The phone is ringing
Doctor: Hello! Dental Surgery “Perfect Dent”. How can I help?
Patient: Good morning, Doctor. Here is your patient, Anna Nowak, speaking. I would like to make an appointment for a consultation. Yesterday I broke off a big chunk of the tooth.
Doctor: Yes, of course. How about today at 7.30 p.m.? I have time after consulting other patients.
Patient: Yes, that suits me. Thank you very much. I’ll be there at 7.30.
Doctor: So, see you then!
After a few hours
Patient: Good evening, Doctor!
Doctor: Good evening! I invite you immediately into a chair. Did your tooth break yesterday?
Patient: Yes, Doctor. While I was eating a peach.
Doctor: I see. I’ll check it out of course, but let me see the entire mouth first. Open your mouth, please.
After the test
Doctor: The remaining teeth are fine. In contrast, the molar is significantly damaged. There is only one wall of the tooth remaining, and the tooth was certainly endodontically treated because gutta percha is still preserved in the chamber.
Patient: Is it possible to do something about it?
Doctor: I think so. You must, however, take some X-rays. I do not have X-ray machine in the office, so I will write you a referral letter to an X-ray lab. It is just around the corner. Today, I will apply only dressing. During your next visit I’ll tell you what you’ll have to do and how much it will cost.
Patient: OK. So when can we make an appointment?
Doctor: It can be tomorrow or next week, because the office is closed on Saturday.
Patient: So maybe tomorrow. Should I come also in the evening?
Doctor: Yes, in the evening at 7.30 after my last patient. Just like today. And now I will apply some dressing.
Next day
Patient: Good evening. I am here as scheduled and I have an X-rays’ results with me.
Doctor: Good evening. Please sit in the chair.
Well, yes. Case is clear. Tooth, as I suspected, was endodontically treated. Canals are underfilled, so you will need to be re-treated, or I’ll have to remove the old canal filling and close the canal again. On the other hand I am very concerned about the bottom of the chamber. It seems to me that there is a perforation – at least it looks like that on the X-rays. This is a big problem, because the success of treatment is questionable. I’ll check if there is no contraindication for the closure of the perforation – there can not be exposed bifurcation. If there are no contraindications, we can start the treatment, but you must know that I can not guarantee success. Simply speaking, despite the fact I do everything according to the art, the treatment may fail. The alternative is premolarisation, which includes cutting the tooth in half and making it into two smaller teeth, or simply removing it. In the case of root canal treatment of tooth with intersection or without cut, you will need to rebuild a tooth with crown-root inserts and crowns or a crown, if I will not perform premolarisation.
Well, yes. Case is clear. Tooth, as I suspected, was endodontically treated. Canals are underfilled, so you will need to be re-treated, or I’ll have to remove the old canal filling and close the canal again. On the other hand I am very concerned about the bottom of the chamber. It seems to me that there is a perforation – at least it looks like that on the X-rays. This is a big problem, because the success of treatment is questionable. I’ll check if there is no contraindication for the closure of the perforation – there can not be exposed bifurcation. If there are no contraindications, we can start the treatment, but you must know that I can not guarantee success. Simply speaking, despite the fact I do everything according to the art, the treatment may fail. The alternative is premolarisation, which includes cutting the tooth in half and making it into two smaller teeth, or simply removing it. In the case of root canal treatment of tooth with intersection or without cut, you will need to rebuild a tooth with crown-root inserts and crowns or a crown, if I will not perform premolarisation.
Patient: I see, Doctor. I am very worried by this news. But I would like to save the tooth without cutting.
Doctor: As I said, there is a chance for saving this tooth without cutting. But I can’t guarantee you that, despite the root canal retreatment and closure of perforation, it will survive years in the mouth. The situation must be clear for you.
Patient: Doctor, I understand everything and decide to follow with the treatment proposed by you.
Doctor: Well, in that case, I must ask you to sign the form stating that you were informed of the efficacy of the treatment and possible complications that may occur during the treatment, and that you understand everything. I’ll calculate the cost of treatment at once.
Patient: Of course. Are you going to start treatment today?
Doctor: Yes, we can start it, if you accept the cost. Today I’ll probably shut the perforation, and I’ll start canals’ work during your next visit.
Patient: Well. Let’ s start then.
VOCABULARY PRACTICE
Rearrange the letters in brackets to create words which suit the meaning best.
- Often perforations are initially relatively ___________ ( LESSAIPN). If they cause an infection, then they become painful and can cause ___________ (SEWLGILN).
- Among the _______ (ISKR) factors for root perforation are _________ (CRVEUD) canals, tooth location, the clinician’s____________ (PERIEENCEX), and tooth anatomy.
- Treatment options ________ (AYRV) and can depend on the ___________ (PRXIOTYMI) of the perforation to the apex. The closer the perforation to the apex, the better the ________ (OPGRNSISO) for the tooth.
- If the perforation is near the _______ (XEPA) sometimes nothing is done other than _______ (ASEL) the tooth with gutta percha when filling the root canal.
- If the perforation is close to the crestal bone _________ (BNEO) the perforated tooth is considered to have a poor long __________ (RMET) prognosis and the best treatment option may be an ___________ (ETRTXACION) and implant placement.
- If the tooth cannot be saved, a treatment plan should be devised to ________ (AODACOTECM) the missing tooth and the patient should be advised of all options including _________ (RIBDESG), removable prosthesis, and implants.
- Perforations may lead to short-term or long-term complications that is, infection, periapical ________ (YSTC), or granuloma (RMFAOTINO).
- Sometimes restorative material may be __________ (TERUXDDE) through the perforation.
Look at the pieces of text below. Put them in oder to create a text about periapical cyst – one of the possible complications of dental perforation.
A. Therefore, these types of cyst are generally featured on the apex of the tooth. A periapical cyst is usually caused by inflammation of the pulp. The cyst itself can contain fluids (blood, gel, or pus, for instance) or even gas.
B. A periapical cyst (otherwise known as a radicular, or odontogenic cyst) can appear on the tooth area. This kind of cyst occurs when a tooth becomes infected, causing the tissue around it to decay. This can spread to the apex, and into the adjacent bone, which can eventually lead to formation of cysts.
C. In regards to treatment, you have a number of options should you develop a periapical cyst. The most common way to resolve the issue is through root canal treatment on the afflicted tooth.
D. They are also notable for the small size. Initially they may not be noticeable, but if it becomes too big it could affect your teeth and to an extent force them to move.
E. Regardless of whether the cyst is causing you pain, you will require root canal treatment, to ensure that the cyst does not re-emerge).
F. The dead pulpal tissue will be removed during this process. Your doctor will fill the space with a root filling to avert any further infection. It will be necessary to monitor this procedure with X-rays.
G. The aim is to save and restore the pulp (the inner part of the tooth). Your dentist will drill into your tooth to allow pus to escape through the tooth.
Lesson 53 answers
