endo refferal
Started by Denture95
#14 has been done Rct by endo and crown lengthening by perio. Six week after, temp crown was put on. But three weeks after temp crown was put on, pt started to feel pain on the left side of the face and head, even left arm. Pt went to see his physician and got prescription for azithromycin and leviquin.Things 's not getting better. #14 percussion(+), little bit food trapped between #14 and #15. Temp crown was out of the occlusion. Pt was refered back to endo for reevaluation. Endo gave pt muscle relaxer due to gringing the tooth. After took off the temp crown, pt did feel better for four days. Then pt came to the office and requsted to remove this tooth beacuse he started to feel same dull pain on the head at 3:00am.
What is the reason to cause this pain? tooth crack or failed Rct?
What is the reason to cause this pain? tooth crack or failed Rct?
Its the GP's responsibility to determine if the tooth is restorable. I was trained at school to take out caries while doing pulpal debridement. You won't make a patient happy if you refer straight to endo (without accessing first), and then hit the patient up with crwon lengthening, or worse yet, a clinically unrestorable tooth. An honest endodontist would nip it in the bud and give you a courtesy call to tell you the tooth may be unrestoable or fractured.
Your patient may have had 1) primary traumatic occlusion 2) a missed 4th canal 3) a fractured tooth. Give the patient the option for another endo eval. If he just wants it out, you gotta respect his request.
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The responsibility of the endodontist lies in being able to diagnose that the specific tooth being referred NEEDS the root canal. This would call into quest whether or not the tooth is symptomatic because of root fracture or pulpal pathology. The endodontist cannot simply rely on the referral note of the GP and perform the root canal solely on the word of the GP (it could have been misdiagnosed).
The restorative phase is outside the scope of practice of the endodontist and relies on the GP for continuation of care. Once the endodontist completes his part, then the patient is referred back to the GP. If the patient is still symptomatic then he/she needs to be re-evaluated by the endodontist.
The restorative phase is outside the scope of practice of the endodontist and relies on the GP for continuation of care. Once the endodontist completes his part, then the patient is referred back to the GP. If the patient is still symptomatic then he/she needs to be re-evaluated by the endodontist.
Mishandled situation. GD determines restorability of tooth, not specialist. Once restorability is determined, options would be given as followed:
RCT: $1200
crown lengt: $400
Core or P/C: $250
crown: $1000
total: $2850
OR
EXT: $200
Implant surg: $1200
prefab abutment: $600
crown: $1000
total: $3000
Now, personally I would want to save my natural tooth before embarking on implant therapy (and I have 2 successful implants from a sports injury 10 years ago). But getting back to the scenario, I feel it was handled wrong.
If tooth is deemed restorable, send to endo (or do it yourself) for RCT. Wait until all symptoms are gone before continuing treatment. Next prep and temp, send to perio for crown lengthening. After crown lengthening I would personally wait 5 weeks for healing. Once healing has finished, modify prep and impress for final restoration. Now, any problems that occur, if you have treatment planned everything right, you know where you need to go. Tooth still hurts after endo, back to the endodontist for eval. Tooth hurts after crown leng, back to perio for eval. As a general dentist, you are the captain of the ship. Ultimately responsibility is on you. You refer to endo, endo does RCT, patient comes back to you and you cant restore the tooth, you are responsible for endo expense.
Acturally pt's Gp did pretty much like what you suggest.
Pt came to the office as TA#14, very bad decay. poss ext. pt requsted to save it. No fracture line found on X-ray(maybe this is beyond the scope of Gp).Tooth was refered to endo for consul and necessary Tx. Temp crown was put on to protect the tooth the day after the Rct. Then crown lengt done one week after.Six weeks after, final inpression taken for crown and new temp was put on(completely out of the occlusion). After Three weeks and just right before del the crown, Pt started to feel dull pain on the head and arm and started to tell Gp her tooth/gum sore ever since the crown lengt done, but just very mild by then.
My question is
1)How soon will the symptoms show if MB2 missed.
2)Can PA show fracture line easily?
3)Can crown lengt cause tooth fracture too?
1- 1 week, 1 year, 5 years, never. Cant predict.
2- Usually no.
3- I cant see how, unless iatrogenic.
Cracks on teeth that have been treated endodontically usually present with pain biting, percussion, and pressure, not unprovoked pain. Dull pain/ache is consistent with infection, and/or missed canal. Possibly a perio infection.
