Re: TO LAXMI(APRIL 2010 DTP case)

[Guest guest]

Very nice treatment plan ?Thanks a lot.Do you think we could include

drill

test on the 6 because the multirooted tooth can show the signs of

hypersensitivity with only one viable nerve when the others are already

dead.So,we can drill through the crown,remove decay and temporarily

restore it

...explaining to the pt.that symptoms could be worse or that we may end

up in rt

canal treatment after thorough cleaning and decay removal.What do you

think?

Thanks a lot.

[Guest guest]

Hi PoonamI hope you are doing wellThank you for such comprehensive treatment planSincerelyLyudmyla From: Poonam Kapoor <docpoonam_99@...> " " < > Sent:

Monday, 28 November 2011, 10:50 Subject: TO LAXMI(APRIL 2010 DTP case)

----- Forwarded Message ----- From: Poonam Kapoor <docpoonam_99@...> " " < > Sent: Monday, November 28, 2011 10:47 AM Subject: Re: help with dtp case

Hi Laxmi, Hope you are fine.I know about this case since april 2010 and initially i thought its tricky but now i feel its quiet straightforward as we need to think very simple way of treating as a general dentist.Treatment plan as you know always depends on the correct diagnosis ,so first of all make a list of diagnosis or diff diagnosis of pts c/c and other findings and only then u can gv the right tt plan.The diagnosis acc to me is.a)Hypertensionb)Allergies c)chief complant diagnosis can be either dentine hypersensitivity or Reversible pulpitis depending upon the clinical findings and investigations...and it seems

it is a case of

reversible pulpitis as there is dental caries in UR6.If the pain history says pain is for longer duration and disturbs sleep and painful on biting then it could be irreversible pulpitis.But the patient had only sensitivity which was not severe and bearrable it is most likely to be reversible and to confirm your diagnosis vitality test could help but it will give false reading in this case as the tooth surface is covered by crowns.so only source of correct diagnosis is history taking.....According to me most likely diagnosis is REVERSIBLE PUPLITIS as i have not taken the history of pain so whatever i could predict from your notes give me this diagnosis. d)Gingivitis,calculus deposits or overhangs depending upon the investigations. e)broken

filling f)dental caries in one

tooth So now we have all the diagnosis ready.......Take the patient as a whole considering that she is getting married soon and has come to you to give some realistic solution to her problem.Thank her for her time to wait when u were making the tt paln and tell her you are going to talk about her complain as well as other findings which are important to discuss as well so that patient is ready to listen to your tt plan. 1.First of all address the medical condition and the allergies and tell the patient i have made a note of it and make sure you take the medicine for high bp regularly.2.Patient has sensitivity...explain how and why showing radiograph and the process of decay and pain...Now the question is can patient

wait untill her marriage for the treatment to be postponed as the new treatment has some risks involved which should be explained.There are various options.Leave the bridge as it is but you may have similar sensitivity which can be controlled by painkillers like paracetamol... pain may or maynot become severe but chances are less as the tooth is protected by the crown from being disinfected by bugs in the mouth....but this option can wait for a small period of time as the decay can progress in the future and damage the inner part of the tooth ..... after marriage,appointment should be made as soon as possible. Other option is a permanent option which involves removal of the bridge and cleaning the deayed part of the tooth and filling it with a filling material and finish the margins around the tooth to give a new

bridge .In this process the bridge may or may not come out in one piece...but the bridge is 30 year old it mat have worn out and it may eaily fracture so giving a new bridge will be considere but if there is no problem with old bridge it can be recemented as well.Before we do anything and whichever choice you make, a temporary bridge has to be made to be on safe side,in case the bridge breaks while removing..we will take moulds of your teeth to make a temporary bridge,made of plastic material which will substite for permanent bridge for few weeks(till your marriage). This temporary bridge can serve the purpose till your marriage making sure you donot chew hard foods in this side. Next option is Implants which is like a metal rod inserted in the

bone and on top of it artificial caps are given.Its an expensive procedure,involves surgery and is done by a specialist so i need to refer you to the specialist.For this the teeth on which you have caps show 6and 3 on the model to the patient will be given caps as normal.This option is safe to start only after marriage.There may be a period while giving implants where the gap needs to be covered by dentures to help in healing for few months...but it depends on which specialist u go to and some might give you immediate implants as well. Ask the patient if he/she has any doubts. The last option is to replace the gap by removable plates which the patient is not interested in but let the patient know its a basic treatment and less expensive.but since the pt is not interested in

it donot go in depth of it. Now explain to the patient there are other findings which need to be considered as well..Some bleeding from gums and some deposits called tarttar have been noticed by me which is due to start of gum disease and can be controlled by professional cleaning and more importantly you maintaining it by tbrushing ur teeth twice daily once during the day and once at night befor bed using fluoride toothpaste.I will show you the technique on the model as well as how to floss in to clean in between the teeth and a special floss to clean around the bridge margins as cleaning around the bridge margins is as important as natural teeth,to prevent any further gum disease and decay underneath the bridge. There is one broken filling which can be filled by temporary today and next time with permanent

filling. One tooth is decayed which can be treated as well and needs to cleaned and filled as soon as possible as decay if remainds for a long time can cause infection in the inner core of the tooth and the tooth may die as well. So this is your treatment plan...do you have any questions or doubts. Yours Sicerely,Poonam Julka From: vijaya

laxmi <drvijaya_laxmi@...> " " < > Sent: Friday, November 25, 2011 10:19 PM Subject: help with dtp case

this case is from jan 2011. can somebody help with the treatment options

DTP CASE:this was a very weird case ......the patient had come to us after seeing another dentist who had told her that her upper right bridge for missing 4 and 5 needed to be re-done or changed or whatever......and she had come to us for second opinion. she had only sensitivity to cold on her bridge which developed recently but she had had the bridge for almost 30 years......she was getting married in 3 weeks so wanted some quick treatment for it.on investigations......3 and 6 which were the abutments, were sensitive to hot and cold but vital, the radiograph showed only 6 which had caries......she wasn't interested in partial dentures and with her wedding coming up dint want to take up the

implants options.......so basically this was it.....had some perio disease with score of 2's in all quadrants.....and one broken filling in one tooth and decay in another........suffered from hypertension for which she was taking medication and was allergic to latex and penicillins.........i have no idea as to what was the correct treatment plan for her.....

thanks

laxmi