NBDHE case studies 17 - 29

Case 17

Your patient is a 60-year old Caucasian male who is a sales representative for a national company and is on the road most of the time. He is married and has adult children who live in another state.

If anesthesia were to be required to debride the teeth with furcations and deeper pockets, what would be the best choice of an anesthetic agent for this patient, taking into consideration, his medical history?

A. Lidocaine HCL 2% with epinephrine 1:100,000

B. Articaine HCL 4% without epinephrine

C. Prilocaine HCL 4% Plain

D. Bupivicaine HCL 0.5% with epinephrine 1:200,000

A

Taking into consideration, the patient’s clinical, radiographic and historical findings, how would you classify his periodontal condition based on the 2018 AAP Classification of Periodontal and Peri-Implant Diseases?

A. Stage II, Grade B

B. Stage III, Grade B

C. Stage III, Grade C

D. Stage IV, Grade B

B

Given the patient’s blood pressure reading, how would you classify it based on the new AHA/ACC Guidelines?

A. Normal

B. Elevated

C. Stage 1

D. Stage 2

D

Of the medications that the patient is currently taking, which might be responsible for his current blood pressure reading?

A. Prilosec should not be taken with Amlodipine

B. Motrin should not be taken with Prilosec

C. Amlodipine and Ramipril should not be taken with Ibuprofen

D. Ramipril and Amlodipine should not be taken together

C

Given the amount of deposit, pocket depths, and bleeding index, what would be the best approach for a dental hygiene care plan?

A. Quadrant scaling with local anesthesia, using both ultrasonics and hand instruments, polishing of the teeth

B. Ultrasonic scaling throughout the mouth, followed by some hand scaling if necessary, selective polishing

C. Hand scaling of all areas of the mouth, polishing of all teeth and topical fluoride application

D. Local anesthesia for #2 & # 31, ultrasonic scaling of all areas of the mouth followed by hand scaling if necessary

D

Upon observing the patient’s study models, how would you BEST describe the patient's centric occlusion?

A. Open bite

B. Overjet

C. End-to-end

D. Crossbite

B

The posterior bitewing radiographs on the right side demonstrate a technique error due to:

A. Insufficient vertical angulation

B. Excessive vertical angulation

C. Film packet placement

D. Horizontal angulation of the cone

C

The facial characteristics at the gingival margins observed on both teeth #8 and #9 are most likely due to what?

A. Bruxism habit

B. Sucking on acidic lozenges

C. Clenching habit

D. Scrub brushing

B

The patient indicated that he has been getting recurrent painful ulcers in his mouth since he quit smoking, what do you suspect these ulcers might be?

A. Herpetic lesions

B. Traumatic ulcers

C. Apthous ulcers

D. Acid reflux

C

After discussing his brushing and flossing technique with him, what other home care recommendations would you make for him?

A. Purchase a power toothbrush; use a toothpaste with stannous fluoride; use a proxabrush between the posterior teeth

B. Use an air flosser; sodium fluoride toothpaste; and an alcohol-based mouthrinse

C. Switch to a soft bristled toothbrush; a desensitizing toothpaste; and use a toothpick in the deeper pockets and furcations

D. Use a stannous fluoride toothpaste; an essential oils mouthrinse; and a floss threader

A

Case 18

The patient is a 68-year old Caucasian male who is semi-retired from farming. He has been a smoker for almost 40 years and has had a few health issues. He is reluctant to totally quit farming as he is helping his son take over the farm. He is 5'10" tall and weighs 185 lbs.

Despite being on an antihypertensive medication, this patient's blood pressure is still in Stage II. What is the most likely explanation for this occurrence?

A. The combination of Diltiazem and Aleve elevates blood pressure

B. BMI falls within the "obese" category

C. The combination of aspirin and Aleve elevates blood pressure

D. He is overweight and smokes

A

The patient's daily use of NSAIDs and aspirin can increase his risk for:

A. Xerostomia

B. GI side effects

C. Kidney problems

D. Bleeding problems

B

What BEST identifies the cause for loss of tooth structure observed in the maxillary occlusal intraoral image?

A. Abrasion

B. Erosion

C. Attrition

D. Abfraction

C

Based on the clinical, radiographic and historical findings, how would you classify the periodontal status of this patient according to the 2018 AAP Classification of Periodontal and Peri-implant diseases?

