the flareup after the best treatment

From: Jinyong Park 
Sent: Wednesday, April 04, 2001 20 36
Subject:the flareup after the best treatment

Hello, I am Dr. Park.How are you? I am Dr.Park., 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 occured 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 problem develping.
 
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 be recommended.
 
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.
 
Sincerely,
 
Blake McKinley, Jr., DDS
Endodontics Exclusively
O: (509) 928-8762
F: (509) 928-0110
email spokaneendo@earthlink.net