The missed diagnosis.

When do you get a loyal patient for life? I believe when you have relieved someone of their acute pain or when you have been able to diagnose something that other fellow dentists have missed and that has helped relieve the patient of her symptoms.

After being in dentistry for over a decade I have a few interesting stories of mine to share one of which happened quite recently.

"I have pain on my entire face", said Rohini.

"What sort of pain is it?"

"What do you mean what type of pain? Pain is pain and I am sick of it."

I could see that I have a very restless patient in my dental chair and as long as I keep calm and do not ask questions that can irritate her, I can save myself from being eaten alive by a very troubled patient who will take out all her frustration on me.

She kept looking at me blankly

"Ok let me help you out. By type of pain I mean is it a dull ache which is continuous or is it throbbing pulsating pain as if somebody is periodically hitting you from the inside."

"It is dull ache which is continuous.", she said while rolling her eyes and simultaneously waving her right hand in the air making a circle as if trying to say stop asking questions and just find the cause.

When I examined her oral cavity I could not find any particular carious lesion or deep pocket which could have caused this dull ache. She had mentioned in her OPD form that she had been to two dentists before visiting me.

"You went to these two other dentists for the same problem?" What did they say?

"Well they said we do not see anything wrong in your mouth" and gave me muscle relaxant to eat for 7 days.

Well they were right I thought. And I was about to do the same when I saw something. Something which could have been easily missed but could be significant I thought.

"Did you get hit on your front teeth?" I asked.

She looked at me quizzingly.

"Yes but how do you know?"

"Was it a recent fall?"

"No it happened a few years back and I broke two of my front teeth because of that."

Then she pointed towards her left central incisor "This is built artificially, it broke into half."

I could see that the tooth was getting darker as compared to her neighbouring tooth and that is what I had seen which prompted me to ask the question in the first place.

"Do you mind if I take a x ray and check what is going on under the gums?"

"Sure but what has this to do with the pain that I am suffering from."

"Let me just shoot the radiograph I want to clear a doubt that I have and then we can discuss it."

I shot the X ray and in 2 secs the image appeared on the screen.

Voila ! there she was,a-radiolucency between 21 and 22.There was the cause of her pain.

"You have an infection in your front teeth and we will have to treat it."

"Are you sure because I have pain on my entire face and not just the front teeth."

"Look at this”, I pointed towards the radiolucency with my pen.

“I suspect that you have a cyst developing between your two front teeth because of the fall that you took."

She was still not convinced.

"Ok lets go about it like this : This finding is anyway significant and needs treatment as this infection will continue to grow and make your front two teeth loose in 5-7 years, we anyway have to treat it, so let's do that and if it relieves you of your pain too nothing like it. By the way this will 100% relieve you of your pain." I was beaming with confidence.

"Ok lets do it" Rohini had understood what I wanted to explain and said yes.

All I needed was a yes and within next 10 minutes I did access opening of both 21 and 22.

We scheduled the surgery for next day and when she reported in the morning the next day, her pain was gone and that is how I got a loyal patient for life. I could see that in her eyes that I had earned her trust and respect for life.

And all it needed was a simple radiograph.

So my fellow gladiators never dismiss a patient when she says she has pain.

Pain is something nobody lies about and it always should be investigated further.

Because if you will not investigate somebody else will.

Do drop a comment if you have had a similar experience in your practic.