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Endo misdiagnosis and inappropriate treatment - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are - www.rxroots.com
From: Terry Pannkuk
To: ROOTS
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 
spontaneous pain).

No changes in the medical history/BP/Pulse.  The only observable 
diagnositic/radiographic change was the new gold crown on #19 which 
looked good.

Any questions or thoughts?  Anything else you want to ask or see? 
- Terry

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" - Terry

Nice example, great documentation - Simon Bender

Silver point removal

Sealer extrusion

Double vision

Tooth #19 NSRCT

Class V restoration

3 distals

Root fracture

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Implant #3

Implant #30

Missed MB2

Hand filing

Implant management

3 Canal premolar

Palatal swelling

Tooth #32

Unusual MB2

Microscopes

MB2

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Trauma slow burn

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Disposable RD

File retrieval

K3 out of apex

Apical resorption

Apical resorption II

Fatiguing case

Dry prophy cup

Reynolds protocol

Multiple teeth

Lateral condensation

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Endo programmes

Apical Delta

No MTA, no polyester

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