A. Stage 1, Grade B

B. Stage II, Grade B

C. Stage III, Grade C

D. Stage IV, Grade C

C

What was the main reason for your selection of the “Grade” category in the above question?

A. Pocket depths

B. Clinical attachment loss

C. Bone loss

D. Presence of risk factors

D

After making adjustments to his scrub-brushing technique, what other oral hygiene home care recommendations would you make for this patient?

A. Whitening toothpaste; power toothbrush; interdental brush; floss threader

B. Stannous fluoride toothpaste with whitening agent; power toothbrush; floss wand; toothpick for furcation

C. Professional in-office whitening; use of a more abrasive toothpaste; flossing; tongue cleaner

D. Over-the-counter whitening agents; interdental brush; tongue cleaner; fluoridated toothpaste

B

What is the radiopaque U-shaped formation observed on the maxillary left molar periapical radiograph?

A. Wall of the maxillary sinus

B. Hyoid bone

C. Zygomatic process of maxilla

D. Air space

C

The patient's medical history findings indicate risk for all of the following EXCEPT:

A. Cardiovascular disease

B. Gastrointestinal issues

C. Gout

D. Cancer

C

Based on the patient's history and examination findings, what is the most urgent recommendation that you should make for the patient?

A. Have the facial nevi checked out by a dermatologist

B. Refer the patient to a periodontist

C. Stop taking Prilosec

D. Quit smoking

A

The bilateral rounded bony projections located on the lingual mandibular areas adjacent to the premolar teeth are most likely:

A. Osteomas

B. Irritation fibromas

C. Mandibular tori

D. Sarcomas

C

Case #19

Patient Profile:

The patient is a 67-year old Caucasian male who is recently retired and lives with his wife. He was the CEO of a large lumber company for the last 20 years of his career. He is 5’9” tall and weighs, 200 lbs. He has had extensive dental work done in the past, with multiple restorations and crowns. He has been a patient in your practice for over 25 years and has been attending regular periodontal therapy and maintenance appointments at recommended intervals. Today is his 6-week re-evaluation appointment after having had 2 previous appointments for scaling and root planing.

Upon examination of the radiograph of the maxillary incisors, what percentage of bone loss is visible on tooth #8?

A. 20%

B. 33%

C. 50%

D. >50%

D

The patient exhibits mobility in the mandibular anterior region. What BEST describes this classification?

A. No greater than 1 mm of visible movement

B. A combination of facial & lingual movement of 2-3 mm

C. A combination of facial & lingual movement totaling 2 mm with the tooth depressible in its socket

D. A combination of facial & lingual movement of 3 mm with the tooth depressible in its socket

a

Taking into consideration this patient’s clinical, radiographic and historical information, how would you classify his periodontal condition based on the 2018 AAP Classification or Periodontal and Peri-implant Diseases?

A. Stage III, Grade B

B. Stage III, Grade C

C. Stage IV, Grade B

D. Stage IV, Grade C

d

Although the patient’s efforts to arrest the progression of his periodontal disease has been good, based on this re-evaluation appointment, what justifies your classification of the Grading choice that you made in the above question?

A. Pocket depths ≥6mm

B. CAL 3-5mm

C. Past history of smoking

D. BOP >10%

c

The radiopaque areas observed in the mandibular anterior periapical radiographs are MOST likely:

A. Compound odontomas

B. Mandibular tori

C. Non-odontogenic cyst

D. Artifacts

b

The patient expresses concern about the continuing separation of his front teeth. Your BEST explanation for this is:

A. Aging

B. Gingival recession

C. Continued bone loss

D. Bleeding upon probing

c

Given the blood pressure readings that you recorded over this patient’s last three appointment, how would you classify these readings according to the new AHA/ACC guidelines?

A. Normal

B. Elevated

C. Stage 1

D. Stage 2

d

Taking into consideration the patient’s height and weight you calculate his BMI to be 29.5 Kg/m2. How would you interpret this reading?

A. Underweight

B. Normal

C. Overweight

D. Obese

c

Based on your responses to questions # 7 & 8, what would you discuss with your patient?

A. He may be at risk for cardiovascular disease

B. He is in good health overall

C. He should make an appointment with his physician to check out his blood pressure

D. A and C

d

The patient has expressed interest in having his teeth whitened. You give him the following advice all of which is correct EXCEPT which one?

