Oral Diagnosis and Oral Medicine Competency

1. Oral Diagnosis and Oral Medicine Competency Collette Lucas Patient Number 487-9-07 Pictures – 09-13-2010

2. The Patient • 55 year old white male • Patient was diagnosed with epilepsy at age 6 after contracting measles and was in a coma for a month • Patient had to relearn everything physically and mentally • Last petite mal seizure was in 2009 but reports that he has never hurt himself during an epileptic seizure • Patient has high also has high cholesterol

3. Medications • Aspirin • Clonazepam • Depakete - anticonvulsant • Dilantin - anticonvulsant • Flomax – alpha blocker • Folic Acid • Keppra – anticonvulsant • Lipitor – high cholesterol • Paroxetine – antidepressant • Synthroid – hyporthyroidism • Vitamin B Complex • Patient reported taking tetracycline in the past

4. The Lesion • Is a yellow/brown discoloration in horizontal lines. This staining is located on all teeth in the maxillary and mandibular arches. The darkness of the color varies from tooth to tooth. The borders of the discoloration are well defined and diffuse throughout the oral cavity.

9. Doctor Patient Dialogue • How long have you had this discoloration? When did you first notice it? • Have you ever taken the antibiotic tetracycline? If so how old were you when you took this medication? For how long did you take this medication? If no did your mother take tetracycline during her pregnancy? • Have you ever tried bleaching your teeth? Id so did the bleach affect the color of your teeth (esp. the darker horizontal bands) • Has this discoloration gotten worse or stay the same over time? • Do you smoke? If so for how long have you smoked? • Have you ever experienced any trauma to your mouth?

10. Diagnosis • Differential diagnosis is tetracycline staining. Due to the fact that the discoloration is present throughout the entire oral cavity and only occurs on the gingival third of the teeth in a horizontal band fits the physical description of tetracycline perfectly • My second differential diagnosis is staining from acquired behaviors such as smoking or coffee drinking. Staining though out the oral cavity in the gingival third can also be cause by extrinisc means such as smoking or coffee drinking

11. Diagnosis • Provisional Diagnosis: Tetracycline staining – based on the information gathered from the doctor patient dialogue it is clear that this is not an extrinsic stain rather and intrinsic stain that cannot be removed through bleaching methods. Furthermore, because this patient developed the staining at a young age and the stain has not progressed further would indicate tetracycline staining. The horizontal bands of varying levels of intrinsic discoloration points directly to tetracycline staining. Furthermore, this patient reports taking tetracycline at a young age but fails to remember the exact reasoning for taking the broad spectrum antibiotic. Therefore, everything adds up and all signs indicate tetracycline as the culprit

15. Treatment and Prognosis • Tetracycline stains do not respond well to bleaching as the stain is intrinsic therefore… • Tetracycline staining can be treated by cosmetic dentists that use porcelain veneers to mask the discoloration of the tooth. Complications of a gray appearing tooth can occur if the dentist uses ordinary materials because theses will still allow the deep stains to come through therefore, a cosmetically experienced dentist should handle these cases.