Let your inner voice have complete freedom. Allow others to know everything you’re thinking.

From a patient that I saw yesterday for a consultation:

I’m with a new dentist now. I left my previous dentist because one day when she was drilling my tooth and you could smell that tooth dust smell she told her assistant that that was the smell of money.

Action: When referring a patient to a specialist, and the specialist’s office says that they are booking 2 months down the road, get on the phone personally and demand to know how many hours per week the specialist works. Something like this is particularly effective: “Two months!? How many days a week do you work? One??”

This scores your office lots of fuck you points and pretty much guarantees that if you try to refer other patients in the future they’ll probably have to wait even longer. Why not teach the specialist “a lesson” by not referring any further patients to them.

Our work is part of our life and how we work is also how we live. The energy that we interact with there is what creates a happy or unhappy work environment for each of us.

I love what I do and I think that I’m pretty good at it. Those two things usually go hand in hand. But last week a particular case highlighted a few things.

The case involved a female soldier suffering from a moderate cellulitis¹. The infection was from a tooth that had had a root canal started at her base. An instrument broke off in the tooth, and infection subsequently set in.

She ended up in the emerg department at a hospital and was started on IV antibiotics and narcotics. I saw her the following day.

By the time I saw her the lip and face were still very sensitive and the overall facial swelling still existed. In a nutshell I had to basically contend with an anxious patient, attempt to achieve some discharge from a tooth that was blocked internally with the broken instrument, and also get her numbed up enough to be able to do the work.

She and I worked together to manage her anxiety and fear and so I was able to achieve some positive results with the tooth and swelling.

I was fucking exhausted afterwards. Even though the work itself for this case turned out to be fairly easy, the whole management aspect just left me feeling drained.

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Footnotes:

1. A painful swelling of the soft tissue of the mouth and face resulting from a diffuse spreading of purulent exudate along the fascial planes that separate the muscle bundles. [↩]

She: You know, eye doctors have this thing where the patient lies on their back and it rotates.

Me: Uh huh?

She: Yeah, maybe dentists should look into something like that.

Me: Uh huh?

She: It’s like the thing that mechanics use. You know, where they lie on it and then it slides under the car.

Me: Uh huh?

She: So the eye doctor rotates the patient so that they are lying upside down and the eyes fall forward and the doctor works on them from underneath.

Me: Hmm. Uh huh?

She: So wouldn’t that be easier for dentists and their patients too?

Me: Working from underneath you like you’re a car?

She: Yeah…like that…

Me: Except you’d drool all over me. No thank you.

She: Oh, you’re right. Hmm.

Me: Uh huh.

The first picture is how this premolar arrived (with the patient) to my office. Discharge was present through the gums from a chronic abscess. Looks like a radiolucent post was placed practically to the apex. There’s some remnant gutta-percha or cement mid-root and probably an apical perforation at the base of the post.

The tooth was retreated over a couple of appointments. Sure enough there was a perforation at the apex of the root, but laterally. I was never able to regain the true canal beyond the perf. A carbon fiber post was removed, Calcium Hydroxide was used as an interappointment intracanal dressing, and then MTA (Mineral Trioxide Aggregate) was used to fully obturate the canal.

There is a 21 month interval between the two films. Osseous healing is progressing well, and no mucosal lesions were evident at the time of the second film.

This case also serves as an example of the fact that a 1-year recall on endodontic cases does not provide enough time to properly evaluate healing. From a strict radiographic interpretation, this case has not healed and is therefore not currently a success. One strike against the relevance or clinical significance of that Cochrane Review.

By the way, I did address the molar’s obvious periodontal issue verbally. The patient is aware of a guarded long-term prognosis there.