A. Continue to use a stannous fluoride toothpaste but purchase one that has a whitening agent in it as well.

B. Whitening will not harm his porcelain crowns, however they will have no whitening effect.

C. Do not use any whitening products on his porcelain crowns as they will cause damage to them.

D. Purchase and use whitening strips on the mandibular anterior teeth.

c

Case 20

The patient is a 50-year old Caucasian male who has been divorced for 5 years. He just recently met someone and has become very self-conscious about the stain on his front teeth. He teaches part time in a community college and also has a small business on the side. He claims he is in good health but does disclose that he is a smoker. He indicates he is overdue for dental care. He is 5’11” tall and weighs 185 lbs.

According to G.V. Black's classification of restorations, what is the classification for tooth #30?

A. I

B. II

C. III

D. IV

B

Based on his clinical, radiographic and historical findings, how would you classify his periodontal case type according to the 2018 AAP Classification of Periodontal and Peri-Implant diseases?

A. Case Type I, Grade B

B. Case Type II, Grade B

C. Case Type III, Grade C

D. Case Type IV, Grade C

c

What was the determining factor for your Case Type choice in the above question?

A. Direct Evidence of disease progression

B. Smoking more than 10 cigarettes daily

C. Indirect evidence of disease progression

D. Presence of furcations

d

In reviewing the patient's profile and chief complaint, the dental hygiene care plan should include all of the following recommendations EXCEPT:

A. Chew sugarless gum to stimulate saliva formation

B. Stannous fluoride dentifrice with both pyrophosphate and hydrogen peroxide ingredients

C. Smoking cessation program

D. Switch to a non-alcoholic mouth rinse

d

What aspect of his daily home care regimen requires enhancement?

A. Use of a floss wand to help him with his interproximal cleansing.

B. Use of an interdental brush to cleanse the posterior regions of his mouth.

C. Use of a fluoridated mouthrinse.

D. Use of a more abrasive toothpaste to tackle his stain.

B

The mandibular left second molar exhibits a furcation that can BEST be described as:

A. Not detectable radiographically.

B. Clinically open and exposed.

C. A through-and-through involvement but is still covered by soft tissue.

D. The involvement can be entered with a probe but cannot pass through to the opposite side.

c

What BEST describes the occlusal relationship between tooth #12 and #20?

A. Open bite

B. Overjet

C. Crossbite

D. End-to-end bite

c

Super-eruption is indicated on which tooth?

A. Tooth #3

B. Tooth #30

C. Tooth #31

D. Tooth #19

c

The bone loss visible on the radiographs is PRIMARILY:

A. Horizontal

B. Vertical

C. Both horizontal and vertical

D. Circumferential

a

Taking the patient’s past medical history into consideration, what aspect of his treatment would you make adjustments to?

A. Recline the dental chair in slow increments

B. Increase the length of his appointments to reduce the number of visits required

C. Treat him in a more upright position

D. Ensure that he has safety glasses to protect his contact lenses

c

This patient is a 75-year old Caucasian female who has been treated in the dental hygiene clinic for several years. She has been retired for over 10 years from the school board where she was an administrative assistant to one of the department heads. She is widowed and spends most of her free time now babysitting her 10-year old granddaughter after school. She is a tea drinker and a social smoker, but she reports only having the odd cigarette with a glass of wine when she is out playing cards with her friends, usually once a week. She is 5’2” tall and weighs 170 lbs.

CASE 22

The clinician’s error resulting in the radiographic image demonstrated in the maxillary right posterior periapical is due to:

A. Incorrect cone placement

B. Decreased vertical angulation

C. Incorrect film placement

D. Incorrect horizontal angulation

C

According to the new AHA/ACC blood pressure guidelines, how would you classify this patient's blood pressure reading?

A. Normal

B. Elevated

C. Stage I

D. Stage II

d

Upon calculating this patient’s Basal Metabolic Index (BMI) at 31.1, how would you classify her weight?

A. Underweight

B. Normal

C. Overweight

D. Obese

d

Given the patient’s medical history and additional findings, what health information would you discuss with this patient?

A. She is in good health overall.

B. She may be at risk for cardiovascular disease and should see her physician.

C. She should quit smoking to lower any potential risk for overall health issues.

D. She is at high risk for cancer given her kidney hydronephrosis, polyps and facial nevus.

b

Based on the patient’s clinical, radiographic and historical findings, how would you classify her periodontal condition according to the 2018 AAP Classification of Periodontal and Peri-implant diseases?

