Introduction: This problem-based learning (PBL) exercise is designed for third-year dental students and covers the management of a partially edentulous patient with diabetes, periodontal disease, and financial constraints. This exercise provides lessons in which small groups of dental students practice integrating their knowledge of basic sciences with their clinical reasoning skills. This case represents one of a series of PBL exercises that faculty have created to help students integrate and expand upon their knowledge in the clinical and basic sciences, and to apply this knowledge to actual patient scenarios. Methods: Each student’s participation within group discussions was assessed by the facilitator, with emphasis on the quality and insightfulness of contributions rather than on the number of contributions by a student. Also assessed were each student’s preparedness and quality of presentation of research of knowledge gaps. A wrap-up/debriefing session was held with facilitators after the last session to get their feedback on experiences and suggestions for improvement. Results: The majority of the students agreed that this case helped them achieve and understand the learning objectives. Student comments from the self-assessment forms express a general positive response to this case and methodology. All facilitators reported that this exercise was a positive and rewarding teaching experience. Suggestions for future implementation of the exercise included completion of the medical history and medical consult prior to completion of the initial prophylaxis, inclusion of endodontic assessment and preparation of the abutment teeth, and more challenging questions regarding the basic sciences processes of diabetes and bone loss. Discussion: The integration of clinical and basic sciences was well accomplished with this case, which will benefit the students' understanding of this integration in the management of a clinical scenario.
After completing this exercise, learners will be able to:
- Discuss the effects of diabetes and its role on oral health and periodontitis.
- Determine the patient’s periodontal diagnosis and prognosis.
- Discuss the cells, tissues, and cellular biomechanics in tooth mobility.
- Diagram the mechanism of tooth mobility.
- Describe the response of soft and hard tissue to loading.
- Describe the consequences of traumatic forces (including partial force considerations) on teeth with existing periodontal conditions.
- Discuss possible emergency situations with a noncontrolled diabetic patient and how one would address these situations.
- Develop and defend an appropriate disease control plan for the patient.
- Explain the biomechanical classification and principles that govern removal partial denture design.
- Discuss the preservation of health of the remaining teeth and oral tissues.
- Discuss the replacement of missing teeth and restoration of function.
- Differentiate the unique requirements of distal extensions and tooth-supported partial denture.
- Discuss ethical obligations in discussing extraction versus restoration with the patient.
- Role-play communicating with a patient while giving unexpected or bad news using culturally sensitive approaches and without using jargon or technical language.
- Given a partially edentulous patient, discuss the factors influencing the prognosis and treatment.
- Role-play how to discuss insurance and financial options for payment with the patient.
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