Dentaltown March 2020 - 53

"Gaseous maximus necrosis" sounds like some Roman general during the times of Caesar.
I'm in the camp of when I see these (maybe once per year), I open them up and find the canals/
chambers to be empty. In fact, I've opened these up and the patient has felt relief as soon as I get
into the chamber. So, is that gas release? I suppose. I have smelled that "stink upon opening"
after I opened these teeth up. But not every time.
But it is a tell-tale sign. Dude walks in, 40 years old, water bottle in hand, his mom is talking
for him (yes, I have seen this more than once), he looks like death, has a look on his face that
says "just get me out of pain please," and sips water every 30 seconds. As soon as you anesthetize
him, he turns into a normal human again rather than a zombie.
As bad as this situation is, they are easily the most satisfying to treat. They come in with
massive pain and they walk out with relief. I will instruct my staff that anyone like this gets put
into my overflow chair and I see them ASAP, even if all I do is anesthetize them a couple of times
while I see others until I get to them. Then it's either an extraction or RCT start/pulpectomy
with caoh that day. These are practice builders. No doubt about it. I used to dread them, but I
now feel quite confident treating them.
Please ignore the "run away" advice. That's great if you have access to an endodontist quickly
and he can see your patient that day. If not, you'd better be ready to access this tooth or remove
it that day. This is not one of those "put on Abx until it calms down" kind of things.
These patients are in real, true pain. I've seen tough guys brought to their knees from this.
After I accessed it, they apologized profusely for being so dramatic, but the pain is ultra-real. ■

It's actually the fact that in presence of inflammation, the thermal receptors reduce their
threshold so that our body's temperature activates them ...

jamie888
Member Since: 07/26/11
Post: 60 and 63 of 81

Connor Jones
Member Since: 05/13/15
Posts: 61 and 64 of 81

This 10-second rule is wrong, by the way. You need baseline testing on "normal teeth." ■

Get help when strange symptoms walk in your door
Whether it's a case like this one or something otherworldly, Townies help each other!
Check out the ever-expanding collection of conversations or start one today about the
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DT0320_MB4_Diagnosis_AG.indd 53

53

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Dentaltown March 2020

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