Oral Health Group

The tooth needs a root canal, should I treat this patient? PART II OF III

August 1, 2005
by Rich Mounce, DDS

This column will continue a discussion initiated in Part I of this three part series, which addressed the factors that go into creating better communication and trust between doctors and patients with a simultaneous eye toward helping doctors avoid unnecessary patient management problems. Specific factors, which can help identify problematic situations, are detailed that will allow the clinician to make decisions as to whether the particular patient is one the clinician can work with in an environment of trust and confidence.

Does the patient blame all of their dental problems on a past provider? Simply put, unless the patient has a genuinely legitimate complaint, it is my opinion that patients who seek to place blame on past clinicians will be very quick to place blame on you should they perceive that something has gone awry with the treatment that you might render to them. While a book could be written on this subject, in short, I do not believe that any of us needs the money enough to treat any given patient against our wishes. If the patient has unrealistic expectations or would appear to be looking to place blame, it is better to simply tell the patient that you feel they would be better served to see someone else and consider referring them to the local dental society and let them more carefully chose who they wish to see. Working on happy patients who share the same philosophy, treatment goals and with whom communication is possible makes for a positive long term working environment and greater long-term satisfaction for both parties.


Does the patient want you to change your present treatment regimen or use alternative materials that are not approved or industry standard? More often than might be appreciated, patients will request deviations from my usual protocols and request that materials of which I am not familiar or do not routinely use be employed in their particular clinical situation. In days past, patients would request materials to be used in lieu of gutta percha. Fortunately with bonded obturation materials such as Resilon and RealSeal (Resilon Research, Madison, CT, and SybronEndo, Orange, CA) this can be done easily. But beyond a switch of this type, changing usual protocols or using materials that are either not FDA approved or with which the clinician is intimately familiar is a recipe for disaster. Simply don’t do it. Tell the patient that you cannot help them and suggest they seek a second opinion or contact the local dental society for another referral.

Does the patient claim that they have never been able to get numb? In my experience, patients who claim to be unable to get numb adequately should be believed. Either the clinician should be well versed in alternative techniques for anesthesia of the irreversibly inflamed pulp or referral for sedation should be considered. Cases of vital inflamed pulps are often difficult to numb and with an often-present overlay of patient anxiety or phobia, the mountain to climb to attain adequate anesthesia and allay anxiety gets much higher. Starting such a tooth with the hope that the patient will get numb often leads to greater anxiety and management challenges rather than approaching the clinical situation from a position of creating overwhelming odds (consider giving the patient intraosseous anesthesia in conjunction with blocks in difficult anesthesia cases and test anesthesia before starting) that the patient will get numb and be made comfortable.

This discussion of how best to make patients comfortable and create trust and confidence will be continued and finalized in part III of this three part series. I welcome your questions and feedback.

Dr. Mounce is in private endodontic practice in Portland, OR and is the endodontic contributing consultant for Oral Health.

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