Article
Readers are encouraged to submit clinical experiences, good and bad, in a culture of open reporting, so that other clinicians will learn from these experiences. Unlike articles in Dental Update, in which published articles are peer reviewed by two experts in the field of the article, this page is not subjected to review other than by the Editorial Director.
My orthodontic colleague asked me to see a patient ASAP. She had finished her ortho treatment and was getting married in 10 days. He had tried to whiten her previously root-filled UL1 and it was not improving. She was ‘squeezed in’ a very busy schedule to see me and then she was late for her appointment. I briefly discussed ‘inside-outside’ whitening and she agreed to try this and we proceeded. I saw her twice more and we did get a good result – she was happy – orthodontist appreciative. Six months later, she e-mailed me with a photo and was worried about a red area on her gum near the tooth. I had just read an update on tooth whitening issues in Dental Update and had been thinking that I do not routinely warn patients about the risk of resorption with this treatment. I had now convinced myself that I didn't warn her of that risk and that this was the issue. The happy ending is that it was not resorption, or a failing root filling; the tooth is stable and we think it may be a type of Lichen Planus. I have had time to reflect on the entire situation and have summarized the salient issues.
What I did wrong:
I was too busy and did not have time to gain proper informed consent about the procedure, gain the entire history of the tooth, and I did not end up sending my usual letter explaining the treatment options and risks….as she was an extra patient on my list, I somehow failed to do the usual.I wanted to help, and I let HER arrange the schedule, and my desire to help my colleague dictated how I proceeded, and then I didn't go about it the way I should have done.My notes were not good enough. After 30 years in dentistry, I definitely know better, but I did not put enough detail in my notes about exactly what I did and why.
What I did right:
Helped my colleague (‘what goes around, comes around’), and I had the patient's best interest at heart.Contacted the patient immediately when she messaged me and arranged to see her then, when I was unsure what was going on, booked her in with our periodontist to help.Took good clinical photos and x-rays of the tooth before and after treatment.Discussed the entire situation with all my colleagues, a problem shared is much easier to deal with.Read Dental Update every month!
