Pathology · patient case with 2 questions
New patient with decay on #14 and #19
Scenario: A NEW patient presents with two decayed teeth (#14 and #19) and wants her teeth checked. NO radiographs were provided in the patient box.
Question 1
What type of examination should you perform?
Show answer and explanation
Correct answer: D. Comprehensive oral evaluation
- A. Emergency palliative treatment addresses acute pain only and is not what this patient is requesting.
- B. A periodic evaluation applies to an ESTABLISHED patient of record returning for recall.
- C. A limited/problem-focused evaluation addresses one specific complaint; it does not meet the standard of care for a new patient requesting complete assessment.
- D. Correct. A NEW patient with no prior records who asks to have ALL her teeth evaluated requires a COMPREHENSIVE oral evaluation — full charting, periodontal assessment, occlusal analysis, soft-tissue and cancer screening, and a complete radiographic survey.
Question 2
What radiographs should you take?
Show answer and explanation
Correct answer: A. Full mouth series (FMX) with a panoramic
- A. Correct per the source key. A new adult patient with clinical caries and no previous radiographs falls under the ADA/FDA selection criteria for an INDIVIDUALISED FULL-MOUTH SURVEY — posterior bitewings plus selected periapicals covering all areas of clinical or historical evidence of disease.
- B. Periapicals with a panoramic omit the bitewings, which are the single most accurate view for interproximal caries.
- C. Bitewings alone or with a panoramic show interproximal caries and crestal bone but do not display apices, which is inadequate for a first comprehensive assessment with active disease.
- D. Bitewings only is far short of the standard for a new comprehensive patient.
Note: Note the ADA/FDA wording: a panoramic is NOT a substitute for an FMX, and radiographs are always prescribed on an individualised basis after a clinical examination — never routinely.