That is not the politically correct term, nor is it particularly specific, but everybody knows exactly who I am talking about. In fact, you can picture several of them right now. The funny thing about the “crazies” is that they aren’t always crazy. Usually, we just don’t know how to help them or what problem they are trying to convey to us. As my dental education and patient management skills improve, I look back on some patients and NOW I know what I should have done for them. Here are a few moments with patients that I just could not understand at the time.
When I was first out of school, I would occasionally get patients with terrible lingering pain after an upper molar RCT. Everything looked great on the PA and I didn’t see any problems during the treatment. A thread on DentalTown opened my eyes to the anatomy I was overlooking, specifically the high prevalence of MB2s. After I bought better equipment, learned better techniques, and set higher standards, the “crazies” suddenly disappeared.
Sometimes, crazy just needs a one more adjustment. I thought these people were just plain nuts and they mostly thought I was a hack of a dentist for not being able to solve their problem. The first patient in this category is the one with pre-existing silent TMJ issues. Someone crowned their initial point of contact and changed their habitual slide. These patients will have you chasing new high spots forever if you let them. Been there, done that. The second patient in this category is the one with occlusal dysesthesia (phantom bite syndrome). I had to refer her to an OFP specialist, but I confidently labeled her as “crazy” in my mind for several years.
Sometimes, crazy has a bag full of dentures. I had an initial exam with one of these patients and sent her away. I am quite sure there is someone with more denture experience who could find a reason why the others weren’t acceptable to her. Perhaps a diagnosis of occlusal hyperawareness syndrome that needs a vastly different treatment approach would have been appropriate. Either way, I was not smart enough to even see the problem, let alone fix it; so I didn’t even try.
The bottom line is that sometimes we get to a point where we no longer see a reason or a way we can help, but that does not mean the patient is crazy. We should either refer them to someone else or study up. I would love to hear about your “crazies,” particularly the ones you found out later weren’t crazy, after all.
Bryan Bauer, DDS, FAGD