the flareup after the best treatment
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From: Jinyong Park
Sent: Wednesday, April 04, 2001 20 36
Subject:the flareup after the best treatment
Sometimes,I feel embarassed with the situation requiring
replacement of old and inadequate restorations for a tooth
with a chronic pulpitis.
Because the pulp had been in a quite state, I was unaware
of the true condition.As a cavity preparation,impression,
temporarization,restoration placement,the chronic pulpitis
was converted to an acute situation and pain developed,
Although the major source of pulpal irritation may have
occurred many years earlier when the previous work was
performed, the present treatment might be erroneously
blamed as the major source of the problem.In this case ,
How do you explain the patient,and What is the best method
to prevent this? Thank you!
From: I. Blake McKinley, Jr.
Sent: Wednesday, April 04, 2001 04 13
Dear Dr Park,
It is not a unique situation to have a tooth which has been
asymptomatic become symptomatic (acutely pulpitic). There is
no way of preventing this or predictiing this. The patient's
needs required that the restoration be replaced, the quiescent
status of the pulp would not give anyone any indication of a
The best way of reducing the patient management factor is to
"pave your way with words" beforehand. The patient needs to be
informed that most of the time the tooth will survive the
restorative process just fine, however, at times a tooth will
become symptomatic following the placement or replacement of a
restoration. If the symptoms are appropriate, a root canal will
Of course, according to your description of the situation,
endodontic treatment is now indicated.
You have described a situation that is not unique to you nor will
it be the last time you encounter this situation. In fact, I would
imagine that most of endodontists run into this fairly routinely.
They recieve what I call a hostile referral of a tooth that is now
symptomatic, and the patient is asking the endodontist if their
dentist did anything wrong. The trick is to diffuse the hostility
quickly while maintaining the referral relationship, helping to
foster and reinforce the patient's confidence in
their dentist, and generating a relationship with the patient.
I hope this helps, this just reflects my experience.
It would be interesting to hear what experience others have.
Blake McKinley, Jr., DDS