Online Endodontic Education
How about testing the teeth? What were the clinical findings?
DIAGNOSIS– Pulp tests
Not sure what pulp testing brings to the table here, other than developing a historical record of the tests. ECIR, even ECIR Class III and IV, usually test WNL—-so what is testing accomplishing? Generally we don’t run tests unless they can alter our action threshold and I can’t see any test result here that can do that. I’m not touching this tooth no matter what the test results are. On Craig’s comments, I agree, on a Class II or Class III ECIR, if the defects were just on the distal—I might be tempted. We all have cases where these sorts… Read more »
For example in this same case…….
Thank you for the tip. It is helpful to be reminded of the potential for other sites of resorption.
Point of clarification, if you don’t mind. Are you saying that the tests were distracting from the main purpose of this post? Or that you didn’t perform any tests in this case?
Brandon, We have had a long and contentious discussion on TDO about “Tests and Testing” extending over many years with an almost uniform conclusion among our users that most dentists don’t understand the role of tests, or even how to interpret them in a way that engenders smarter decision making. So I was trying to engender a discussion about that in responding to the query about running additional tests. Technically, I did run some tests to confirm the patient’s claim that the tooth was asymptomatic. Percussion, palpation, chewing, bite tests, probing test, etc. And the CBCT itself should be considered… Read more »
Makes sense. Thank you for clarifying!
Thank you Dr.Carr for the orientation on the tests and decision making.
You mentioned that you are not going to touch the tooth — poor prognosis
— How do you discuss this with the patient?
Where did I say I was “so sure” about anything? I leave being “so sure” about decisions having to do with ECIR, to others. Indeed, decisions about ECIR are dominated by uncertainty and in environments dominated by uncertainty, one should be humble about what one knows with certainty and what one doesn’t know. What do we know about ECIR? 1. We know we have a poor understanding of its genesis, progression, and to what extent our treatments are always beneficial. 2. We know the disease progression is episodic and not predicable and we lack knowledge of the triggering events. 3.… Read more »