CDA Essentials 2018 • Volume 5 • Issue 4

34 | 2018 | Issue 4 S upporting Y our P ractice Dr. Joel Fransen The initial assessment His dentist examined the man’s mouth and took a panoramic and periapical radiograph. A cold test was performed, but the results weren’t recorded. The dentist identified tooth 36 as the culprit and recommended a pulpectomy ( Figure 1 ). The periapical X-ray showed an usual finding at the apex of 37. Could it be a Stafne bone cyst or something else? The patient went home and returned to the dental office in the afternoon for the pulpectomy of 36, which was performed by a second dentist ( Figure 2 ). This dentist clamped a tooth on either side of 36, to see if there were any cracks. Because the patient had old shallow amalgams, which are associated with cracks, clamping a tooth on either side of 36 allowed the dentist to look at the mesial and distal marginal ridges for cracks that might extend into the root. For the most part, treatment was uneventful, but the patient did report a sharp electrical sensation when the local anaesthetic was injected. The patient was prescribed Tylenol 3 for post-operative care. The patient declined the prescription as he works with heavy machinery and did not want to lose any shifts at work. Theviewsexpressedarethoseofthe authoranddonotnecessarilyreflect theopinionsorofficialpoliciesofthe CanadianDentalAssociation. joelendo@ gmail.com The patient ended up in the hospital for two weeks. How did things go so bad? Case Report: A toothache that spiralled out of control Dr. Fransen is an endodontist in Richmond, B.C. In this article, he presents a case that he was asked to provide an opinion on, in terms of how the case was managed. Figure 1: Periapical radiograph of 36 and 37, pre-op. Figure 2: Periapical radiograph of 36 and 37, medicated with calcium hydroxide, post-op. Figure 3: Swelling in the vestibule buccal to 36 and 37. A 37-year old male went to see his dentist one morning because he was experiencing vague, spontaneous pain in the lower left area of his mouth. He felt pain when biting but wasn’t particularly sensitive to hot or cold. The patient suspected the problem was with the last tooth (37) but it could have been 36; he wasn’t sure. He was healthy but had extensive restorations and had lost most of the teeth in the posterior of quadrant four due to trauma from a car accident about 10 years ago.