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Cervical hypersensitivity and acute sensitivity
From: Rob Kaufmann
Sent: Wednesday, May 26, 2010 1:45 PM
Subject: [roots] Nike ...or else
Some days I must admit that I really hate what I do for a living.
61 year old female sent to me by top 5 referral, for consultation regarding
cervical hypersensitivity and acute sensitivity to cold in the right mandible.
More recently she has begun to have cracked tooth symptoms in the maxillary
first molar. The patient has a relatively low dental IQ but has had one molar
endo/crown in the left first mandibular molar. She was so senstive on the
right sde that she asked me not to probe the area, even before I examined her.
She had been previously treated with RD applied topical cervical desensitizer.
Oral hygiene was poor and poor plaque control has contributed to acute marginal
gingivitis in the quad. (See photo) After examining the area I concluded that
the amalgam crowns on the molars (and pinned amalgam in the premolar) were deep,
had poor margins, exhibited creep and were leaking. After several attempts,
I finally managed to isolate the hypersensitive area to the buccal cervical
aspect of the second molar. The patient was considering extraction of the
offending tooth (whichever it was... she didn't care....she just wanted her
problem solved.) I excused myself and phoned the RD.
I said that managed to isolate the acute sensitivity to the mandibular second
molar but that I could not guarantee that just treating the second molar would
relieve all her symptoms because ALL teeth in the quadrant were acutely sensitive
to cold. I explained to the RD that there were multiple teeth on that side that
needed endo/crowns and I felt that a proper treatment plan for this side was
needed. (We have had this discussion regarding other patients many times before
...with him referring "A tooth" to me for treatment rather than having a treatment
plan.. He's frankly tired of me calling and telling him that the cases need a
treatment plan - he claims his patients won't let him do this and that his practice
(which is booked months in advance) seems to mostly work on the "single tooth/work
to the Ins. max" principle. His patients have the reputation of being very tight
with their money. (It's a cultural/regional thing....well known. Ironically, this
town has has some of the highest growth in income of any place in the province.)
Finally he said he would deal with OH/Perio issues and implied that if I wasn't
willing to " just do the endo on that tooth", he would find someone who would.
That last remark got the message thru to me and I said "Fine, I'll treat the
second molar and that's it." and disgustedly put down the phone. I was furious.
She scheduled to treat both the mandibular 2nd molar and cracked maxillary
first molar. The rest of it be damned.
Regular patient or patient who comes only when symptomatic, he seems to treat
them all the same. I think he's just about reached the limit of tolerance for my
" isn't a comprehensive care based treatment plan is what is best for your patient"
sermon. I must admit I am totally frustrated by his mode of practice. However,
he IS a top 5 guy, a friend of almost 30 years and losing him
would not be very good for my practice.
Sometimes I REALLY hate referral practice. - Rob Kaufmann DMD MS(Endo)