18 www.pagd.org Q dentistry issues • Don’t ask us if the tooth is restorable. You already know this. There must be 4mm of ferrule from bone to height of ferrule or, if not, can 4mm be created through forced orthodontic eruption or osseous recontouring. • Don’t anesthetize a patient that you are sending right over for diagnosis and emergency treatment. If anesthetized, we cannot duplicate the symptom or perform the needed tests to prove the diagnosis. • Do be cautious. If pulpal symptoms, cement the crown with temporary cement or leave the provisional in place until symptoms subside. Pulps can die slowly and quietly so be sure to pulp test before cementing with permanent cement. Also, take a PA as a quiet lesion of endodontic origin may be present; particularly if the pulp has been symptomatic. The worst thing to do is permanently cement a crown that turns into a pulpitis. We get this almost every day from one of your patients, “What, you are going to drill a hole through my new crown! Who is going to pay for that? Shouldn’t my dentist have known this before they cemented the crown?!” Hard to make you look good. • Do PAVE YOUR WAY WITH WORDS. Again, whether you are restoring a buccal pit cavity or full mouth rehabilitation, let these words flow from your mouth, “It is an infrequent possibility but as we restore your teeth to health and a beautiful appearance, occasionally the tissue inside a tooth or teeth will need to be removed and, if this were to happen, we would do root canal treatment to predictably save your tooth, or sometimes I will bring in our endodontist.” No need to make a big deal out of it. Say it and get on with your treatment plan explanation. This is simply informed consent. Note it in your chart that the patient has been informed about possible endodontics. • Do probe the apparent toothache tooth. It may be periodontally hopeless or an obvious fracture. Of course, if unsure, get that endodontic “diagnostic monkey” off your back and bring in your endodontist. • Do not refer a sinus tract tooth as an emergency. It is not. • Do establish with your endodontist what constitutes an emergency. • Do not tell the patient the endodontic fee. We do not know what it is until diagnosis. Tell the patient they will know the fee after diagnosis and before endodontic treatment. If the patient insists to know a range, tell them it is about the same as new TV. And, of course, there are different qualities of TV’s. Your patient understands this. • Do not think you have to be perfect. We ALL make mistakes. We all have unintended outcomes from time to time. We are human and we do not make perfect results every time. In fact, to be honest, most dentistry is not perfect but rather a degree of perfectionism. Dr. Bob Barkley, the father of preventive dentistry, is quoted as saying, “Dentistry makes patients worse at the slowest possible rate.” He was right. We do our best and sometimes best is not enough. • Do not attempt an endodontic treatment unless you have a strong confidence that you are competent to treat successfully. Remember, you are held accountable, as with all specialty care, to the standards of, in this case, the endodontist. • Don’t tell the patient that the treatment will be done first visit unless that is what you and the endodontist have agreed to. • Do tell the endodontist what you know about a treatment that you have attempted. For example, “I found all the canals but cannot find the MB2 canal of a molar or I did not try to go down the canals.” Another example, “I have tried to get down this canal for an hour and so I gave up. Can you finish?” Knowing EXACTLY what you have done or attempted to do and how long you spent on attempting the desired outcome is hugely valuable. Treating a patient with a broken file in a canal without your telling the patient once again makes it hard to make you look good or to stay away from a litigious situation. • Do keep accurate records. “Good clinicians keep good records.” • Do be honest about a new associate becoming your “in house” endodontist. • Change is the only constant and one constant change that I am observing as a teacher is that groups are sending their new dentist to learn as much as they can about endodontics so that they can keep endodontic patients in their practice and reduce the number of patients being referred to the endodontist. Typically, this new dentist enjoys endodontics and is happy to
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