Hey everyone,

Patient came in today for a COE and I noticed a strange radiolucency on her PAN and PA's. She didn't present with any history of pain on the lower anteriors. Pulp vitality tests were inconclusive due to the crowns. I have the following questions:

1. What do you think the radiolucencies are?
2. The patient has limited finances (I'm in dental school). How would you approach this case if she cannot afford FMR (hence she's not referred to PG Prosth or Perio)
3. How do you treat a tooth with severe buccal recession and cervical erosion? I can't imagine prepping these for crowns and having a clear margin on the buccal.

I included my notes for convenience,

Thanks gang!

SUBJECTIVE

54 yo Female Caucasian presents with CC "I need a deep cleaning and I want to try to fix my teeth while keeping much of them as I can."
MHx: History of bulimia (claims no longer), Seizures once a year since 2013, Stroke 2016 (single occurrence and only lost fine motor skills)
Rx: Gabapentin
DHx: Last visit to a dentist was 2002 for the anterior crowns. Pt brushes twice a day and flosses but no professional cleaning. Pt does not eat sweets but snacks on fruits 3-5x/day. Pt claims to grind at night and during day when stressed. No recent history of dental pain.
SHx: Pt is a recovering alcoholic since last year. Smokes half a pack daily. Started at age 18. Roughly 18 pack years.

OBJECTIVE

EOE: No LAD nor pain upon palpation; no gross assymetry
IOE: Generalized gingival erythema, edema, and blunting. Probings 1-5mm. Recession 2-5mm throughout with furcation involvement. Several erosive patterns and wear facets on occlusal and buccal surfaces.
Radiographs: Large periapical radiolucencies #25-28

#25-28 percussion - , palpation - , PD 1-3mm , cold WNL, EPT inconclusive, mobility class I - II

ASSESSMENT

Moderate Generalized Chronic Periodontitis
#25-28 inconclusive (referred to radiology for further evaluation with CBCT)

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