What could possibly be more fun than a root canal and a crown, or an extraction, implant, and crown?
This morning a patient came into our office, a patient that we had not seen for years. She had, for convenience reasons, changed dentists to an office closer to her home years ago, and we were naturally saddened to have lost her as a member of our patient family. So I was uplifted to see her on the schedule for today.
Her concern was that she had had pain in a very specific upper molar for several days, an intense sensitivity to hot and cold, and to biting pressure. Her own dentist had told her the tooth was cracked, and would need to have either a root canal and a crown or extraction, implant, and crown; he was pushing her toward the latter.
Then, several days ago, the sensitivity and the biting pressure pain stopped. She was curious, and sought our thoughts on the subject. Hence, the visit this morning.
We ran a series of tests, from evaluation of the gum position and health to visual and radiographic examinations of the tooth; all results looked good to excellent. There was no decay present, although the existing filling had some minor wear and superficial chips. The only abnormality I could detect was that she was hitting hard on the tooth when she bit and chewed. In fact, it was the only tooth in the back on that side that hit.
I explained to her how, if all the biting pressure is focused on one or two teeth, the nerve tissue in and around that tooth, or teeth, goes on “high alert”, and responds with both greater intensity and to lesser stimuli than normal. I also mentioned that a crack in the tooth does not heal, but only gets worse, which was the opposite of her situation with this tooth. And the complete absence of any swelling or draining abscess or gum problems led me to believe that there was nothing really amiss with the nerve.
With her consent, we polished down those areas on the tooth that were hitting hard, probably taking off the thickness of a coat of paint. Her eyes lit up, and she said that everything felt much different now, and that she suddenly felt the other teeth touching “as they used to”.
I told her that it was my belief that this would likely resolve her issues. Well, not all–the existing composite filling in the tooth should be replaced–but certainly major work was not in the cards. I further expressed how disappointed she much feel to realize that she would probably not be getting a tooth pulled, and an implant placed, or a root canal and a crown. She assured me that she could deal with that.
The take-home lesson on this is that not all dental issues are major, even if they feel as though they may be. Sometimes all it takes is a few moments to work backwards, to figure out the symptoms, instead of jumping in and assuming the worst-case scenario is the only scenario.
One of the major advantages to having undergone extensive post-graduate studies in a variety of dental specialties is that it allows a perspective on problem, and more tools to treat effectively, with minimal time and expense and discomfort for the patient. “When all you have is a hammer”, the saying goes, “everything looks like a nail”. Well, over the years we have constantly added to our tool bag, and can work more effectively than ever before to correct the problems, and not just to treat symptoms.
The patients universally appreciate this conservative, minimally invasive, approach to their health, comfort, and appearance. And everyone, not just the patient, sleeps better at night for it.