On Wednesday, January 31, 2018, Valerie LaScala DMD 18 gave the third Grand Rounds presentation of the academic year at the Henry M. Goldman School of Dental Medicine (GSDM). Dr. Carl McManama, Professor in general Dentistry, moderates all Grand Rounds presentations, which showcases students’ treatment plans from their 10-week Externship rotation. The students that are is selected to present their respective cases in a Grand Rounds format is chosen based upon the quality of their case and the accompanying documentation.
Ms. LaScala spent her Externship in Fort Meyers, Florida at the FirstChoice KidCare from July 31, 2018 – October 10, 2018. What made her experience so unique was her mandatory hurricane evacuation, causing her to miss some of the patient’s treatment. As such, much of her treatment plan had to be hypothetical.
Her patient was a 50-year-old African-American male with Asperger Syndrome. He was also HIV positive and suffered from anxiety. He presented with multiple missing teeth, including #12, #14, #18, #19, #28, #30, and #31. His chief complaint was his inability to chew food, but he had a lengthy list of issues that would need to be addressed over time.
The patient also had a history of poor oral hygiene and had had multiple extractions, composite fillings, and a PFM crown. After a full exam, Ms. LaScala and her mentors informed the patient that he would require root canal treatment on tooth #11 due to it having a periapical lesion, address his primary complaint of difficulty in chewing, restore teeth that had caries, treat his generalized gingival recession, and address the crown or root remnants on teeth #1, #13, and #28.
Ms. LaScala crafted a four-phase treatment plan for the patient. After the initial diagnostic assessment, they would begin stabilization treatment. This entailed root canal therapy on tooth #11, extraction of the root and crown remnants on teeth #1, #13, and a facial composite on tooth #28 , periodontal intervention by a periodontist, and fabrication of upper and lower transitional acrylic dentures. Following stabilization, they would need to reassess the patient’s needs before deciding the next steps.
Due to some financial limitations regarding insurance coverage of dental implants, the best care plan called for rehabilitation via partial dentures. Recall visits by the patient would be of the utmost importance in order to monitor the fit of his dentures, assess his prosthodontic issues, and assess his caries risk.