Consultation is an essential part of a treatment. There are many benefits for having a consultation before starting a treatment with a dentist or an endodontist. During the consultation, your referral letter from your dentist will be reviewed, your previous and current symptoms and clinical signs will be discussed with you again, a new X-Ray or a 3D scan might be obtained, more clinical tests might be performed, or the previous ones might be repeated. Based on your tooth’s history and the results of the examination, a diagnosis will be made. Since the state of inflammation/infection inside a tooth will change during time, there might be some developments in clinical signs and symptoms because of it. Therefore, a new X-Ray, a new set of tests or new history taking might reveal new results, which will eventually change the current diagnosis. Hence, a new diagnosis will establish a new treatment plan.

In some situations, you might have seen another endodontist before. While we appreciate it that another endodontist examined your tooth and gave you a treatment plan, it might be necessary for you to have a consultation session with our Endodontist. The same reasons, which was explained above, applies to this situation too.

 

Look at the case below, which is an example how diagnosis and treatment plan change during time.

 

Mr. A was referred to me by his general dentist for diagnosing his persistent pain.

Mr. A started to notice that he had pain to heat and cold food and drinks for the past couple of weeks. While he could not say whether it is in upper or a lower tooth, he thought that his upper right first molar was painful when he bit together on an almond in his cereal that morning. The pain got unbearable, so he saw his dentist the same afternoon. The dentist examined Mr. A, however, could not conclude on a definitive diagnosis. The pain seemed to be transient and sporadic, thus Mr. A’s dentist advised him that the tooth might have had cracks, which are common with his grinding and clenching habits. Mr. A was booked for an appointment for making an occlusal splint to protect his teeth during sleep.

Few months later, Mr. A  made an emergency appointment to see his dentist again. On examination, Mr. A  told the dentist that the pain had changed to be aggravated by heat, however, it got better with applying cold. That was the reason why Mr. A had carried a cold drinking bottle with ice cubes in it and sipped every few seconds from it to relieve the pain. Mr. A  also told the dentist that his pain radiated to his right ear, and he could not sleep the night before as pain killers did not seem working. Mr. A cannot touch his right lower molar teeth with his tongue. The dentist examined Mr. A’s lower right molars and he could not still find anything wrong with them. Both first and second molar teeth in the lower right had crowns. None of them were responsive to the tests, which the dentist performed. However, the first lower molar on the right-hand side was slightly more tender to the tapping tests. The small X-Ray did not show anything wrong with the lower and upper molar teeth on the right-hand side.

Since the dentist was not sure which lower molar was causing the pain, Mr. A was referred to me. When I saw Mr. A, he told me that his pain is getting less severe, however, he could not chew on his right-hand side. The pain was not to heat or cold, however, it seemed to be more localized at the back of Mr. A’s first molar tooth on the right-hand side. On my examination, both first and second lower molar teeth were tender to be touched. To make a correct diagnosis, I had to repeat all the previous tests. Additionally, we also decided to obtain a CBCT scan in order to rule-out other potential causes.

 

Above example shows how pain will change its form, location and its severity during time. If examination, tests and X-rays were not repeated, Mr. A would have ended up in treating a wrong tooth.