But my vacation won't be ruined?


Shortly before they go on a vacation it is not uncommon for patients  to come in with a problem that has been bothering them for sometime. Although it can turn out to be nothing important, but  it can be a problem that can not be solved in one short visit before they go away.

 Recently I saw a patient  who was in pain. She had visited a urgent care center over the weekend and received some Rx'x for her pain, but figured since it was a tooth problem and she was about to go away on a vacation, she should see me. Good idea!

She wears a partial denture and the tooth that was holding one of her clasps was loose and painful. She explained that she felt swollen around the tooth. She was going away in a few days and wanted to wear her partial comfortably on vacation.  After examination, I determined that the tooth was loose , exhibited widening of the periodontal ligament on her radiograph, was painful to percussion and had an eight mm pocket on the palatal side of her tooth . These findings didn't bode well for her tooth since she had already had a root canal and a post and crown on this tooth. The findings were suggestive of a hopelessly fractured tooth.

 I suggested we take the tooth out, since usually a patient feels better after a cracked tooth is extracted and her tooth looked like it would come out easily additional trauma. She agreed . We went over possible options. One option was to  take an impression and send the denture to my lab and have an immediate partial repair so that later when her tooth was removed she would be able to put in the repaired partial with the new tooth added. This option wouldn't allow us to complete her extraction in time for her upcoming vacation.  Instead we decided to  just take out the tooth and possibly wear her unprepared denture using denture adhesive to help keep it in place.  We planned to fix her partial denture when she came back afterwards.

We went ahead with the second option and I was able to remove her "bad tooth" easily in about two minutes. I explained that she would probably feel better soon.

The next day, when I woke up  I got a somewhat frantic call that the denture was hurting her when she was wearing it and when she removed it she observed a pus ball. I really have never observed a pus ball and I explained that this was unlikely to be purulent material but instead she seeing the cellulose sponge that I placed in her socket to help stop the bleeding after her extraction. I asked her to come to the office after it opened so I could see what was going on.

When my patient came, it turned out that my hunch was right and what she observed was actually piece of Gelfoam that had partially popped out of the socket. She actually seemed  disappointed that I didn't find pus since she actually hoped there was an infection causing her pain and that I could fix her problem by draining it and   give her some antibiotic to  make her symptoms subside before the following day when she was scheduled to go on vacation.

The good news is that she went away on vacation and had a great time and when she came back for her repair her mood was considerably improved. I'm glad, since she is a great patient and we opted for a treatment that would allow her to go away and not "ruin her vacation". I was glad that everything turned out ok in the end, but clearly it would have been less stressful to deal with this painful tooth a month before she went away.




from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/10/but-my-vacation-wont-be-ruined.html - http://lspindelnycdds.blogspot.com/

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