Cheek and tongue biting

Patient: RHONDA H

Chief complaint:

-Rhonda complains of biting the inside of her cheek on the left side and this annoys her. Cannot bite into an apple.

-Her husband says she has a somewhat “grumpy” appearance, lower lip in front of upper lip and biting upper lip

 

History of chief complaint:

-Sore mouth for approx 4 years, sometimes biting tongue as well

-Rhonda has sought 3 other opinions. Dr Calavassy was the first to come up with a definitive treatment plan

 

Rhonda would like to get rid of cheek and tongue biting and if we could eliminate “grumpy” look (partly due to lower jaw protrusion) it would be good

 

Medical History:

-Numerous joint replacement surgeries…both hips, both knees, both shoulders

-NO TMJ clicking, crepitus or pain

-Uses a walking stick

 

Extraoral examination:

-Class 111 skeletal with mandibular protrusion

-Mild deviation of mandible to right when viewed from the front

-Excessive submental fat

 

Intraoral examination:

-Class 111 malocclusion

-Numerous restorations (generally sound), 17 may need some attention

-Overcontoured restorations on distal of 34 and 45 (intentional)

-Generalised slacing lower arch

-Very slight forward functional shift of mandible CR to CO

-Negative overjet 1 mm in CR

-Signs of some wear/bruxing

 

Periodontal examination:

-Probing levels normal

-Marginal gingivitis 32, 44

-1-2 mm recession 34 44

 

Radiographic examination:

-Lateral Ceph: Mandibular prognathism

-OPG/bite wings/periapicals: Generally good