Interesting Dental Case with Mild Trauma

 

A patient of long standing came in last week with some concerns.  The work delivered to this patient over the years includes a 6-unit dental bridge in the upper anterior, a dental implant with crown on the upper left, and several fillings throughout the mouth.

When he appeared he was concerned that there was a problem with the dental implant on his upper left first molar. He claimed it was sore, particularly when he was ready to go to sleep.  Fortunately I saw nothing wrong with the implant on the x-ray and there was nothing wrong when I inspected the implant and crown in the mouth. When tapping on the tooth with a metal instrument, also no problem.

The tooth behind it was the one that was sensitive to percussion. This tooth had an MOD composite filling (goes through the middle of tooth from the back of the tooth and to the front). I noticed that the filling was hitting a little heavy and that could cause some discomfort, but the info was not all adding up.

Now the patient offers up that he was in a small car accident a couple of days ago and he hit the side of the window where he was driving. This is a much different scene than was originally offered by the patient. Evaluating the situation in light of this new data gives a different conclusion and a different expectation. The trauma is now the cause of any discomfort and the area needs to be evaluated in that light.

With trauma and no visual or radiographic signs the treatment is to wait and reevaluate. He had not taken any over the counter oral analgesics, so that would be a good place to start. I normally recommend another radiographic in the area in 6 weeks and 6 months to make sure the upper second molar does not need a root canal from the trauma. I also can evaluate in there is a small fracture on that tooth requiring a full crown, especially since it is a rather large filling back there. The examination last week did not indicate treatment for a fracture at that time.