DENTAL CARE

Jeffrey Gross, DDS, FAGD

Q:A:I Have Pain Here, Here (and here) So the story goes as I saw two patients this week. Both of them had pain in multiple areas of their mouths. One of them had 2 areas of discomfort. That would be the “here, here” patient. The other one had 3 areas of pain. That would be the extra “and here” patient. One of these patients was a patient of record. The other one came along with his wife who was being seen that day for treatment and asked for a consultation. The 2 “here” patient was really in a lot of discomfort. The 3 “here” patient knew something was wrong but a consultation scheduled in the future was fine for him. The 2 “here” patient called for an emergency appointment that day. I am human and have seen a lot of issues over the years. Our brain is so filled with facts and cases that some times we diagnose before getting enough evidence. As soon as a patient starts to relate their symptoms, my mind starts to sift through the possibilities for the cause. These two patients were no different. However, the results were drastically different. One of them, upon obtaining more facts, was not at all what I expected. The other one proved to be a perfect initial diagnosis. Let’s take a step back for a moment. Any time in medicine when we experience or hear of discomfort in multiple areas, this usually is a good sign. For example, unusual appearance on one leg can be a variety of bad things. On the other hand, if this appearance is mirrored on the other leg, we usually chalk it up to being a normal deviation in that person. This generalization also holds true in the mouth. Whenever a person complains of pain in multiple areas, my disease searching antenna and level of concern goes down. Pain or issues in one area of the mouth can be a totally different story. Let’s look at our 2 patients. The gentleman who just stopped in with 3 areas of concern sat in a chair and allowed me to take a quick peek at his mouth. I knew that he needed a cleaning. First of all I could see it and secondly, he told me that he had some gum treatment a few years earlier but never really followed up with regular maintenance. I reassured him and set him up for some x-rays and a cleaning. When I looked at the films, I realized that he a number of real issues. Yes, he had “discomfort” as he described it, on both sides of his mouth. Remember what I said previously about having issues on both sides of the body. His presentation, went against this “rule.” His issues were significant. He had bone loss and gum disease throughout his mouth. However, this did not cause the pain. His pain was due to large cavities attacking his teeth under the diseased gum tissue. There were large areas of decay that were close to the nerve of various teeth. Had he waited much longer, those areas of discomfort would have turned into a lot of pain as the gum disease and cavities progressed. My other patient had a top and bottom issue. Again the bells go off that we are not dealing with anything really serious. She complained of pain when flossing a lower tooth. However, the worse pain came from the upper right area behind the teeth. Unlike our first patient who had multiple areas of concern that were all a result of one problem, her discomfort came from 2 different causes. One cause was excessive clenching resulting in an inflamed TMJ (temperomandibular joint). The other problem was due to an open space between an old crown and a natural tooth that result in food impaction in that area. Her fixes were easy and predictable. 2 visits and she is done and happy. Our other patient will require a lot more time and effort to reach a state of health. He will need ongoing maintenance. Her concerns are a one time phenomenon.

I enjoy playing detective and using every one of my brain cells to sort through all the facts and listen carefully to your concerns. It is one of the most exciting and stimulating parts of my practice. If either of these patients sound like you or even if you have a couple of extra “and here” areas, call Megan to schedule a talk. She can be reached a t 440.951.7856 and I look forward to hearing from you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com