As I have grown my practice, one thing that I am quite proud of is that I attract a certain type of patient. And that’s a patient who values their health and advocates for it. These are the patients who want to know what is happening in their bodies, and who value education and focused, compassionate care. So when a patient like this came to me with tooth pain in an old root canal, I was honored to help her navigate this new sensation in an old treatment area.
This is a tooth story about an empowered patient. A patient who took it upon herself to discover the why behind the sensation she was experiencing on the upper left side of her face. And a patient who was ready to take charge of her treatment! Talk inspiring! Let’s get into it …
New tooth pain in an old root canal: an empowered patient’s story
This particular patient had a root canal done on tooth #14 years ago.
But recently, she started having new pain in the old root canal. Admittedly, she said the symptoms were hard to pinpoint or even explain. But one thing was clear: she was bothered by pain and ready to pursue treatment that could get her back to feeling 100%.
Take a look at the initial radiographs I took on this case.
Her root canal was okay. It seemed alright, though I did see areas where it could be improved upon. So I definitely didn’t rule it out as the source of the issue.
Strangely enough, there was no obvious lesion on the CBCT, either. Hmm.
But then it got good …
The Pesky MB2
You see what I’m seeing below? On the axial slice of the CBCT, I could see some evidence of an untreated MB2 …
And even more evidence in the coronal view…
During treatment, I had to trough quite a bit, but eventually, I was able to find that MB2. I’ve said it once, and at the risk of sounding like a broken record—these bad boys are always hiding out. So check for MB2s and treat them every. dang. time.
We need more empowered patients in the world!
What’s interesting here is that even on the CBCT, there is no lesion. So here’s something very important that all us dental professionals can learn from this case: patients know their body best, and we need to listen to them.
When a patient experiences something like tooth pain in an old root canal, whether the pain is severe or not, we must thoroughly investigate all the options and make sure we crack the case. You know I love my CBCT, but it only gives us a snapshot in time. It is easy to misinterpret the data from the CBCT, because it seems that the process was just starting for the patient and a lesion just hasn’t had enough time to form so that it was visible on the CBCT.
Our job is to listen to our patients and to understand as much as possible about what is going on inside those teeth. And that we make sure we find those MB2s. Yes, EVERY SINGLE TIME.
First and foremost, the moral of this story is to listen to our patients. The body is stubborn and will usually provide all the information (in the form of symptoms) that us professionals need to understand to make the proper diagnosis.
Secondly, take time with the diagnosis, use all the tools at your disposal, and check for the MB2.
And lastly, when patients who are interested and engaged show up in your chair, make sure you encourage them by speaking candidly about what’s going on, use your radiographs to show them everything, and thank them for their proactive approach to health. Because that’s how we save more teeth!
Keeping your patients up to speed on their diagnosis and treatment plan, and getting their informed consent is crucial! Facilitate the process of communication and empowerment with my free patient consent download here.
Thanks for the blog. 2 questions: 1. How could you be sure the pain was from the missed MB2 (which I could clearly see on the first xray as being missed)? 2. With a redo rct, do you redo all canals or just the missed canal (I would think all of them due to bacteria).
With experience you just learn what things make people feel strange. And when I retreat, I retreat all the canals.