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