“Mind the Gap”: Dee Gulis DMD 12 Kicks Off Grand Rounds

Dee Gulis DMD 12 presented the first in a series of 2011-2012 academic year Grand Rounds. Her presentation titled, “Mind the Gap,” was based on a 51 year old, male patient that she treated during her externship at Blackstone Valley Community Health Center (BVCHC) in Pawtucket, Rhode Island. Gulis was on externship at BVCHC from May 16 to July 22 and her preceptor was Dr. Lalita Bhattacharya.

Gulis’s patient was originally from Cape Verde and spoke mainly Creole. She was able to successfully treat his chief complaint—“I don’t like the gaps in my upper front teeth,”—with the help of a BVCHC translator. The patient was vague on the details of how he lost his two front teeth, but Gulis believes that he was possibly involved in an altercation or traumatic event. The teeth had been missing for some time, but he had finally had enough and was seeking treatment to fix the issue.

Gulis said he was a, “pretty healthy guy” despite not having received routine dental care, having poor oral hygiene, and possibly using street drugs. Upon further inspection she found visible plaque, mild to moderate bleeding and inflammation, recurrent caries in several teeth, tenacious calculus, periodontal pockets, multiple edentulous pockets, and some super erupted and tipped teeth.

Armed with this knowledge, Gulis developed a detailed four-phase ideal treatment plan with some of the highlights being orthodontic treatment and implant placement. However, she also developed a second treatment plan that took into account his finances (the patient was unemployed and on Medicaid), his questionable compliance, and the fact that he was really only motivated to restore his upper arch. The second plan was accepted and the patient was fitted with an upper cast partial denture. Gulis also points out that though Medicaid does not cover cast partial dentures, BVCHC wanted her to have the experience of creating and placing one, so they offered to offset the cost to the patient.

Said Gulis, “The patient was extremely happy with the esthetic outcome. As soon as he saw it he smiled and said, ‘When can we do the bottom?’”

As Gulis walked Grand Round attendees through her presentation and treatment plan decisions for this patient she was careful to review the pros and cons of each potential treatment. Grand Rounds Moderator Dr. Carl McManama said, “I really liked the way Dee determined the treatment plan based on a comparison of pros and cons. I agree that a partial denture may be the best treatment plan for this patient considering his compliance and income. And it can also be changed later on. Overall Dee did an excellent job and I was very impressed with her presentation.”