Sometimes It Just Is

Amy Beth Dukoff, D.M.D.
Sometimes It Just Is

Amy Dukoff	OMETIMES a patient presents with a chief complaint that surprises the practitioner. The complaint may not correspond to the practitioner’s assessment of the patient’s condition. At times, the patient’s perception may be mistaken; at other times, however, complications such as hard-tissue changes or calcification may be affecting the practitioner’s diagnosis. In such cases, listening carefully to the patient and following the clues in the patient’s complaint are essential to making the correct diagnosis. Hard-tissue changes can make diagnosis difficult. Calcifications can make the diagnosis confusing. Extensive formation of hard tissue on the dentinal walls can occur along with the obliteration of the pulp chamber. This condition may be caused by trauma, caries, periodontal disease, or other irritants. Furthermore, pulp stones and diffuse calcifications can occur. Pulp stones usually occur in the pulp chamber, while diffuse calcifications occur in the radicular pulp. Calcification makes the location of the pulp chamber difficult to read, which may mislead the practitioner as to the proximity of the caries to the pulpal chamber. Listening to the patient will give the practitioner important clues to lead the practitioner to the right tooth or area in question. When a patient presents with pain on a tooth with hard tissue changes, the practitioner should be alerted to the likelihood that changes occurred due to pulpal reactions. Many times caries may be present, but since the pulp chamber is obliterated, the depth of the caries in relationship to the pulp chamber can be misleading. Also, if a crack is present, the pulp chamber may become obliterated. Therefore, even if a shallow restoration is present or does not exist, pulpal obliteration can be caused by a crack. Lastly, trauma may also cause excessive stress, which in turn may initiate pulpal calcification. Evidence of calcification gives clues to the practitioner that the pulp has responded to an irritation. Therefore, if the patient is complaining in the region, a full evaluation of the teeth in question is vital. A tooth free of restoration may have a surprising result in response to pulp testing. As always, listening to the patient is key in accurate diagnosis. Fall 2004
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