on being a dentist...

convincing people that they need treatment when a tooth is asymptomatic is a real challenge that i face every day. and it's amazing what supervised neglect over time can do, and how you can throw a curveball both at someone and surprise even yourself. take this gentleman i saw today who was visiting our hygienist for his recall and perio maintenance visit. i pop in for my five-minute exam when she's through and i see his bitewings, noticing a rather deep, old amalgam that clinically looks intact but is pretty darn close to the nerve. i think there may have even been some zinc phosphate base in there, the filling must have been done when he was small (dinosaur stuff, he's about my age, late twenties, early thirties, and they used that when we were kids. it's real old school). when i see something like that, i'm like, hmm, maybe we should get a periapical (root view) of this tooth, make sure nothing's going on under the nerve. i wasn't expecting to see anything significant, really, it was more for my edification and his peace of mind. imagine my surprise when i see a nice, big old radiolucent area on the distal root, right on the side where the filling has barely touched the nerve. in a nutshell, the tooth is dead, has been for quite a while, and now the low-grade, chronic infection has infiltrated into the bone. this probably took at least a few months if not years to develop. so now i had to explain to this gentleman why he needs a root canal on a tooth that has never caused him any pain whatsoever and had never been singled out for anything of significance in the past. didn't anyone tell him that this filling was deep when it was done and that it may cause problems in the future? didn't previous docs before me take a fleeting glance at this tooth and say, "hey, let's keep an eye on this one because it looks like it could potentially be trouble"? so when i, a doctor who has never even seen him before today and who he knows from a hole in the wall, propose this expensive and invasive procedure, why wouldn't be thrown for a loop? and i have to ask him to soak about $700 to save a tooth that isn't even bothering him. i took him to the consult room and explained everything to him and he certainly seemed to understand and accept what i was saying, but the first thing out of his mouth was, "why didn't anyone else take a picture like that?". ummm....how do i annwer a question like that??? yikes!

and then the next patient totally threw me for a loop. a young gentleman walks in for a complete exam but complains of some nagging discomfort on his upper left side. so i take a radiograph and find an existing filling that wasn't deep at all, but i did notice significant pathology at the root. i was so baffled i had my assistant re-take the picture three times to make sure it wasn't an artifact, because i don't want to schedule something like a root canal without being totally sure. but there it was, and the tooth was sensitive to percussion, no evidence of fracture or anything. the nerve just....died, i guess. i suppose these things happen from time to time and you read about them in dental journals and textbooks and see them in lectures, but you don't expect to see them in your chair. it's like that saying, don't go looking for zebras in barns (or something akin to that!). but every now and then you get one.

and that's my blurb on being a dentist.