On Tuesday, May 2, 2017 McAllister Castelaz DMD 17 delivered the fourth and final presentation in the 2016-2017 series of predoctoral Grand Rounds presentations to an audience of faculty and students in classroom G-301 at the Boston University Henry M. Goldman School of Dental Medicine (GSDM). This was the only Grand Rounds presentation held on a Tuesday, allowing a new group of students, residents, faculty, and staff to attend than the previously held Grand Rounds presentations.
Nearly 100 faculty, students, staff, family, and friends were in attendance for Ms. Castelaz’s presentation, which was—like all predoctoral Grand Rounds presentations—about a treatment plan she developed for an extraordinary patient at her 10-week Externship rotation site located at the Blackstone Valley Community Health Center in Pawtucket, Rhode Island.
All pre-doctoral students in the 10-week Externship program presented their treatment plans to faculty in the Department of General Dentistry. Four finalists were chosen, and Ms. Castelaz’s presentation was selected to give the final Grand Rounds Presentation by Professors Dr. Celeste Kong, Dr. Cataldo Leone, and Dr. Carl McManama.
Dr. McManama also moderated the Grand Rounds presentation.
The case Ms. Castelaz chose for her treatment plan involved a 62 year-old African American female presenting with a broken tooth. The patient had previously been diagnosed with Type II Diabetes and Hypertension, and was taking the following medications; Atorvastatin, Lisinopril, and Metformin. Her previous dental treatment was inconsistent at best, and she had not visited a dentist in over five years. The patient also had a three-unit bridge present in the upper left (UL) quadrant, as well as both successful and failed root canal treated teeth.
After a full medical exam, Ms. Castelaz and the team at Blackstone Valley compiled the following list of findings; wear of maxillary lingual anterior dentition and mandibular canines; edentulous Upper Right , Lower Right, and missing teeth #2, #3, #14, #30, and #31; inadequate root canals on #13 and #15; open margins on a fixed bridge; caries on several posterior teeth (#18, #19, #28, #32); recurrent caries on #4, #8, and #13; occlusal disease on #4, #17, and #32; inadequate coronal coverage of a root canal treated tooth; and erosion on the lingual surfaces of the anterior dentition.
While considering her treatment plan options, Ms. Castelaz considered a handful of influencing factors. First, the patient’s dental insurance didn’t cover the full cost of treatment, including the replacement of crowns and another root canal procedure. Secondly, her preexisting medical conditions (diabetes and hypertension) needed to be taken into consideration by scheduling morning appointments and complying with her medications to ensure a safe blood pressure when using local anesthetics. Lastly, the patient needed to be counseled on improving home care and her diet to ensure successful treatment outcomes.
While some of the procedures could and would be completed at Blackstone Valley Community Health Center, the patient was referred to three specialists for specific treatment; first, to an oral surgeon for the extraction of tooth #17; secondly, to a periodontist for implants on both #14 and #30. The third and final consult was with an endodontist for root canal retreatment of teeth #13 and #15.
Ms. Castelaz designed multiple treatment plans, but the patient finally settled on her four-phase treatment plan. Phase I called for a comprehensive exam, an endodontic consultation for the root canal on #13, followed by a composite tooth implant for #18, the original complaint. Phase II began with adult prophylaxis, then the removal of the partial bridge with hopes of restoring tooth #15. A partial denture was also recommended, as well as the root canal retreatment for #13. The third phase began with the replacement of the composite on tooth #8, followed by amalgam restorations on #4 MO, #19 MOB, and #28 DO. Phase IV, the final phase would occur three months later, where the patient would begin a prescription fluoride toothpaste and mouthwash regimen, as well as receive a post-treatment occlusal analysis.
Following the presentation, a lively conversation and Q&A session ensued among the students, residents, faculty and staff, including Dean Jeffrey W. Hutter.
The Grand Rounds presentations will resume during the 2017-2018 academic year.
“Congratulations and many thanks to McAllister for her successful Externship rotation and Grand Rounds presentation,” said Dean Hutter.