gingival recession * root caries * Increased mobility > "Removable partial dentures requires regular patient recall and high maintenance" > -McCord, Smales 2012 *** * *Longevity of Removable Prosthodontics: A Review of the Clinical Evidence [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2015 Apr 10. SUMMARY OF EVIDENCE. Available from: https://www.ncbi.nlm.nih.gov/books/NBK304786/* * *McCord F, Smales R. Oral diagnosis and treatment planning: part 7. Treatment planning for missing teeth. British dental journal. 2012 Oct;213(7):341.* * *Carlsson GE, Hedegård B, Koivumaa KK. Studies in partial dental prosthesis III. A longitudinal study of mandibular partial dentures with double extension saddles. Acta Odontologica Scandinavica. 1962 Jan 1;20(2):95-119.* * *Hussain KA, Azzeghaibi SN, Tarakji B. Suppl 1: M3: Iatrogenic Damage to the Periodontium Caused by Removable Prosthodontic Treatment Procedures: An Overview. The open dentistry journal. 2015;9:187.* #### Partial Maxillary and Mandibular Acrylic Denture Survival - Survival after five years: 86.3 – 100% (Canadian Agency for Drugs and Technologies in Health 2015). - Survival after ten years: 33.3 – 100% (Canadian Agency for Drugs and Technologies in Health 2015). - Survival after ten years: 50% (McCord, Smales 2012). #### Risks Associated with RPDs (Carlsson et al. 1962) RPDs can increase occurrence of: - Caries - Damage to the periodontium - Increase the amount of trauma on natural teeth #### Plaque Retention and Maintenance (Hussain et al. 2015) RPDs can increase dental plaque retention, leading to: - Periodontitis - Gingival recession - Root caries - Increased mobility #### Maintenance Requirements > "Removable partial dentures requires regular patient recall and high maintenance" > - McCord, Smales 2012 #### References - Longevity of Removable Prosthodontics: A Review of the Clinical Evidence [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2015 Apr 10. SUMMARY OF EVIDENCE. - McCord F, Smales R. Oral diagnosis and treatment planning: part 7. Treatment planning for missing teeth. British dental journal. 2012 Oct;213(7):341. - Carlsson GE, Hedegård B, Koivumaa KK. Studies in partial dental prosthesis III. A longitudinal study of mandibular partial dentures with double extension saddles. Acta Odontologica Scandinavica. 1962 Jan 1;20(2):95-119. - Hussain KA, Azzeghaibi SN, Tarakji B. Suppl 1: M3: Iatrogenic Damage to the Periodontium Caused by Removable Prosthodontic Treatment Procedures: An Overview. The open dentistry journal. 2015;9:187. # Prognosis - Prosthodontic ## Partial maxillary and mandibular acrylic denture - Survival after five years 86.3 - 100% - **Canadian Agency for Drugs and Technologies in Health 2015** - Survival after ten years 33.3 - 100% - **Canadian Agency for Drugs and Technologies in Health 2015** - Survival after ten years 50% - **McCord, Smales 2012** ### Carlsson et al. 1962 RPDs can increase occurrence of: - Caries - Damage to the periodontium - Increase the amount of trauma on natural teeth ### Hussain et al. 2015 RPDs can increase dental plaque retention: - Periodontitis - Gingival recession - Root caries - Increased mobility "Removable partial dentures require regular patient recall and high maintenance" - McCord, Smales 2012 #### Partial Maxillary and Mandibular Acrylic Denture Survival - Survival after five years: 86.3 - 100% (Canadian Agency for Drugs and Technologies in Health 2015). - Survival after ten years: 33.3 - 100% (Canadian Agency for Drugs and Technologies in Health 2015). - Survival after ten years: 50% (McCord, Smales 2012). #### Risks Associated with RPDs (Carlsson et al. 1962) RPDs can increase occurrence of: - Caries - Damage to the periodontium - Increase the amount of trauma on natural teeth #### Plaque Retention and Maintenance (Hussain et al. 2015) RPDs can increase dental plaque retention, leading to: - Periodontitis - Gingival recession - Root caries - Increased mobility #### Maintenance Requirements "Removable partial dentures require regular patient recall and high maintenance" - McCord, Smales 2012  Clinical dental figure showing a side-by-side comparison of two intraoral views: left panel displays teeth with significant discoloration and potential decay, right panel shows improved alignment and cleanliness. The images serve to demonstrate treatment outcomes or diagnostic findings. Thank You and good luck with your own case presentation Dr Lyndon P. Abbott Bmus, DMD lyndon.abbott@uwa.edu.au  Clinical photograph of dental instruments (including forceps and explorers) laid out on a surface, serving as a visual backdrop for the presentation slide titled 'Thank You and good luck with your own case presentation'. 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