Lillie M. Pitman, DMD


March 13, 2013

Clinical Presentation

A 58-year-old black woman, referred by a prosthodontist, presented to the dental office. She stated, "My bridge is loose, and I need a tooth pulled." She reports having had a "toothache" for the past 2 years, during which time she has been placing a small piece of cotton dipped in over-the-counter "gum pain reliever" next to the aching tooth. She has had the current fixed partial denture for more than 5 years.

History and Dental Examination

History. The patient's medical history is significant for asthma, for which she was hospitalized 5 years earlier. She uses an inhaler (albuterol sulfate) and a nebulizer daily. She reports an allergy to morphine.

Dental examination. Extraoral examination reveals no facial asymmetries or swelling. Intraoral examination reveals large diastema, whitish material in the sulcus of tooth 9 distal, and caries through and through under the fixed partial denture on tooth 9 (Figure 1).

Figure 1. Note the cotton pellet in the gingival sulcus of tooth 9 and the slight gingival swelling on the facial surface of this tooth.