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Volume3 Issue5
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S
upporting
Y
our
P
ractice
OasisDiscussions
TheCase of the
MysteriousMolar
Understandinga
SchizophrenicMind
The followingCaseConferenceoriginallyappearedon theOasisDiscussions
websiteat
oasisdiscussions.ca
. Thissiteanswersyourclinicalquestions,
discusses issues related to theprofession,andshowcases interestingclinical
caseswithaneducational component fordentistsand theentiredental team.
When treatinga patient diagnosedwithamental illness, the treatment plan
must be developedwith that condition inmind to ensure the best possible
outcome for the patient.Dr.DavidClark, clinic director of dental services at
theOntarioShoresCentre forMentalHealthSciences, treats patients living
with complexand seriousmental illness onadaily basis.He recentlydiscussed
the case of a patient diagnosedwith paranoid schizophrenia, andhowhis
approach focused onboth optimal oral healthand riskmitigation.
Casepresentation
In2008, a23-year-oldmalepatientwashospitalizedat theOntarioShoresCentre
forMental HealthSciences for themanagement of paranoid schizophrenia. He
presented to thedental clinic for a routineexamination. Hehadno toothdecay
andonlyneededcleaning. Itwasnoted that hewas congenitallymissingboth
lower secondbicuspids andas a result hehad retainedprimary teeth75and85.
Thepatientwasdischarged shortlyafter his admission.
In2014, thepatientwas readmitted to thehospital. Dr. Clarkwas askedby the
patient’spsychiatrist toassesshisoral healthandprovidecomments, ashehad
expressedaclear concernwith tooth85. Thepsychiatristwanted to know if it
was solelyadirectmanifestationof acurrent delusional thought processor if the
patient actuallyneededdental care.While itwasnot incapacitatinghim, the tooth
wasnonethelesspreoccupyinghimamajorityof the time.
Investigation
Thepatientwas examinedat thehospital’sdental clinic. Hewas verypersonable
andpleasant, andheengaged ingoodconversationwith the team. Itwasnoted
that tooth75hadbeenextracted since thepatientwas last seen in2008; the
patientwashowever unable toprovideagoodprior historyexplaining the reason
for theextraction. The teamperformeda thoroughoral examinationand took two
Howwouldyou treat
suchacase?
Watch thecaseconferenceat
