Does Your Patient’s Tooth Still Hurt?
If you’ve been doing dentistry long enough you’ve had at least one patient come in after completed treatment with pain, sensitivity, soreness, or all of the above. After seeing your patient several times for follow-ups and adjustments, you and the patient finally decide either to redo the restoration and/ or conclude the tooth now needs a root canal.
And after all of the tooth dust settles, the patient comes back in and is still having pain: “It’s better doctor, but it’s still not quite right.” One of the most common things I have found that causes the issue is occlusion. I’m not talking the standard “bite up and down.” If it were that easy, after the tooth is adjusted a few times it’s usually taken out of occlusion, and the symptoms would go away.
Sometimes we are lucky enough to find a heavy lateral excursive contact that may be causing the issues. Once it is relieved, the symptoms go away. But sometimes even after having the patient do everything we can think of, it’s still not right. Well, before you give up, look at the extreme crossovers, protrusion and lateral movements. I have had a few patients that when nothing else seems to make a tooth comfortable, when I have them move their jaw to an extreme lateral, protrusive, or crossover position, they have a heavy contact present in the problem area.
Some patients may go to that place during nocturnal brusixm and some may even do it during the day at times, and just simply “play around” on the area. I have found by eliminating that contact area, the symptoms resolve rather quickly. So, next time when nothing else seems to be making a difference, check it out in the extreme position.
Jeff Lineberry, DDS, Spear Visiting Faculty [www.jefflineberrydds.com]
For a detailed look at occlusal guidance patterns, history and research, view our free lesson: Understanding Occlusal Guidance.