Dentaltown April 2021 - 26

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John Pulsipher
Member Since: 08/31/05
Post: 11 of 88

Yikes! Anyone reading this should learn that this is not a GP case, save very few who do a
ton of surgery, biopsies, etc. In hindsight I am sure you agree that this should have been referred
from the start. Don't hesitate any longer.
Is this a reflection of our society's communication skills or the deterioration of GP/specialist
relationships? Why will we ask this on the internet rather than asking a local expert?
Thank goodness we have good advice here. ■

9/29/2015

mickeyt107
Member Since: 02/18/15
Post: 15 of 88

I removed #7 as it was very painful for the patient and fractured at the gumline. She only
has a few anterior teeth left and is headed for a denture. Extraction took care of the pain for the
patient, but her CC was the bad taste she was still getting.
I should add that at the time of extraction I was able to drain most of the swelling on the
palatal through the socket, and upon reeval four weeks later the swelling was no longer present.
The reason I didn't refer immediately is it looked like an AAA, which in the past I've lanced and
drained with no further issues.
I'm contacting the patient today for referral to OSX. I'll try and post an update when I hear
back. ■

9/29/2015

mickeyt107
Member Since: 02/18/15
Post: 29 of 88

Bloom-Chicago
Member Since: 03/20/02
Post: 33 of 88

Still waiting for the report from OSX. When I spoke to him on the phone, he was thinking
it was just a cyst. ■

10/22/2015

I would have done the extraction too. First priority was the pain and swelling. At least 95
out of 100 would have been predictably fine. The fact that this one isn't fine is certainly reason
to make the referral.
If I'd have done anything different, it would be to follow up sooner and make the referral
after a week or so, not a month. I ask the patient to help me with that by describing what I'm
expecting to happen (because it almost always happens like that), but to call me if it isn't happening that way in the time frame I describe. I talk about a potential 1-3 days of soreness and
all signs and symptoms tapering down to zero. If it isn't happening like that, then they should
call me on the fourth or fifth day. Of course, I am usually describing onset of dry socket, but
that description of what I'm expecting is to help them understand " normal " vs. " not normal "
postoperative experience and they need to let me know if anything is " not normal. " (I wouldn't
be surprised to find that the OP's patient was waiting out that month to see if it went away and
didn't notify the office until she realized it wasn't going away.)
If anyone here is suggesting that the OP should have not addressed the pain and swelling by
extracting the " most likely suspect, " and instead should have immediately sent this patient to the
OMFS, then I respectfully disagree. That is Monday morning quarterbacking. ■
10/31/2015

jgne
Member Since: 03/20/14
Post: 41 of 88

I think it's been a little hard on the OP to say that a month was a big mistake to wait, when
the biopsy results (which were made with the antennae already on alert due to extraordinary
happenings) will still take a week or two.
Yeah, in a perfect world, everyone would get specialists involved ASAP. Not always going to
happen. I take Medicaid patients. Good luck getting a specialist even when you know you need
one, let alone when it just looks like another neglected dentition. No need to have surgeons take
out every #7 with an abscess that had some time to brew. He's at the point where things didn't
go as expected; now is when you realize it just might be that zebra after all.
Wish you and the patient best of luck as this is resolved. ■
11/2/2015

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