A. Periodontal Health

B. Case Type 1, Grade B

C. Case Type II, Grade B

D. Case Type III, Grade B

a

You note that the incisal edges of her mandibular incisors are quite worn. What would you attribute the cause of this “wear” to be?

A. Too heavy a bite

B. It is a normal part of aging

C. From drinking too many acidic types of drinks

D. Grinding her teeth at night

d

Upon studying the radiographs, what might explain the “sensitivity” the patient has complained about between her maxillary molars?

A. Deep periodontal pockets

B. Overhanging amalgam restorations

C. Carious lesions

D. Cracked tooth syndrome

c

The patient has demonstrated her brushing technique to you. What recommendations would you make that could help her to change to a better mode of brushing?

A. Purchase a soft bristled toothbrush and show her how to brush her upper and lower teeth separately

B. Purchase a power toothbrush with a rounded end that can be placed on each tooth individually

C. Praise her and tell her that she is doing an excellent job, no change in technique is required

D. Switch to a medium bristled toothbrush and use a circular motion rather than a scrubbing motion

b

What other home care recommendations do you think would MOST benefit this patient?

A. Ensure that she is using a toothpaste with stannous fluoride; demonstrate the use of an interdental brush; use of superfloss to cleanse under her 2 bridges

B. Demonstrate use of a floss threader to clean under her bridges; recommend she use a floss wand to improve her flossing in other areas; use a sodium fluoride toothpaste

C. Use a toothpick to clean under her bridges; demonstrate use of a floss wand throughout her mouth; use a baking soda toothpaste as it is less abrasive

D. Rinse her mouth daily with a non-alcoholic mouthrinse; use an interdental brush to clean under her bridges; use a floss threader in all other areas

a

What would you attribute the cause of the extrinsic stain to be that you note on most of her lingual surfaces?

A. Drinking wine

B. Cigarette smoking

C. Drinking tea

D. B and C

d

CASE 23

Your patient is a very personable 35-year old Caucasian male, whom you have not seen previously in your practice. He indicates he worked in Africa for the World Health Organization as a nurse for one year and returned home last year. He is now employed at one of the hospitals in the area. He did visit a dental hygienist when he returned from Africa and had some therapy done at that time but is now overdue for a maintenance appointment. He has several crowns on his teeth and is concerned about keeping his mouth healthy. Although he is under the care of a physician and is on multiple medications, he works out regularly and considers himself healthy. He claims he is very health conscious and eats well.

This patient is on multiple medications but has not disclosed why they are being taken other than prophylactically and claims he is in good health. What is this combination of drugs typically used for?

A. HIV/AID

a

After examining his clinical and radiographic findings, how would you classify his periodontal condition according to the 2018 AAP classification of Periodontal and Peri-implant diseases?

A. Gingivitis

B. Stage I, Grade A

C. Stage II, Grade B

D. Stage III, Grade C

c

What were the determining factors for making the diagnostic decision in the question above?

A. No CAL; no bone loss; bleeding index >10%; pocket depths ≤3mm; no tooth loss due to periodontal disease

B. CAL 1-2mm; horizontal bone loss; bleeding index >10%; pocket depths ≤5mm; tooth loss due to periodontal disease

C. Presence of risk factors; BOP >25%; pocket depths 3-4 mm; bone loss over 1/3rd of root; CAL 4-5mm

D. CAL of 3-4 mm; bone loss in coronal third; Pocket depths ≤4mm; no tooth loss due to periodontal disease

d

What is the most accurate statement regarding the thrombosed varix appearing on this patient’s lip?

A. It could be a premalignant lesion and should be removed as soon as possible.

B. It is an acquired benign vascular lesion that does not required removal unless the patient wishes.

C. This type of lesion is often found to be malignant and should be biopsied.

D. Although benign, this type of lesion has the propensity to continue growth and should be removed.

b

The gingival inflammation in the mandibular anterior sextant is MOST likely attributed to:

A. His current medical condition

B. An adverse reaction to his current medication

C. Oral biofilm being in a state of Dysbiosis

D. Malocclusion of his mandibular anterior teeth

c

After reviewing his power toothbrushing technique, what other home care recommendations would you make for this patient?

A. Ensure that his fluoridated toothpaste is stannous fluoride; introduce a floss wand to assist him with flossing; demonstrate use of an interproximal brush for the 4mm pockets.

B. Ensure that his fluoridated toothpaste is sodium fluoride, not stannous fluoride; go over brushing technique with him in all areas.

