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From: Mark Dreyer
Sent: Tuesday, August 01, 2006 5:47 AM
Subject: [roots] Interesting dx
I thought this would be an appropriate case to present.
This case reminded me of a few things. First of all, don't assume that
the tooth (or even the quad) that they think is the source of the pain
is the actual source. Secondly, listen to your patient's complaints
and hx very carefully, and lastly be willing to bring them back another
day for a repeat try at a dx.
This guy was dying in pain. Referring office said the pain was UL,
but they couldn't figure it out. Sent him over. Tough one because all
teeth UL responded sharply to cold, but couldn't check for delayed
sensation because he had a constant low level throbbing that never went away.
I tried serial pdl injections (selective anesthesia) on the upper teeth,
and couldn't get the pain to subside. I was about to send him away
to come back another day to repeat testing.
Prior to sending him away with an injection to break the pain cycle and
some meds, I reviewed his hx (listen to your patients!) and verified
that he was experiencing pain into his ear and neck. To me this was a
key indicator of a possible lower tooth involvement. Also, when I
started mentioning that I suspect the lower molar (prior to getting that
telltale x-ray), he suddenly remembered that the evil amalgam was
removed a few months ago in favor of the much better white filling
(sarcasm mine-he didn't say it quite that way). He also mentioned that the
lower second molar was endo tx'd and crowned and that tooth was lost to a fx.
As I suspected, once I removed the resin, there was a crack. I did some
gg work and bleach soak (8pm, so no OS open now) prior to closing it
up and referring him off to see an OS tommorow. Lots of work for must
a $250 non-restorable fee, but an intersting case nonetheless. Hey,
and the guy at least thanked me, which is sometimes worth more than the
money. (although after the recent renovations to my house,
I could use more than just gratitude! :-)) ) - Mark
Mark, thanks for very interesting dx case! But why would not
you extract the tooth yourself, if this was really needed?
Do OS only have that right?;-)) Anyway, what was your thought?
Thanx - Dmitri
Dmitri, I chose a while back to limite my practice to endodontics.
Certainly I have the right to extract teeth, but I also have the right to
chose what I'll do and not do - Mark