September 2, 2022
by Dr. Sanjukta Mohanta, BSc., DDS
Doesn’t it feel great when patients come in with pain and, like a magician, we use our trained hands to get them smiling again?
How about when we cannot get the patient out of pain? What if the condition is outside of the scope of dentistry? Is it out of our hands?
Sadly, this is what happened to one of my patients. Last year, a lovely woman pointed to her gum at the apex of 23 and said it was painful to touch. She had a large restoration and I diagnosed that she had irreversible pulpitis. She had a root canal, but the pain worsened. She again pointed to the gum as the main source of pain, but now she had pain in the left side of her face. She was desperate to get out of pain and asked for the tooth to be extracted, declining other options. The tooth was extracted uneventfully, and the pain continued. She had a CBCT which showed no concerns. If there were no concerns, why was she still having pain?
My patient was frustrated that she was still in pain and I was disappointed that I got the diagnosis wrong. Let’s look at her symptoms: intense pain in the left side of her head, her left eye, her left cheek and the gum at the 23 apex site. The pain remained even after the tooth was extracted and the pain did not dissipate with local anaesthesia at the 23 site. The pain was not from the tooth.
I referred her to her medical doctor and asked for her to be seen by a neurologist. The most likely diagnosis was trigeminal neuralgia. The neurologist prescribed carbamazepine, but it did not help. She went to the hospital with extreme pain and was prescribed gabapentin. Now she was dizzy from the side effects of the medications and the pain worsened. She had an upcoming appointment with her neurologist in a few days, but she was in so much pain she came in to see me. I told her that I am unable to treat her and her neurologist will help her soon. It was heartbreaking to see her in so much pain and not be able to help.
I put my arm around her and walked her to the parking lot where her son was waiting for her. I helped her into the car and talked to her son. I apologized for not being able to help and they thanked me for always being available and kind. I wished them well and walked back to the office feeling sad that she was in so much pain. Then, a man on a motorcyclist stopped to say, “That was beautiful watching how caring you were to her.” I was stunned – I felt like I did not care for her; she was still in pain.
I followed up with her and she is on a new medication and is getting a CT scan. She is in less pain and is hopeful. After everything she has been through, she thanked me for always being caring. That is when I realized that, as dentists, we learn how to do so much with our hands, but sometimes the best way we can heal with our hands, is to hold someone else’s.
About the Author
Dr. Sanjukta Mohanta is a general dentist who graduated from the University of Toronto in 1999. She practices in Brampton, Ontario. She can be reached by email: firstname.lastname@example.org