Posted: May 24th, 2022

Dental Case Study analysis

Dental Case Study

The patient in the case that is presented is a Latino male just over 13 years old. He has sickle cell anemia, and suffers from an intellectual disability. This paper reviews the case study from a dental health perspective.

What is sickle cell anemia? The genesis of this disease is found within the abnormal hemoglobin in the blood stream; the red blood cells that carry oxygen throughout the body change shape when the individual has sickle cell anemia. Hemoglobin S. has the effect of changing the shape of the red blood cells so that they become “fragile, sickle-shaped” and they bring less oxygen to the tissues of the body (National Library of Medicine). Moreover, the shape of the changed red blood cells means that cells can become “stuck more easily in small blood vessels” and they also break into many pieces which of course reduces the amount of oxygen to the body’s tissues. The patient suffers from fatigue, from a rapid heart rate, his eyesight suffers, he has ulcers on the lower legs in many instances and his ability to think is reduced (National Library of Medicine). Painful episodes may last for several days; they are called “crises” and when a sickle cell patient has a crisis he is in severe pain (the bones in the back and chest are especially vulnerable to these attacks) (National Library of Medicine).

Why was this patient chosen for a case study — what are his needs? According to author Amr Moursi, Associate Professor and Chairman of the Department of Pediatric Dentistry at the New York University College of Dentistry (Moursi, 2012), the 13-year-old was a recent immigrant to the U.S. from the Dominican Republic, and he clearly needed to see a dentist for his decaying teeth. Brief background: His mother speaks only Spanish but his father is bilingual so when the boy goes to the hospital (he has been hospitalized four times for sickle cell crises) both mother and father are present. The father indicated that the boy was “extremely resistant to oral home care,” and as a result he doesn’t brush his teeth. He was been on penicillin prophylaxis through the first nine years of his life but when he went to the dentist he was not on any medication. The hematologist asked that the boy be admitted to the hospital for a day when the dental work was to be conducted.

He needed to be placed under general anesthesia (GA) and needed to be monitored for his levels of hemoglobin; the doctor believed that a blood transfusion may be necessary. Because he is a patient with sickle cell, prior to his treatment the dentist needs to know: when his last vaso-occlusive crisis occurred; was there any damage to any organs; his history of transfusions; what infections has he had; and what psychosocial issues he has experienced recently.

Dental care and dental examination for this patient: The patient has a “highly cariogenic” diet because he snacks frequently on sweets and drinks large quantities of fruit juices (Moursi, 298). His extra-oral exam showed that he has “marked strabismus” and has “proclined maxillary incisors, indentations in lower lip due to pressure from incisors” (Moursi, 298). His intro-oral exam showed that there is: “permanent dentition with rampant cervical dental caries”; “mandibular incisor retrusion can be seen secondary to large overjet and lip pressure”; “gingival enlargement”; “pallor of oral soft tissues”; and “pulp stones” (Moursi, 299).

The boy has “rampant dental caries” and the gingival inflammation is serious; he also has a “deep overbite” (10-mm overjet and 100% overbite) Moursi explains. The boy risks periodontal infection at the time he was examined and the doctors noted that he must be under general anesthesia each time he goes through an exam or a procedure.

Prognosis: A full-mouth series of radiographs will be taken to determine which teeth might be restorable. After those radiographs are reviewed it was determined that the anterior teeth can be restored with “composite resin,” and the posterior teeth can be treated “with stainless steel crowns,” Moursi explains on page 299. A dentifrice with a “high fluoride concentration” must be prescribed and when he is under GA, a fluoride treatment will be applied. Also, the boy’s parents will need to develop strategies to achieve much better oral hygiene in the future. His diet must be modified as well, Moursi writes.

The prognosis for better maintenance of this patient is not good, the author explains. “Unless the parents make a concerted effort to improve their son’s daily oral hygiene,” he may need to have several teeth extracted (Moursi, 299). Should there be a need to extract his teeth, this patient “is not a good candidate for replacement with fixed prosthesis” (Moursi, 299). What Moursi doesn’t mention — but is an important consideration — is that because sickle cell sufferers are sensitive to light, the boy “should be offered sunglasses to wear while the examining light is being used” (Raposa, et al., 2012).

Patient education: After the treatment this boy is to be brought back in every three months so that the dentist can: a) continue to evaluate oral hygiene status and talk to the parents about their success (or failure) in teaching the boy to brush his teeth; in other words, have the techniques shared with the parents been effective? b) review the recommendations in terms of the healthier diet the boy should be following; to wit, have the parents succeeded in making the changes to his diet, which is problematic due to his intellectual challenges; and c) the restored teeth in the boy’s mouth must be carefully checked as well.

Works Cited

Moursi, Amr M., da Fonseca, Marcio A., and Truesdale, Amy L. (2012). Clinical Cases in Pediatric Dentistry. Hoboken, NJ: John Wiley & Sons.

National Library of Medicine. (2011). Sickle Cell Anemia. Retrieved November 13, 2012, from http://www.ncbi.nim.nih.gov.

Raposa, Karen A, and Perlman, Steven P. (2012). Treating the Dental Patient with a Developmental Disorder. Hoboken, NJ: John Wiley & Sons.

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