Instant diagnosis?


Many patients come to my office in search of a diagnosis. Often after a brief discussion and a look at their radiographs it is clear what the cause of their symptoms.... but sometimes I cannot say for sure what is the cause of their symptoms. This is because nothing difinitive shows up in their physical exam which reveals a specific diagnosis. Instead I have a number of possible choices and each would end up requiring a different course of treatment.

In the event that I can't pin down the exact cause, I often choose a benign treatment option. One that is non invasive or involves removing a tooth. This could involve cleaning around a tooth, antibiotics, or having a patient wear a nightguard.

If a tooth has definite symptoms of chewing sensitivity or sensitivity to hot and cold and has a large filling or visible crack lines I will often remove the filling and the excavate cracks in order to get a better look inside the tooth. Often this gives me more information about the nature of a tooth's problems. Some teeth with cracks will end up requiring a root canal treatment but others my just need protection with an onlay or crown.

While it is true that for many tooth problems, either extracting or performing a root canal will eliminate a patients symptoms, sometimes this sort of treatment constitutes over kill and a less drastic treatment might suffice (crowning a tooth, refilling a tooth, waiting and seeing if the pain goes away etc...) This is a conservative approach and eliminates needless dentistry, but can sometimes frustrate "impatient" patients who just want to "fix" their problem.

TV's  Dr House  is clearly a master diagnostician , but often he can be stumped for a period of time ( at least for a hour) . Since it is not real life , but TV land, his patients rarely die, but instead he comes up with a proper diagnosis in the nick of time. Luckily for us dentists, today people rarely die from their immediate dental problems but sometimes making the proper diagnosis can be a gradual process and taking a week or two to narrow down what the most likely cause of the a patients discomfort  is sometimes the best way to proceed when presented with non specific symptoms.





from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2017/08/instant-diagnosis.html - http://lspindelnycdds.blogspot.com/

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