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Endo tips    Better Endo    Endo abstracts    Endo discussions

the flareup after the best treatment

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From: Jinyong Park
Sent: Wednesday, April 04, 2001 20 36
Subject:the flareup after the best treatment

Sometimes,I feel embarassed with the situation requiring 
replacement of old and inadequate restorations for  a tooth 
with a chronic pulpitis.

Because the pulp had been in a quite state, I was unaware 
of the true condition.As  a cavity preparation,impression,
temporarization,restoration placement,the  chronic pulpitis 
was converted to an acute situation and pain developed,
Although the major source of pulpal irritation may have 
occurred many years earlier when the previous work was
performed, the present treatment might be erroneously 
blamed as the major source of the problem.In this case ,
How do you explain the patient,and What is the best method 
to prevent this?  Thank you!

From: I. Blake McKinley, Jr.
Sent: Wednesday, April 04, 2001 04 13

Dear Dr Park,

It is not a unique situation to have a tooth which has been 
asymptomatic become symptomatic (acutely pulpitic).  There is 
no way of preventing this or predictiing this.  The patient's 
needs required that the restoration be replaced, the quiescent
status of the pulp would not give anyone any indication of a 
problem develping.

The best way of reducing the patient management factor is to 
"pave your way with words" beforehand.  The patient needs to be 
informed that most of the time the tooth will survive the 
restorative process just fine, however, at times a tooth will 
become symptomatic following the placement or replacement of a 
restoration.  If the symptoms are appropriate, a root canal will 
be recommended.

Of course, according to your description of the situation, 
endodontic treatment is now indicated.

You have described a situation that is not unique to you nor will 
it be the last time you encounter this situation.  In fact, I would 
imagine that most of endodontists run into this fairly routinely.  
They recieve what I call a hostile referral of a tooth that is now 
symptomatic, and the patient is asking the endodontist if their 
dentist did anything wrong.  The trick is to diffuse the hostility 
quickly while maintaining the referral relationship, helping to 
foster and reinforce the patient's confidence in
their dentist, and generating a relationship with the patient.

I hope this helps, this just reflects my experience.
It would be interesting to hear what experience others have.


Blake McKinley, Jr., DDS
Endodontics Exclusively
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