View from the Chairside: to probe or not to probe?
By Dr. Thomas Shackleton
Dr. Shackleton is a general dentist in Calgary, Alberta, with a practice limited to endodontics. He is currently working on a 3-year master’s degree in orofacial pain and oral medicine through the University of Southern California.
I see cases like this almost daily. The patient comes in with mild discomfort, especially when eating. Some swelling that comes and goes. An occasional bad taste. The radiograph shows a large, radiolucent “J” shaped lesion around one of the roots. Often the lesion will extend into the furcation.
We diagnose it as an abscess, which is exactly what it is. The question is: Why does my patient have an abscess? It can be one of many reasons: periodontal disease; an endodontic lesion; a cracked or fractured root. But without probing, you won’t be able to diagnose which one. Even though the above radiograph and patient symptoms are entirely consistent with a cracked root, it’s best to be certain. The following probe guidelines will help you sort out your diagnosis:
- Normal probe depths with an isolated deep probe (5-10+mm) adjacent to the radiographic lesion would confirm a vertical root crack/fracture. Poor prognosis – extraction is your only option.
- Normal probe depths all around the tooth may indicate an endodontic lesion. Be cautious, as there may still be a root crack/fracture, but retreatment may be indicated as this may be an endodontic lesion. Retreatment, using a surgical microscope or flap surgery, are the only options to treat this tooth. Remember – always look for a crack!
- Multiple probe depths of 4-8+mm would be consistent with a periodontal lesion. This tooth may be restorable. Surgical debridement is the treatment of choice.
Probing is simple, fast and provides so much diagnostic evidence. It saves you and the patient from wasting time, money and untold energy. You have nothing to lose and an accurate diagnosis to gain!