for the individual posts where they are. Photos courtesy Mark Dreyer - ROOTS
From: Mark Dreyer To: ROOTS Sent: Friday, August 04, 2006 6:36 PM Subject: [roots] Bruxism case This patient presented with symptoms which on the surface seemed to be consistent with an endodontic issue, but upon further investigation, proved to be related to bruxism. Multiple teeth responded very sharply to cold with throbbing which lingered at least a minute, and every single tooth in the quad was ++ to apical percussion. Muscles of mastication were very tender to palpation. Dx: Trauma from occlusion. Morale of the story: Yes, normally when there is prolonged throbbing after a cold stimulus, you're dealing with an irreversible pulpitis. The one exception is trauma from occlusion. Be aware when more than one tooth in a quad responds badly to cold and apical percussion, as it would normally be too coincidental to have two irrev pulpitis situations (absent recent dental work) at the same time. Look for other potential etiology such as trauma from occlusion. You can always do a rct in the future if you mis-dx'd as occlusal trauma, but you can't take back an uncessary rct - Mark DreyerExcellent case Mark. I had a similar case 2 days ago where the patient had pain in 3 out of 4 quadrants and has had dentists do endo and crowns to relieve pain but her pain has not got any better since the past 1 year. I believe it was trauma from occlusion as she was a grinder and clencher. Rachna chhabra
