1. Oral Diagnosis & Medicine Tyler SlaughterTeam 2 11/15/10 Competency Case # 434-2-87

2. Patient History • 78 year old Hispanic Female. • Occasional high blood pressure. • Type II Diabetes controlled with diet and exercise. • Pt. has arthritis and the beginnings of osteoporosis. • Pt. was hospitalized in 1987 for hysterectomy due to excess bleeding caused by a fibroma. • Mastectomy in 1995 with no complications. • Pt. had enlarged thyroid during pregnancy 40 years ago, but has had no complications since that time. • Pt. suffers from depression which is treated with Prozac. • Pt. was taking Fosamax beginning in 2004, but stopped taking this medication in 2009. • Pt. had “Zimmer Total Joint Surgery”, and takes Azrithromyacin for premedication due to allergies.

3. Allergies • Penicillin Allergy-the patients tongue swells and fingernails have fallen off when she has taken Penicillin in the past. • Clindamyacin- caused the pt. to break out in hives. Benadryl was taking to relieve this reaction. • Epinephrine-caused heart palpitations in the past. • Codiene-caused heart palpitations when taken in the past. • The patient takes Azrithromyacin for premedication with no significant side affects.

4. Medications • Aposolvent Sterules- one a day • Avalide- 300mg/day • Calcium-600mg BID • Diltiazem- 180mg/day • Fiber- 2 capsules/day • Fluoxetine 10mg BID • Metformin 500mg BID • Oleptro- 50mg/day • Prozac- 10mg bid PRN • Vitamin A and D- 1000mg/day

5. Lesion Description • The lesion appears as large, bilateral, bony growths from the lingual aspect of the mandible. The lesion does not appear to be negatively affecting the patient’s oral health at this time.

9. Patient Dialogue • Does this growth ever caused you any pain? No. • How long have you had these growths? Did they arise recently? No, I have had them my entire life. • Have these growths ever cause you any pain? They have not cause me any pain. • Has anyone reported these growths to you before? Yes, I have had them removed before, but they have always slowly grown back. • Do you ever grind your teeth at night or when you are anxious or nervous. Maybe sometimes, but not a lot.

10. Diagnosis • Differential Diagnosis: Periodontal Abscess, Salivary Gland Tumor Bone Tumor Fibroma • Provisional Diagnosis Bilateral Mandibular Tori • Consultation Pt is a 78 year Hispanic female with a complex med hx(listed above). Please evaluate the lingual aspect of the mandibular arch. There are large, bilateral, bony growths extruding from the lingual aspect of the mandible. My differential diagnosis include fibromas, tumors, and periodontal abscess. My provisional diagnosis is bilateral mandibular tori. Could you please evaluate the patient for definitive diagnosis, thank you.