Most challenging case(s)

[mdhan]

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What were some of your most challenging cases while in clinic? Just thought it'd be interesting to share.

I have a 60-year-old patient who complained of constantly having pus coming out of her left maxillary second molar area(distal). She had a tiny bit of 'pus'(or it could have been food debris - either way it was negligible) coming out when pressed with a probe, and had caries on the distal surface. X-rays showed nothing in terms of periodontal damage(meaning moderate loss of alveolar bone typical of the patient's age). There were no signs of continuous pus discharge like the patient said she was experiencing, and she didn't have any ENT problems.
With ENT problems ruled out, I presumed that the cause of her 'pus discharge' was either periodontitis(it wasn't a periotontal abscess) or caries(I'm not saying that the caries caused the pus discharge, but thought it might have contributed to the 'unpleasant mouthfeel' she complained of and that she might have expressed this feeling has 'having pus coming out'). Since she needed a crown-lengthening procedure on her maxillary second(the decay was below the gingival margin), I decided to see how her symptoms change after scaling/root planing. Her condition didn't improve so now I'm waiting to see how things will turn out after crown-lengthening followed by a filling.

 

[sandman]

Any possibility of a necrotic pulp, could be a draining sinus tract. I've had three so far with clinic patients.

I have a lady who's 80 years old on Oxygen and a two page list of meds. By the time we got to her prosthedontic needs her xerostomia and poor oral hygeine had decayed her teeth again so that we had another round of fillings to take care of before we could begin with the partial. Now, finally on the partial and the lab has screwed up the framework three times so far.
Her oxygen tank is good for two hours, which in itself isn't very conducive to a dental school environment. Basically just a really fun patient that shows no signs of ever being completed

 

[dentalman]

Your patient most likely won't be lying about pus draining out. True, they may mistake it for something else. This is less likely, however. But you don't have to actually see pus when you do the exam. Why was it not a periodontal abcess? No deep probings? Have you done an EPT on the suspicious teeth? I agree with Sandman to try to rule out a sinus tract stoma.

 

[Buckyball]

My hardest case right now is a roundhouse over roundhouse. The patient did not want RPD/RPD, and is willing to pay for it! I was like, hell yeah... let's go baby!

It's gonna be a bitch, but it's all worth it!