Amy Dukoff
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 OME
NEW PATIENTS come to your office after having sought you out because they
feel that you’re the one who can solve their problems. They have
been “all over” and no one has been able to find what is causing their
pain. But they are sure that you can. The patient may localize
the pain to one side, and then it’s up to you. You are in a difficult
position. It’s tempting to tell the patient that what another practitioner
did was not as good as what you could do. Don’t give in to that temptation.
In addition, don’t be too quick to treat a tooth. Take the time for
a thorough evaluation and diagnosis, and take the time to establish trust
and confidence between patient and practitioner.
I had a patient present herself to my office with
pain in the upper right quadrant. She had had three new posterior
composites placed a few months earlier. She did not know the source
of her pain. On her first emergency visit, it seemed that tooth #4
could easily be isolated as the source, due to her intense symptoms of
thermal pain and the depth of her filling as revealed radiographically.
However, the next day she returned with the pain continuing and hardly
abating. Her two other molars, #2 and #3, seemed as if they might
also need root canal therapy. However, with her wisdom teeth present
and pressing on teeth #2 and #3, a consultation with an oral surgeon regarding
the wisdom teeth was in order. Upon her visit there, the surgeon
confirmed that both wisdom teeth would need extraction at a later date,
and that tooth #2 did need root canal therapy. The patient returned
the same day to initiate treatment. At that time, even though she
would need root canal on tooth #2, and probably to tooth #3, she felt very
comfortable with the treatment plan. A level of trust and confidence
had been built between us because I had not rushed to initiate treatment
on the teeth but instead took care to ensure that therapy was a necessity.
In her case, root canal therapy was the answer.
However, there are other reasons for odontogenic pain, which are not pulpal
in origin. It is important to understand the other causes of odontogenic
pain while diagnosing. The factors that can provoke pain include
postural changes, occlusal disharmony, sinus involvement, and hormonal
changes. Of course, an accurate history describing the pain must
be taken; this can help in diagnosing non-odontogenic facial pain, which
may be caused by trigemial neuralgia, cluster headaches, acute otitis media,
acute maxillary sinusitis, or temporomandibular joint, to name a few.
Making the right decision creates a better bond between you and the patient
while the patient gains trust in your diagnostic skill.
November - December 2005
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Making
the right decision creates a better bond between you and the patient.
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