"Great Root Canal Doc. But, Why Am I Still In Pain?"

 This is a guest post by my friend, Dr. David Dane, an excellent endodontist who practices in Manhattan. He has written a post about the importance of fully listening to a patient before providing treatment. 


That is a question no one, neither dentist nor patient, ever wants to encounter. In the over 25 years that I've been teaching dental students and hospital residents, I've given advice that was given to me: "Don't just do something. Stand there, and listen!" The following situation illustrates why.
   Last month a 56 year old female was referred to me for endodontic ("root canal") therapy due to severe pain along the right side of her upper jaw. She was very upset, and was actually in tears. The pain kept her awake the previous night.
   She had a history of liver cancer one year ago that was successfully treated with surgery and chemotherapy. She had thyroid cancer many years ago that was successfully treated with surgery. No chemotherapy was needed. With all that she's been through, it's no wonder she was distraught. She had a "runny nose" and was constantly sniffling. That happens when someone's been crying. But, I decided to ask her about it. She mentioned that she always has a nasal drip. That gave me pause.
   After listening to her history and all that she had to say, I examined her. Tapping the upper right teeth (a "percussion" test) revealed SLIGHT sensitivity, but nothing remarkable. No tooth was more sensitive than the other. An x-ray did not reveal anything significant. At that point, I started to doubt that she needed root canal therapy. I had her stand up, bend forward (as if touching her toes) and tuck her chin in to her chest. When she returned to the standing position, I asked her if the movement changed the character of the pain. When she said it did, I reassured her that she did not need endodontic treatment. She had sinusitis. When the sinus is infected, it becomes congested with fluid. Bending forward causes the fluid to move in the sinus, and the person feels a change in the pain sensation.
   I referred her to an otolaryngologist (an "ears, nose, and throat" specialist), who found that BOTH her right and left sinuses were infected. He prescribed antibiotics and decongestants and will continue to treat her sinus condition.
   This is an example of how listening to the patient and asking appropriate questions, enabled a proper diagnosis and avoided performing a procedure that would have been unnecessary and not helpful. So, the answer to "Great root canal Doc. But, why am I still in pain?" may be that the tooth that was treated was never the source of pain.
   Listening to the patient comes first and foremost!