The Patient Files- Part 6
This series of articles deals with real patients who came to my office for a second opinion. Not all dentists see things the same way, and there are almost always multiple options for every patient. There is not always one “best” treatment plan for a patient, but there is usually a right one.
I recently treated a patient who came to me with a complaint of severe facial pain and swelling in her cheek. She had a very complex medical and dental history that made treating her successfully very difficult. About 15 years ago, she had orthognathic surgery to align her jaws with the goal of improving her function and appearance. The surgery is aggressive and involves physically sectioning the jaw from the skull and using plates and other methods to position the jaw in the proper position for healing. Unfortunately, my patient had a very bad experience with the surgery including multiple infections that required further surgeries and bone grafts that occurred over the following years. To complicate the situation, she was also diagnosed with breast cancer shortly after her jaw surgery and her chemotherapy schedule was adversely affected by the complications arising from that problematic jaw surgery.
She continued to have problems with facial pain for years and had extensive routine dental treatment performed three years ago.When I saw her she was in extreme pain in her upper and lower jaw and had noticeable swelling in her right cheek. She had seen 3 oral surgeons, 2 general dentists and an endodontist (root canal specialist) and none saw any infection in her teeth. The only recommendation was from one oral surgeon who advised TMJ (jaw-joint) surgery.
When I examined the patient, I noticed that all of her fillings were very deep and close to the nerve, and that one of her teeth had a root that was more that half resorbed (dissolved). The first and most important goal was to get her out of pain, and that initially involved the removal of one lower tooth that had a retreated root canal that could not be saved and three root canals on her upper right jaw. I also let her know that my treatment would not likely remove all of her facial pain, but should improve the situation. Residual facial pain from her previous surgery and some discomfort in the TMJ area would remain unchanged.
After the extraction and the root canals, much of her pain and swelling slowly resolved. The procedure did not go completely smoothly, however, and some adjustments and antibiotics were also required as she healed. When I think about the other dentists who saw her and told her she did not have any dental infections, I believe it was the complexity of the patient’s medical and dental history that influenced them into not taking the definitive action that was required. Not all dental treatment is predictable and routine, but as a dentist we have an obligation to try to treat every patient to the best of our ability. If we cannot treat the patient ourselves, then we need to refer her or him to another dentist who can. Clearly, relieving a patient’s pain is of the highest priority.
Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket).