Rachel Sattler, age 20, presents for her routine dental cleaning and checkup. She reports a constant dull ache in her top right second bicuspid that is exacerbated by temperature changes. X-rays reveal a large lesion on the distal of tooth #13 that extends toward the pulp. The likely diagnosis is extensive decay causing nerve involvement and pulpal exposure. The recommended treatment is a root canal, followed by a post/core buildup and porcelain crown to prevent fracture.

1. Marci M.

2. Patient Fact Sheet
 Name: Rachel Sattler
 Age: 20
 Reason for Today’s Visit: 6-month recall
 Established Patient: Yes

3. Scenario
Rachel presents today for her routine 6-month dental cleaning and
check-up. She is due for her routine bitewing x-rays. Upon greeting
Rachel she seems a bit concerned which is unusual for her personality.
You ask Rachel if she is having any problems with her teeth.
Hesitantly, she responds
“well, I have been having some pain on the top right.”
Your response is:
“what kind of pain and can you pinpoint which tooth?”
She responds a constant dull ache that is exacerbated by extreme
temperature change. She also points to her 2nd bicuspid.”
You explain to Rachel that she is due for her x-rays today and that they
will most likely show where the problem lies.
You take Rachel’s bitewing x-rays.
This is what is found!

5. X-Ray Reading
 Large radiolucent lesion seen on distal of #13
 Appears to be located in interproximal region
 Lesion appears to extend towards pulp

6. Diagnosis
 Based on Rachel’s x-ray, what do you think is the most
likely cause of her pain?
 Extensive decay causing nerve involvement and pulpal
exposure

7. Treatment
 Root canal therapy, followed by post and core build up
completed with a porcelain crown to prevent fracture