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1. A 65-year-old male patient presents with a history of hypertension, diabetes and smoking.
He has not visited a dentist for over 10 years and complains of bleeding gums and loose teeth.
You perform an oral health assessment and find generalized severe chronic periodontitis with
probing depths of 6-8 mm, bleeding on probing, calculus deposits, tooth mobility and
furcation involvement. What is the most appropriate initial treatment plan for this patient?
a) Scaling and root planing, oral hygiene instruction, smoking cessation counseling and
referral to a periodontist.
b) Extraction of all teeth, denture fabrication and referral to a physician for medical
management.
c) Fluoride varnish application, oral hygiene instruction, smoking cessation counseling and
referral to a dentist for restorative treatment.
d) Scaling and root planing, oral hygiene instruction, smoking cessation counseling and
antibiotic therapy.
*Answer: a) Scaling and root planing, oral hygiene instruction, smoking cessation counseling
and referral to a periodontist.*
Rationale: This is the most appropriate initial treatment plan for a patient with severe chronic
periodontitis, as it aims to reduce the inflammation, infection and risk factors, and to consult
with a specialist for further evaluation and management.
2. A 25-year-old female patient presents with a history of bulimia nervosa and frequent
vomiting episodes. She has not visited a dentist for over 5 years and complains of tooth
sensitivity and enamel erosion. You perform an oral health assessment and find generalized
moderate erosion of the enamel on the palatal surfaces of the maxillary teeth and the occlusal
surfaces of the mandibular teeth. The teeth also show signs of attrition and abrasion. What is
the most appropriate initial treatment plan for this patient?
a) Fluoride varnish application, oral hygiene instruction, dietary counseling and referral to a
dentist for restorative treatment.
b) Scaling and root planing, oral hygiene instruction, dietary counseling and referral to a
psychologist for behavioral therapy.
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