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This book is designed to explain to dental students the processes of diagnosis and treatment planning, through consideration of clinical cases and problems associated with aspects of all dental specialties. It presents a series of case histories from all the major areas of dentistry, and uses a question-and-answer format to guide readers through the process of examination, differential diagnosis, investigations, diagnosis and treatment. It prepares readers for the wide variety of problems likely to be encountered in clinical practice. 56 cases in clinical dentistry are presented in a practical, problem-based approach, leading the reader toward the correct diagnosis and treatment. | SECOND EDITION Clinical Problem Solving in Dentistry A high caries rate Summary A 17-year-old sixth-form college student presents at your general dental surgery with several carious lesions one of which is very large. How should you stabilize his condition Fig. 1.1 The lower right first molar. The gutta percha point indicates a sinus opening. HISTORY Complaint He complains that a filling has fallen out of a tooth on the lower right side and has left a sharp edge that irritates his tongue. He is otherwise asymptomatic. History of complaint The filling was placed about a year ago at a casual visit to the dentist precipitated by acute toothache triggered by hot and cold food and drink. He did not return to complete a course of treatment. He lost contact when he moved house and is not registered with a dental practitioner. Medical history The patient is otherwise fit and well. EXAMINATION Extraoral examination He is a fit and heal thy-looking adolescent. No submental submandibular or other cervical lymph nodes are palpable and the temporomandibular joints appear normal. Intraoral examination The lower right quadrant is shown in Figure 1.1. The oral mucosa is healthy and the oral hygiene is reasonable. There is gingivitis in areas but no calculus is visible and probing depths are 3 mm or less. The mandibular right first molar is grossly carious and a sinus is discharging buccally. There are no other restorations in any teeth. No teeth have been extracted and the third molars are not visible. A small cavity is present on the occlusal surface of the mandibular right second molar. What further examination would you carry out Test of tooth vitality of the teeth in the region of the sinus. Even though the first molar is the most likely cause the adjacent teeth should be tested because more than one tooth might be nonvital. The results should be compared with those of the teeth on the opposite side. Both hot cold methods and electric pulp testing could be used because .