C. Ensure he continues to use either a stannous or sodium fluoride toothpaste; use of a floss wand; rinse daily with a CPC mouthrinse.

D. Use any toothpaste that has antimicrobial properties; review flossing technique for all areas of the mouth; rinse daily with a a salt water solution.

a

What classification BEST describes the interarch relationship of teeth #10 and #22?

A. Excessive overbite

B. Open bite

C. End-to-end

D. Anterior crossbite

d

Given the prophylactic medications that this patient is currently taking, what medical tests would he be required to take regularly in order to monitor the effects of the medication?

A. HbA1c and blood glucose values

B. CD4 Count and Viral load test

C. Blood pressure and cholesterol readings

D. CT scans every 6 months

b

Using the G.V. Black's classification of restorations, what describes the restoration on tooth #9?

A. Class I

B. Class II

C. Class III

D. Class IV

c

What periodontal maintenance interval would you recommend for this patient given his current oral and medical condition?

A. 3 months

B. 4 months

C. 6 months

D. 1 year

a

Case 24

The patient is a 62-year old Caucasian female who is an elementary school teacher. She indicates she loves her career and is not looking forward to retirement as she has no children of her own. She has always taken good care of her teeth but has lost a few due to periodontal disease. She has been on a 3-month periodontal maintenance program for several years. She considers herself in good physical condition and plays tennis twice a week with her husband.

After evaluating the patient’s medical history, clinical and radiographic findings, how would you classify this patient’s periodontal condition based on the new 2018 AAP guidelines for Periodontal and Peri-implant Diseases?

A. Stage I, Grade A

B. Stage II, Grade B

C. Stage III, Grade B

D. Stage IV, Grade B

c

Under which of the American Society of Anesthesiologists (ASA) categories for physical condition, does this patient fall under?

A. ASA I

B. ASA II

C. ASA III

D. ASA IV

b

According to the new blood pressure guidelines published by the AHA/ACC, how would you categorize this patient?

A. Normal

B. Elevated

C. Stage I Hypertension

D. Stage II Hypertension

b

In assessing the radiographic image of tooth # 30, how would you best describe the bone loss and type of pocket that you observe on the distal side of the tooth?

A. Horizontal bone loss with an infra-bony pocket

B. Horizontal bone loss with a supra-bony pocket

C. Vertical bone loss with an infra-bony pocket

D. Vertical bone loss with a supra-bony pocket

c

What would improve the diagnostic quality in the left premolar bitewing radiograph?

A. Straighten out the film placement anteriorly

B. Decrease the vertical angulation

C. Position film placement posteriorly

D. Increase the mA setting

a

How would you address her question and concern regarding the purchase of an electric toothbrush?

A. Given the amount of recessions that she has throughout her mouth, you would not recommend the purchase of a power toothbrush as they have been shown to cause gum recession.

B. You would recommend purchase of a power toothbrush as they do a better job, but use only a soft brush head to eliminate the possibility of causing more recession.

C. The research shows that power toothbrushes that are used properly do not cause any gum recession and remove biofilm more effectively than manual brushes. Thus you would recommend that she purchase one.

D. Suggest that if she were to purchase a power toothbrush, since they have been shown to clean better, that she uses the least abrasive toothpaste when brushing.

c

Which of the following regimens would BEST assist the patient in addressing her chief complaint?

A. Stop using a hard toothbrush; purchase a power toothbrush with a rounded head and pressure sensor and instruct her in its appropriate use.

B. Change her current hard bristled brush to a soft bristled toothbrush and demonstrate the Bass brushing technique and recommend a less abrasive toothpaste.

C. In addition to her current oral hygiene regimen, purchase and use an oral irrigation device such as a water flosser.

D. Introduce use of an interproximal toothbrush for the posterior teeth and a rubber-tipped stimulator for the anterior teeth.

a

In viewing the radiographic images, which of the following teeth have an overhanging margin on the restoration present?

A. #2

B. #5

C. #12

D. #30

d

With generalized recessions visible on the images of the facial surfaces of both maxillary and mandibular teeth spanning from the right premolars to the left premolars, what would be your BEST ESTIMATE for the range of clinical attachment loss (CAL) measurements in these regions.

A. 1-2 mm

B. 2-3 mm

C. 3-4 mm

D. 2-6 mm

d

Since the bleeding on probing was minimal and detected primarily in the posterior molars, what addition to her oral hygiene regimen would you recommend to reduce the inflammation in these areas?

