My sincere thanks go to Dr. Joel Fransen who took the time to prepare and share this important case with our Oasis audience. Such unfortunate situations happen and it’s great to be able to share them and learn from them.
Dr. Fransen is a seasoned endodontist in Richmond, BC and a frequent contributor to CDA Oasis.
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Until next time!
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Dr. Fransen’s Notes
This case demonstrates how things can cascade out of control for what, upon first glance, appears to be innocuous. A thirty-something gentleman reports vague pain in quadrant three. The medical/dental histories are unremarkable save a car accident ten years prior that required extensive restoration of many teeth. There were no overt signs of infection or other problems. The dentist reports pulp and periradicular testing revealed 36 as the culprit. The pulpectomy was uneventful and Tylenol No. 3 was prescribed. Nevertheless, over the proceeding days and weeks things deteriorated to such an extent the patient spent ten days in ICU.
There are a litany of lessons that can be gleaned from this case. Generally speaking, whenever a response to endodontic treatment or extraction is suboptimal, be wary and consider further radiographic investigations (i.e. CBCT, angled PA’s) and second opinions from colleagues or specialists. Post-op fascial space involvement, numbness, vomiting, sleep disruption, and the like are serious sequelae warranting a comprehensive re-evaluation of the diagnosis and treatment to-date. A delay in an accurate diagnosis and decisive treatment can have dire consequences.
Full Case Presentation (32.03″)