Why diagnosis of dental problems can be inexact?

Even after after taking x-rays and performing a thorough clinical examination of a patient in pain, it is not always possible to make a definitive diagnosis in just one visit. Sometimes there are multiple possible causes for a patients discomfort. Often a patient having pain originating from one quadrant has multiple restorations and more than one can be  experiencing pain. Also, some pain can be associated with a virus.

Just last week a patient came in after a trip to China complaining of pain. She hadn't slept all night. My clinical examination showed that the pain was coming mostly the area around tooth number three, which had previously had a root canal, post and crown. The mesial papilla of the tooth  was swollen and painful. It had what may have been  a pseudo pocket of 5-7 mm. No drainage was observed when the gums were probed.  Clearly her pain could be due to a failing root canal or a fracture of one of her roots. The x-rays taken were non conclusive.

To make the diagnosis more complicated the gingiva on the buccal and palatal of the tooth had multiple small uclers which suggested an out break of herpes (viral).  If the patient's pain was caused by a virus, most likely her pain and gingival symptoms would subside without any consequence within two weeks.

I placed her on amoxicillan and sent her to my oral surgeon, the next day, to confirm my impression that her symptoms might be viral and require no treatment at this time. My surgeon numbed the area and probed and curreted around the tooth and he didn't observe any purulent drainage( purulent drainage might mean the patient had a bacterial infection).

It was decided that the best course of treatment was to do nothing more for the present but to speak with her in the following week to see if she was experiencing any improvement. If there was no improvement he could then check her again to see whether there was an actual tooth problem that required treatment.

Although patients in pain often want immediate relief, sometimes the best way to handle  a problem is to do nothing. This is especially true when the dentist is not sure what is causing the problem and there is a possibility that the symptoms will go away if the patient is given enough time. If the problem persists for more than a week or two , the patient should come back to the dentist in order to have him better diagnose the cause of the symptoms and often the source of the problem may become more apparent if given additional time.