INTRODUCTION
A patient’s chief concern is to be taken seriously if we consider ourselves caring professionals.1 Too often, we as practitioners consider diving into treatment without first addressing the reason why the patient has sought care from us in the first place.2 Sometimes, this is due to treatment phasing and ensuring that treatment is completed in the proper order.3 Therefore, it is fortunate for all involved when a patient’s chief concern aligns with treatment that can be completed at his or her initial appointment. This case report demonstrates how a patient with an embarrassing condition sought help after avoiding treatment for several years and was rewarded with immediate relief.
CASE REPORT
A 32-year-old female patient presented for a comprehensive examination. Her chief concern was, “I’m embarrassed. I can’t talk very well because something is pushing under my tongue, and it’s uncomfortable.” The patient spoke with noticeable lisping. The radiographic examination, via panoramic radiograph, revealed a radiopaque mass superimposed over mandibular teeth Nos. 20 to 29. The mass measured 2 cm in height with a 6.2-cm radius (Figure 1).
Figure 1. Panoramic radiograph showing a radiopaque mass in the mandibular anterior area.
During further conversation with the patient, generalized plaque and tartar were noted on the labial surfaces of the maxillary and mandibular anterior teeth and gingiva, with pronounced calculus accumulation on the cemento-enamel junction areas of teeth Nos. 24 and 25 (Figure 2).
Figure 2. Calculus observed on the labial surfaces of the mandibular anterior teeth.
The initial clinical examination revealed an extensive red-brown mass that filled the sublingual space and extended from teeth Nos. 20 to 29 (Figure 3).
Figure 3. Extensive calculus mass in the sublingual area.
When the patient was asked about oral home care, she revealed that she hadn’t brushed her teeth or flossed “in many years.” At this time, a definitive diagnosis of sublingual calculus mass was made, and this was determined to be the cause of her speech concerns and discomfort.
Dental calculus is a mineralized mass of bacterial plaque that is most commonly seen on the surfaces of natural teeth in areas where saliva empties into the oral cavity via salivary ducts.4 It harbors a living, bacteria-rich biofilm, which can infect the adjacent periodontium.5,6 Due to its proximity to sublingual salivary ducts, the most common location to find dental calculus is on the lingual surfaces of the mandibular anterior teeth.7,8 Therefore, the mass noted on this patient wasn’t unusual due to its location but instead for its substantial size.
Treatment was performed by removing the calculus mass and debriding other supragingival calculus present. The largest section of the mass measured 3.8 × 2.0 cm (Figure 4), and other fragments were removed that adhered to the lingual and facial surfaces of teeth Nos. 20 to 29 (Figure 5).
Figure 4. Calculus mass measuring 3.8 × 2.0 cm.
Figure 5. Calculus mass and fragments.
Figure 6. Sublingual space, free of calculus mass.
Figure 7. Red and inflamed tissue following removal of calculus.
The underlying soft tissue was red and inflamed. Following the debridement, the patient reported that her tongue immediately felt freer, with increased movement (Figures 6 and 7).
The patient was able to communicate more clearly and intelligibly following treatment. She was emotional as she expressed her gratitude that she would be able to speak more confidently after years of communication deficits due to her condition.
The patient also received comprehensive oral hygiene instruction. This included an explanation of the cause of the condition the patient was experiencing,9 as well as modeling of proper brushing and flossing, with the patient performing what she had learned. A treatment plan was developed to address the patient’s periodontal disease by following up with full-mouth scaling and root planing, then recare.
Follow-up treatment proved to be difficult due to appointment failures. The next appointment was 5 months following the debridement. The patient reported that she was not brushing and flossing daily. The clinical evaluation revealed mandibular lingual plaque and calculus present (Figure 8), but the soft tissue had fully healed with the exception of the areas adjacent to the teeth, where calculus was present.
Figure 8. Calculus and plaque observed on the lingual surfaces of the mandibular anterior teeth.
The patient shared at this appointment that she was pleased with the results from her initial treatment, but she didn’t want to return for continued care. Although an extensive treatment plan remained, it was determined at this time that the calculus mass removal procedure successfully resolved the patient’s chief concern.
CONCLUSION
This case report briefly illustrates how an uncomplicated dental procedure can greatly impact a patient’s comfort and quality of life. It also highlights the importance of consistent home care and its role in the prevention of unwanted oral conditions. Unfortunately, patient education and treatment are restrained when patients refuse further care. As professionals, we must recognize that patients must ultimately advocate for their own health.
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ABOUT THE AUTHOR
Dr. Eaton is an assistant clinical professor at the Midwestern University College of Dental Medicine in Phoenix. He can be reached at jeaton@midwestern.edu.
Disclosure: Dr. Eaton reports no disclosures.
