Here is another tooth story that could have been written differently. If all of us professionals could just take a moment and appreciate the importance of an endodontic diagnosis, I think this particular patient might have had a very different experience in the chair.
As healthcare professionals, diagnosis is at the heart of what we do. For that reason, it is imperative that we get it right, because everything that follows is based on identifying the offending tooth, and getting to the heart of the patient’s symptoms.
I spend a lot of time on diagnosis, because it’s how I determine what the options are for the patient. And from there, I can thoroughly explain their condition, what’s going on inside their mouth, and how we can treat it. When you lay it all out there for your patient, you’ve managed their expectations, and they’re likely to have a positive experience in your practice.
It all sounds so easy, right? But the diagnosis is never so straightforward. That’s why we go to dental school and spend lots of hours in CE like E-School!
Let’s dive into a tooth story so I can really drive home the importance of an endodontic diagnosis that is spot-on and can give us some insight on how to do right by our patients.
The importance of endodontic diagnosis
This patient came into my office a few months back after having a biopsy of the area. Not so long after, the soft tissue lesion came back and they were suffering from the same associated symptoms.
From the looks of the preoperative periapical radiograph, it was really hard to see if there was a problem with this tooth, so I knew right away this might be a tough case. The nostrils are perfectly aligned with that apex on this radiograph.
The patient had a sinus tract, so we traced it and that gutta percha went straight to the apex of #9. The tracing, plus a cold test that revealed that #9 had no response to cold, helped confirm the diagnosis that tooth #9 had a Necrotic pulp and Chronic Apical Abscess.
Getting the whole story
As per usual, a CBCT can help us get the whole story.
I used my cone beam as part of the diagnostic process because it helps me get a handle on the anatomic features of a tooth and understand more completely what’s going on underneath the surface.
As you all know if you’ve been reading for awhile—I’m a huge advocate for CBCT technology and in this case it was super helpful to understand what the patient was dealing with.
Naturally, when we are talking about the importance of endodontic diagnosis, we have to talk about cone beam technology. A CBCT can help us dentists diagnose a problem early on and even spot disease before it starts to present as serious symptoms. Which means we can start treatment right away without waiting for things to get nasty, and it can also confirm our diagnosis.
You also know I’m big into communication and empowering our patients and I find that the imaging that comes from the CBCT is an important tool for patient education. With these images we can do more than just tell our patients about their diagnosis, we can show them what’s going on. That’s powerful!
Thank you, sinus tracts!
Sinus tracts are a wonderful present to the patient because they keep them from having too much pain both before the root canal and after the root canal, too! So thank goodness that’s what we were dealing with here. In fact, they’re even a gift to us as clinicians because they help us with diagnosis. Sometimes they even make us look like heroes (and hey, sometimes we are heroes!) because the patient has little to no postoperative pain to deal with.
In general, though, sinus tracts take about 2 weeks to really resolve. So make sure you manage your patient’s expectations and let them know this, since some of them may think it should go away immediately.
The moral of the (tooth) story
The lesson here is this: endodontic diagnosis is so important—and it is important to EVERY single specialty, not just when a patient is sitting in an endodontist’s chair.
I feel so passionately about this. I’ve hosted CE trainings and webinars on it. I talk about it in E-School: Everyday Endo Made Easy and I practice good endo diagnosis processes day in and day out. I said it once and I’ll say it again—it’s at the heart of what we do as dentists.
Want a little support around diagnosis? Check out my pulpal and periapical diagnosis checklist for some solid tips you can put into action right now.