I have never been great at clinical documentation. This doesn’t mean the patient chart; what I am talking about is taking pictures of patient cases, making slide shows of procedures to show how procedures turn out, basically making case presentations of my work. When I think back on all my years as a dentist, I have really done a lot of great cases that I would love to be able to showcase. Just about every time I complete a big case my wife asks, “Did you take pictures?” It is always the same answer, “No, I just concentrated on the case and did not waste time on making a case presentation. As I look back on all the years of clinical outcomes it brings to mind a theory I have…”The placebo effect of telling someone they may need a root canal”. This is definitely something that I wish I had documented.
So here is how it works:
When patients come for a routine checkup we ask, “Is anything bothering you?” Often the patient complains about symptoms in a particular tooth. Usually it is a tooth that seems to be sensitive to temperature, most of the time to cold. There are a few reasons a tooth becomes hypersensitive to cold: A cavity, exposed root surface at the gumline and the dreaded pulpitis. Pulpitis is when the nerve inside a tooth becomes inflamed, over time this condition can cause irreparable damage that causes the tooth to need a root canal procedure. So if we rule out a cavity and root sensitivity often we wonder, Is this tooth on the way to needing a root canal. In this case, I explain to the patient that it seems as if the nerve is inflamed and causing the cold sensitivity, we will have to wait and see what happens and if it gets worse, becomes hot sensitive or starts aching on its own, YOU MIGHT NEED A ROOT CANAL?
Once in a while this indeed is the case and the person needs a root canal. Now, here is my undocumented theory: Most of the time the idea of needing a root canal overshadows whatever mild symptoms the patient may have been concerned about. At the next checkup when we ask, “What is up with the tooth that was bothering you last time?” Miraculously, “It’s fine!”
So what is the moral of the story: You should always let your dentist know if there is something bothering you; some symptoms in the teeth are normal and do not require treatment.
I have heard my patients say many times “I never would want to have a root canal!” My answer is always the same, “That is because you don’t NEED one.” If in fact you need a root canal it is almost always very obvious and the relief of your symptoms make having a root canal something you will want.
Until then hopeful my Placebo will do the trick.” :-)
-Dr. Dave