Man, I only have about seven blogs left. Next week is Thanksgiving, so I might write one blog. Then I will have two a week for three weeks, and then it’s Christmas. I keep thinking about life without the blog, and it is kind of weird. I have been doing this blog for almost four years.
I know it is going to continue without me and I am looking forward to hearing what the new bloggers have to say. But, I am going to miss it. All day, I constantly wonder if this situation is blog-worthy. I must remind myself 50 times a week to “put this in the blog.” Of course, I forget.
I think back about all the funny things that I have written about. There have been some classics. I think about all the trouble I have gotten myself into. I have been through about eight new staff members. I have been through three or four staff members at the AGD. I have bought my practice, had a kid, been to three national championships and have run four marathons. We have been through a lot together.
If you are a long-time reader, leave a comment telling me your favorite blog. There have been some good ones, that’s for sure. The first marathon blog was really crazy and my last one was equally as crazy (the one where I got a ride to the start from an Englishman). I am starting to water up, so let’s talk about today’s topic.
I have had a really tough week. One of the things that gets me down is when a simple thing goes bad. I’m not talking about the bombed out tooth that you try to save. You know, the pulp exposure where you do direct pulp cap on it and you tell the patient there is about a 50/50 chance of needing a root canal. I’m not talking about the molar that has been hurting to chew and you find a crack. You tell the patient that that you will do a crown and see what happens. If the crack is into the nerve, you are going to need an RCT, too.
I am talking about the patient with the 27-year-old MODF filling. It was time to do something with this tooth. There is good and there is bad, and this tooth was in the grey area between them. I explained to the patient that if they waited until it got bad, they would not be able to control what happened. But, if they took care of it now, they could dictate what would happen. Then I recommended taking the filling out and doing an onlay. I believeed what I told them; I was not upselling. This is what I would to do to my teeth.
I took all the decay out and cleaned it up. It looked great. We prepped it for an onlay and everyone was happy. When they came back to put the onlay on, they said the temp was a bit sensitive. We blamed it on the temp not having a great seal, put the onlay on, and it looked beautiful. Three days later, they called back saying it hurt.
No problem. This happens all the time and 99% of the time, it is occlusion. I told the patient that we would get them in here to adjust that. I was a bit angry, but I knew that most likely, this tooth is going to be fine. They came in and I adjusted the occlusion. See you in six months!
Again, three days later, I got the call. This was not good. This is the kind of thing that really gets me down: a tooth that didn't hurt the patient (a friend from church) now probably needs a root canal. I told them to hold off as long as they could. I know it is annoying that it hurts when you bite on it and I know it is super-sensitive to cold, but let’s just see if goes away.
It didn't go away. I do root canals, but I referred this one to an endodontist. I was so disgusted with myself that I didn't want to be reminded of my failure anymore. I don't know why, but this kind of stuff really makes me feel like a sucky dentist.
At the same time this was going, on a patient came in with a broken tooth. It was a #3 MODFL amalgam and a little sliver of tooth that is left. He is an employee at the golf club about a mile from my office, and I was going to wow him with my gentleness and charisma. I told him that he needed an onlay and we would make it beautiful for him.
We did it and he was thrilled. He came back two weeks later for the cementation appointment and he said that the tooth had been a little sensitive. What? I told him that temps don’t seal very well but it will most likely be fine once I put this one in. And we started all over again.
He was back in today for his fourth occlusal adjustment. It doesn't hurt to hot and cold. It only hurts when he eats on it. It is just annoying, not painful. I danced around the fact that he is probably going to need an RCT. So much for wowing him with my gentleness and charisma.
I have been in a total funk all wee, and I know it is because of these two patients. Wait. I put in a couple crowns in the few weeks that looked okay before I cemented them. I cemented them and then my assistant cleaned them and told me that the patients said that the crowns felt high. I adjusted the crowns but saw a band of cement. I don't like seeing cement. That means the margins are not perfect.
Again, this really bothers me. I feel like a very average dentist. Do you get in these funks? I want to do good by these folks. I just feel like I am letting them down.
I am slowly coming out of it. I got a couple of complements today and that made me feel good. Maybe I need some antianxiety drugs (the AGD does not encourage taking pills to make you feel better, unless prescribed by a physician). What can I say? I am an emotional person. I hate being this way, but I guess being this way makes me a better dentist.
How are you guys doing?
john
Hi John,
ReplyDeleteWe all have those days - you just have to swallow those bitter pills and remember tomorrow is a new day. I make sure whenever I touch anything remotely deep I inform the patient that there is always a POSSIBILITY they will need an endo. Sometimes they remember I told them, sometimes not. It happens to all of us. Your blog has been great for me because we are the same age and have been practicing for the same amount of time so its very productive and heartening to see someone with the same emotional and professional struggles that this profession brings.
Keep fighting the good fight and treat your patients like gold no matter what - it always comes back to you.
KenJ
Oh and really disregard the haters. You will never please everybody.
Thanks KenJ
ReplyDeleteI appreciate you. You would be an awesome therapist.
john
Hi John,
ReplyDeleteThis is the first time that i read your blog and probably my first time to comment on a blog.I'm a Dentist myself,graduated in 2004,Still struggling and can relate to you very well. The funny part is that whenever i see senior dentists like you with fellowships and all,i always use to think that nothing can go wrong with them.Glad to know that no one is perfect.
Hi John,
ReplyDeleteThank for your blog. It has been very helpful for me as I struggled last month with very similar situation. My patient was so upset that left the practice. It really sucks when it happens where you least expect it!
Know a collegue next door who always does RCT in these cases and then the full coverage. Patients are always happy no such problems. His style is not mine but sometimes wonder .....
I.S.
I started a rct on one of these patients.
ReplyDeleteI also did a couple of fillings that needed to be replaced.
The one tooth started to feel better but now one of the ones I did a filling on is starting to hurt.
This guy is going to leave my practice for sure.
As far as root canaling everthing. I was thinking the same thing. This is why they do it.
More money, less headaches.
But it is still wrong.
I am glad my pain makes you feel better (just be reassured that your pain makes me feel better)
john
John, I have the same issues with asymptomatic cracks that sometimes end up requiring rct after the restoration is placed. 1st, to keep it in perspective. The tooth had issues before you even touched it. You removed the bad and restored it to a better condition. The fact that decay or a crack was already encroaching on the the health of the nerve led to the need for rCT. You did not inflict those conditions. I always try to empathetically tell the patient that by doing the restoration when and how we did, we tried to give it the best prognosis long term. As a side note, if there is a rather large restoration that has any sign of a crack under it during replacement I let my patients know that these are liabilities. I usually plan for full coverage in these situations too. I used to do a lot more onlays and conserved a lot more tooth structure. However, now I feel as if I might be sacrificing a bit of tooth structure and avoiding more endo. To me, this is probably the lesser of the two evils.
ReplyDelete