One of the most critical components of the examination is evaluating for “at risk” occlusal conditions. These risks can take even the most seemingly simple operative dentistry into the rabbit hole and have the patient blaming everything they are now experiencing on the dentist. Hope you've never been there, I have and it is NOT a happy place.
This patient presented with sensitive teeth on the lower left and had two occlusal composites placed. The dentist told the patient that he was surprised they were sensitive as they did not seem to be very decayed despite the brown stains in the grooves. The sensitivity did not go away, it was in fact exacerbated by the trauma to the first and second molars. The patient feels worse and is becoming a little concerned with the decision to have you treat the teeth.
Pulp test these teeth now and you are virtually assured that they will appear totally fired up – no doubt the nerves are or are becoming pathologic. It's idiopathic! ... and it's not a fun ride for the dentist or the patient. Some of these end up with the endodontist and some even with the implant surgeon. Occlusion was the initiator and the continuing aggravator.
Whether your patient is in your chair for an emergency exam before an emeregency procedure, an initial examination or a comprehensive evaluation, looking closely at the occlusion can tip you to where the white rabbit is hiding to pull into the hole where the Queen of Hearts waits to lop off your head.
Always check for first point of contact with the leaf gauge and look at the functional occlusion. The images show what is happening on this occlusion, but you don't need to mark every occlusion to SEE what's happening. Talk about what you see BEFORE doing even simple procedures – if you are wrong regarding what might happen no one will be happier than you. If you are right, well, we're never happy when patients are uncomfortable but sometimes the lesson that comes with discomfort are more deeply understood, and you look like a genius.
Read more dentistry articles by Dr. Gary DeWood.
Gary DeWood, D.D.S., M.S., Spear Faculty and Contributing Author