A. Use an interdental brush or interdental brush-head on an electric toothbrush in the posterior molars; floss threader or superfloss under her bridge.

B. Floss threader for under her bridge; and a floss wand for the rest of the teeth to facilitate her flossing problem.

C. Rubber tip stimulator to cleanse under her bridge; interdental brush or interdental brush-head on an electric toothbrush for all posterior regions.

D. Power toothbrush in all regions; floss wand in all regions; and a floss threader for under the bridge.

a

Case 29

The patient is a 23-year old Caucasian male who presents for the first time in your office. He appears very fidgety and nervous and declares he hasn't been to a dentist since he was around 12 years old! He said he had some fillings done at that time and remembers the whole thing being a very traumatic experience. He really hates needles and pain and says he doesn't want to go through that again but knows he needs a lot of work. He is getting married in 3 weeks and his fiancée pleaded with him to come in and get his teeth fixed before the wedding. He is 5'10" tall and weighs 165 lbs. He works at the docks unloading ships as they come in. He says it's really good money and he has been employed there now for 2 years.

When taking his blood pressure reading into consideration, what category would he fall into based on the recent AHA/ACC guidelines?

A. Normal

B. Elevated

C. Stage I hypertension

D. Stage II hyperten

D. Stage II hypertension

What would you suspect would be the best explanation for his blood pressure reading?

A. Frequent intake of Ibuprofen

B. Consumption of Lansoprazole

C. Smoking

D. Family history

A

You also note from his medical history that his pulse is quite high. What might be the best explanation for that?

A. Anxiety

B. Frequent intake of Ibuprofen

C. Frequent intake of Lansoprazole

D. Smoking cigars

C

Given the vast amount of breakdown of his tooth enamel and the black discoloration, what do you suspect may be the primary cause of this deterioration?

A. Acid erosion from the high dietary intake of acidic drinks

B. Smoking both cigars and cigarettes

C. Smoking Marijuana

D. Intake of hard drugs such as metamphetamine and cocaine

D

In order to address his “Chief Complaint” what would be the most realistic course of action?

A. Full mouth reconstruction beginning with his maxillary teeth spanning from #5 - #12

B. Getting his periodontal condition under control first before any major reconstruction is begun

C. Referral to an endodontist immediately

D. Referral to an oral surgeon immediately

B

Based on your clinical, radiographic and historical findings, how would you classify this patient’s periodontal status according to the 2018 AAP Classification of Periodontal and Peri-implant diseases?

A. Stage 1 Grade B

B. Stage II Grade B

C. Stage III, Grade C

D. Stage IV, Grade C

C

Although not all of the criteria were fulfilled for the Grading classification of this condition, what was the most important determining factor for your choice?

A. Amount of smoking and direct evidence of progression

B. Indirect evidence of progression and pocket depths

C. Type and amount of bone loss

D. Smoking and pocket depths

A

What immediate oral hygiene recommendations would you make for this patient to assist him in improving his oral health?

A. Purchase a power toothbrush; use a fluoridated mouthrinse; use a sodium fluoride toothpaste; teach him to floss.

B. Correct his scrub brushing method; replace his hard bristle brush with a medium/soft bristle brush; recommend a stannous fluoride toothpaste; instruct him to use an interdental brush; stop using the alcohol-based mouthrinse.

C. Continue to use his scrubbing method as he is comfortable with it; add a fluoridated toothpaste, preferably sodium fluoride; teach him how to floss.

D. Change his brush to a power brush; add a more abrasive toothpaste for the black stain; instruct him to use an interdental brush and rubber-tipped stimulator.

B

What IMMEDIATE health promotion recommendations would you give to this patient concerning his oral and general health?

A. Stop using both his antacid and ibuprofen medications; have his blood pressure checked; enroll in a smoking cessation program.

B. Stop using recreational drugs; enroll in a smoking cessation program; book an appointment with a physician.

C. Visit a physician to check medication use and blood pressure; reduce intake of acidic drinks; get his oral inflammation under control prior to having any major oral reconstruction done.

D. Reduce the intake of acidic drinks; stop taking Advil; seek assistance with smoking and substance abuse.

C

When evaluating a patient’s profile for dental erosion, all of the following are risk factors to consider EXCEPT one.

A. Sustained use of recreational drugs

B. Habitual use of acidic foods and drinks

C. Sucking on antacid tablets

D. Acid reflux and bulimia

C