CDA Essentials 2017 • Volume 3 • Issue 5

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27 Volume 3 Issue 5 |
Supporting Your Practice
Oasis Discussions
The Case of the
Mysterious Molar
Understanding a
SchizophrenicMind
The following Case Conference originally appeared on the Oasis Discussions
website at This site answers your clinical questions,
discusses issues related to the profession, and showcases interesting clinical
cases with an educational component for dentists and the entire dental team.
When treating a patient diagnosed with a mental illness, the treatment plan
must be developed with that condition in mind to ensure the best possible
outcome for the patient. Dr. David Clark, clinic director of dental services at
the Ontario Shores Centre for Mental Health Sciences, treats patients living
with complex and serious mental illness on a daily basis. He recently discussed
the case of a patient diagnosed with paranoid schizophrenia, and how his
approach focused on both optimal oral health and risk mitigation.
Case presentation
In 2008, a 23-year-old male patient was hospitalized at the Ontario Shores Centre
for Mental Health Sciences for the management of paranoid schizophrenia. He
presented to the dental clinic for a routine examination. He had no tooth decay
and only needed cleaning. It was noted that he was congenitally missing both
lower second bicuspids and as a result he had retained primary teeth 75 and 85.
The patient was discharged shortly after his admission.
In 2014, the patient was readmitted to the hospital. Dr. Clark was asked by the
patient’s psychiatrist to assess his oral health and provide comments, as he had
expressed a clear concern with tooth 85. The psychiatrist wanted to know if it
was solely a direct manifestation of a current delusional thought process or if the
patient actually needed dental care. While it was not incapacitating him, the tooth
was nonetheless preoccupying him a majority of the time.
Investigation
The patient was examined at the hospital’s dental clinic. He was very personable
and pleasant, and he engaged in good conversation with the team. It was noted
that tooth 75 had been extracted since the patient was last seen in 2008; the
patient was however unable to provide a good prior history explaining the reason
for the extraction. The team performed a thorough oral examination and took two
How would you treat
such a case?
Watch the case conference at