Endo misdiagnosis and inappropriate treatment - Courtesy ROOTS
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From: Terry Pannkuk
Sent: Wednesday, September 16, 2009 3:43 AM
Subject: [roots] Another Consult Continued
.......Ok, Here's the continuing saga:
Attached is the referral slip with the dentist reminding me of the deep
caries and that things looked ok on a 6 month recall. Also that the pain
had started to become more intense the last week (slight to moderate
No changes in the medical history/BP/Pulse. The only observable
diagnositic/radiographic change was the new gold crown on #19 which
Any questions or thoughts? Anything else you want to ask or see?
Ok, here's the rest of the findings, plan, and execution. The second
molar demonstrated pain upon release from biting pressure, moderate
percussion sensitivity, no response to cold thermal stimulation or
the EPT. The findings on #19 were a bit sketchy with a clear response
to cold stimulation and a subtle lingering response to heat.
My tendency is to always go with the sure bet unless the chief complaint
is clearly not related. The patient was certain that #18 was the culprit
when biting down on the tooth. I was sure it needed endo so we decided
to treat that one first, but #19 is still a possible contributor to the
pain component. It was clearly stated before I accessed #18 that #19 might
need treatment as well and needed to be re-evaluated. If you don't state
this you will be falsely accused of treating the wrong tooth.
Even when you state it, sometimes the patient "forgets" you told
them about it.....but when you write it out on a written treatment
plan and hand that to a patient, it's a little more difficult for them
to complain about it. Joey D, "Your absolutely correct Terry...I'll
add there's nothing worse then treating a tooth and NOT taking care
of the chief complaint"
Attached are the additional radiographs, findings, access photo showing the
crack, and the final radiographs. When called the patient said his symptoms
were gone. #19 will continue to be watched, maybe indefinitely.
As far as I'm concerned endo misdiagnosis and inappropriate treatment is
epidemic. Most dentists do not take the time to think beyond the obvious and
make gross assumptions regarding pain etiology. This is a very deficient topic
in dental education that should be taught at the predoctoral level. Instead
predoc students are taught that they can learn to shape a canal in 5 minutes
and clean it with a 30 minute soak while starting another case in the next
operatory. There is nothing worse than treating a tooth that doesn't need to
be treated then treating it poorly predicated upon entrepreneurial "a-hole-ology"
Nice example, great documentation - Simon Bender