Normal postoperative sensitivity is something we are all aware of. So how many times have you had a patient who was sensitive after their restoration, be it a filling or a crown? How long do you wait until you make a referral? And what are your steps before you make your referral?
Do you rule anything out, like occlusion?
Well, here is a story for you…
Was it Normal Postoperative Sensitivity?
It was the day after Christmas and all was peaceful. I went into the office to do a little end-of-the-year cleaning, and was organizing my desk when one of my team members asked me if I could see a patient for an emergency evaluation. (I didn’t mind because I didn’t want anyone to be in pain over the holiday.)
The patient came in and stated that she had a new crown done about 8 days ago and that now she couldn’t bite or tolerate anything cold. When I asked her what her pain level was, she reported a 6 out of 10. Knowing that it could just be normal postoperative sensitivity, I went ahead and diagnosed her to figure out what was causing her to be in pain.
Diagnosing the Pain
My diagnostic tests confirmed her symptoms of cold sensitivity with lingering pain, along with pain to percussion and the bite stick. I also confirmed that her occlusion was totally normal. I noted the mesial and distal decay on tooth #19 and diagnosed her with Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis.
Since she was in a good bit of pain at the evaluation, I offered to open her tooth right then and there. I was concerned that her pain could get worse over the remainder of the holiday weekend. I gave her a treatment plan and presented her the fees, but she decided upon checkout not to stay for treatment. (Turns out she realized her insurance had maxed out. I guess her pain wasn’t that bad after all?)
The Passage of Time
Fast forward a few weeks and now we are into the new year, when the insurance benefits roll over, lol. The patient was back on my schedule for treatment. I was really surprised that she could tolerate the pain for so long!
When I walked into the room and asked her how she was doing, she said she was “fine” — and in my opinion, she was almost TOO fine to be in my chair. I asked her if she had been functioning on that side. Her response was that she only had a little pain to heat but that she could now chew on that side, so I decided to retest her. She responded normal to cold with no lingering pain and no longer had any pain to percussion. Say what what??! She said she still has a little bit of pain to heat, but that it was only for that moment and it disappeared right away once the stimulus is gone.
Time Heals All Wounds?
I stopped my testing and informed the patient that we could do the root canal at any time. However, I added that, if the passing of time was making her feel better (just like with normal postoperative sensitivity), then perhaps leaving things alone and giving her MORE time would help her recover even more.
One piece of the puzzle that I didn’t know initially: She had a bite adjustment from her GP a few days before she came to my office the day after Christmas. Apparently, she had insisted on a referral to my office based on her previous experiences with tooth pain. I wasn’t aware of this until her second visit, since she said her pain was initially an 8, then after the bite adjustment a 6, and then down to a 3. (No wonder why I didn’t notice that her bite was off at the time of the evaluation — it was already adjusted!)
At this point, she had no pain at all, although all of her initial tests indicated that she needed a root canal. I know now, because we waited, that her testing was a false positive. Do you see now how time could “heal all wounds”? It is something that you need to be aware of as a possibility, just as with normal postoperative sensitivity.
The Rest of the Story
When she found out that she wasn’t going to have a root canal, she gave me a look of complete gratitude. Yes, her buildup was deep, but so were some of the restorations on her other teeth… perhaps she can tolerate deep restorations. Since the crown was on with permanent cement already, I wanted to wait for more definitive symptoms. Yeah, I lost some production that day, but it’s better for me to do it this way. Man, am I glad that we waited for her treatment!
It just makes me wonder, how many root canals are we doing because we are not giving the patient the chance to recover from the normal postoperative period?
Normal Postoperative Sensitivity vs Something More Serious
I often give the patient what I call a “two week check.” If a patient comes to me and has either symptoms that are not that bad or are localized — or they recently had some dental work that could be the culprit — I usually have them wait before we start treatment. I then schedule to see them again at no additional charge (and I tell them beforehand so they will actually come back). At that point, I re-evaluate them and go through my diagnostic tests again, comparing the findings to my initial tests. If they get better, then hooray — we move on! But if their symptoms are not better, then we initiate treatment knowing that treatment is really necessary.
- Always give your patient time in order to decipher between normal postoperative sensitivity and a tooth needing a root canal.
- Don’t underestimate the power of a bite adjustment.
- Make sure your treatment is warranted. Re-test if you’re not sure! It may mean you don’t go through with the treatment.
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