So the story goes as I saw two patients recently. Both of them had pain in multiple areas of their mouths. One of them had two areas of discomfort. That would be the “here, here” patient. The other one had three 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 an existing patient. The “here and here” patient was really in a lot of discomfort. The “here, here, and here” patient knew something was wrong, but a consultation scheduled in the future was acceptable for him. The “here and here” patient called for an emergency appointment that day.
I am human and have seen a lot of issues over the years. Facts and cases fill my brain so that sometimes a diagnosis starts 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 the patients was not at all what I expected upon obtaining more facts. 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, an unusual appearance on one leg can be a variety of nasty things. On the other hand, if I hear about the same issues 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 go down. Pain or issues in one area of the mouth can be a different story.
Let’s look at our two patients. The gentleman who just stopped in with three 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 had many real issues. 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 severe. 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 resulting from one problem, the second patient had discomfort coming from two different causes. One cause was excessive clenching resulting in an inflamed TMJ (temporomandibular joint). The other problem was an open space between an old crown and a natural tooth that resulted in food impaction in that area. Her fixes were easy and predictable. Two visits and she will be happy. Our other patient will require a lot more time and effort to reach a state of health. He will need ongoing maintenance.
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 parts of my practice. If either of these patients sounds like you or even if you have a couple of extra “and here” areas, call our office at 440-892-1810 to schedule a talk. 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 • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 • www.jeffreygrossdds.com