Dental pain and its isolation to a particular tooth (if that is the cause) can be complicated and difficult to diagnose.
This can sometimes lead to accusations against the dental practitioner as being the cause of the problem, especially if work has been done recently on this particular tooth. The patient may believe that it is a simple case of cause and effect:
“I came to see you without any significant pain, you drilled my tooth, and now it is very painful”.
Follow a clear process
The importance of a thorough history must be strongly stressed, especially with regard to the history of that particular tooth and also the need for accurate clinical notes with all details and radiographs recorded including tests performed, and local anaesthetics used etc. These requirements are comprehensively listed at the Dental Board.
Once a diagnosis has been made, the patient must then be provided with an explanation as to which tooth is responsible for their discomfort and why. All too frequently the patient is told that the tooth probably has a crack. This of course may be the case, however, in many situations it leaves the patient without an unsatisfactory explanation of their plight.
Discuss effects of inflammation
Perhaps a clearer understanding of the pathology is that provided by Professor Herbert Schilder, the father of modern endodontics. He used the analogy of the dental pulp being similar to the appendix, namely where you have a large volume of tissue with a relatively poor blood supply. This tissue (the appendix) can become inflamed for reasons we don’t understand resulting in the patient having appendicitis and thus requiring remediation
With regard to the pulp of a tooth, each time a tooth is filled there is a zone of inflammation in the pulp in proportion to the size and depth of the cavity prepared. This inflammation causes discomfort. Fortunately, in most cases this inflammation is reversible, the discomfort resolves and the tooth becomes ‘normal’ again with regard to its response to heat and to cold.
However in some cases, and it cannot be predicted when, this inflammation doesn't resolve and the tooth remains painful. Consequently, the treatment options then are either root canal therapy or extraction. Such an explanation is easier for the patient to comprehend than that of discussing the possibility of a crack existing, unless of course that can be shown clearly to be present.
A précis of your discussions regarding diagnosis and management should always be properly reflected in your clinical notes.
Use examples wherever possible
Presenting dental issues in this way with examples the patient can easily understand, results in a better appreciation by the patient of their situation. It provides useful information about why a tooth may suddenly become sore and the reasons why a tooth may become sore following a dental procedure.
