Case History and Application of Spectrum of Care Model

A 55-year-old female client in good general health arrives at the office for preventive maintenance. She is postmenopausal, with intact ovaries, and takes no prescribed medications. She has not had a physical examination for two years. She takes an over-the-counter product called Remefemin, which contains the herb black cohosh. This is widely used to treat hot flashes in Germany. She complains of burning mouth and tongue on a continual basis, but does not have xerostomia. A thorough medical and dental history is taken, blood pressure is measured, and an extra oral and intraoral examination is performed. No lesions or swellings are noted, and blood pressure is 110/75 mm Hg. The client wears a partial upper denture to replace tooth No. 3, No. 12, and No. 13. Periodontal pockets measure 3–4 mm, and tissue is pink and firm.

Client concerns and perceived needs:

• Function: Unable to enjoy spicy or hot foods, but chewing is adequate.

• Symptoms and Pathology: Unpleasant taste and burning sensation in mouth and on tongue.

• Esthetics: Client considers upper partial denture unattractive.

Dental hygiene assessment:

• Function: Partial denture is functional.

• Symptoms and Pathology: Upper partial denture, replacing tooth No. 3, No. 12, and No. 8.

• Esthetics: Partial denture appearance could be better.

Client’s ability to tolerate stress of treatment:

Consultation with physician may be necessary to evaluate BMS.

Client’s functional capacity and resources for maintaining oral health:

Excellent.

Identifying optimal level(s) of care and treatment options:

• Option A: Proceed with preventive maintenance and monitor symptoms of discomfort in mouth.

• Option B: Proceed with preventive maintenance and consult with physician for medical testing.

• Option C: Either A or B, and replacement of missing teeth with dental implants or fixed partial dentures.

Presentation of options and prognoses to client:

Client decided on option C, with dental implants.

Plan of care:

• Preventive maintenance performed by the dental hygienist, including self-care instructions and demonstrations.

• Client is referred to oral surgeon and prosthodontist for dental implants.

• Client is referred to physician to rule out possible causes for her burning mouth symptoms, such as anemias, iron deficiency, diabetes, anxiety or depression, and hormonal imbalance.

Reevaluation:

• Client returns in three months, with symptoms greatly relieved. Her medical examination was unremarkable, with the exception of initiation of hormone replacement therapy. This was not a true case of BMS, rather a symptom of low estrogen levels.