Sinus tract tracing, proper diagnosis, and patient education are all the big players involved in this incredible tooth story!
It is NO surprise that I love all of my advanced diagnostic tech (I gush about my cone beam technology every chance I get)! When imaging so directly helps me figure out the source of pain plaguing my patients, it’s worth investing my time and energy into the latest tech. But keeping things old-school has its value too. I want to show you a case where a classic diagnostic method—sinus tract tracing—proved invaluable in my endodontic diagnosis.
This isn’t the first time I’ve gotten on my soapbox about sinus tracts, and how important it is to trace them every single time. Sinus tracts can help pinpoint an infection BEFORE any pain starts flaring up. It’s an amazing diagnostic tool, worthy of another blog post!
So let’s go back to a time before my precious CBCT to see how sinus tract tracing helped save a tooth.
A Sinus Tract Tracing Surprise
Let’s make sure we’re on the same page: sinus tracts don’t normally cause patients any pain on their own. This one was no different. When I examined the patient, he wasn’t in any discomfort, but he had a bump on his gums that was driving him crazy. His referral slip said to treat tooth #13, so I assumed that tooth was the chief suspect behind the sinus tract.
Take a look at the patient’s preoperative radiograph.
See how there’s a periapical radiolucency from the apex of tooth #11 to tooth #14? This radiograph seemed to confirm that tooth #13 was behind the sinus tract, and the patient was already expecting to only have that tooth treated. But these things can be tricky, so I always trace the sinus tract first, just to be safe. I performed the tracing, and wow! We could have missed something really big if we’d called it good then and there.
The sinus tract tracing revealed that the sinus tract actually belonged to tooth #14—it traced right to that tooth’s MB root. So, the patient’s diagnosis was Previously Treated and Asymptomatic Apical Periodontitis #13 and Previously Treated and Chronic Apical Abscess #14. Both of these teeth had failing root canals due to a missed canal in each tooth—the palatal canal in tooth #13, and the MB2 in tooth #14.
Getting The Patient On Board
Unfortunately, now was the make-or-break point with the patient. I told him we needed to operate on two teeth, not just one, a thing nobody wants to hear. Until now, he was only expecting problems with tooth #13, so I knew I had to be strategic in how I broke the news. I focused on two things: telling the patient his tooth story, and focusing on his own chief concern.
I don’t use tooth stories just to educate other dentists—I use them to educate my patients about the treatments that will benefit them the most. I find that explaining diagnoses to patients this way makes it more likely that they will accept all the recommended treatment. It’s a matter of setting proper expectations and reasons.
In this case, I walked the patient through everything I just described, including explaining how I used sinus tract tracing to link the infection to tooth #14 instead of tooth #13. Now, the patient was understandably not super thrilled at the prospect of having two teeth retreated instead of one. To help him accept the treatment, I focused on the implications for his chief concern: the bump on his gums. I explained that if I only treated tooth #13, as his original dentist had recommended, the sinus tract would remain right where it was, and the bump on his gums wouldn’t go away. This did the trick. He quickly changed his mind and agreed to treatment for both teeth.
If your referred patient ends up needing a different treatment than expected, I always recommend explaining your process very clearly and relating it back to their primary concern. It’s so important for the patient to understand the long-term implications and effects of different proposed treatments, especially as they relate to the things they care about most.
Trace Every Tract
I want to make sure that I do right by my patients, which is why I wrote this case study. Always, always double and triple check your diagnoses! It’s easy to assume we know the answers and jump to conclusions, especially when you’re part of a busy practice. In this situation, many of us would have assumed tooth #13 was the culprit, and wouldn’t have bothered to complete sinus tract tracing. But that would be doing the patient—and your practice—a huge disservice.
Sinus tract tracing is an inexpensive and easily teachable diagnostic tool that deserves a place in any practice. It proves you don’t need to spend thousands of dollars on a CBCT machine or other advanced technology to land an accurate diagnosis. You only need to do what we must all strive to do: invest a little extra time and effort into your patient.
So, the next time you see a sinus tract, don’t make an exception—trace it! You never know when it might save the day.
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