Additional Endodontic Evaluation: But Why?

When you refer a patient out, does your endodontist’s additional endodontic evaluation get under your skin? 

Have you ever wondered why your endodontist does another evaluation on your patients before they start treatment?  I mean, you just diagnosed them as needing a root canal, right? So why would someone else need to tell them the same thing?  

Well, I think this is a great topic to discuss, because it tends to be a point of frustration for all parties. I’d like to take you inside my head and focus on the top reasons why we, as endodontists, do an additional endodontic evaluation.  

Reasons for Additional Endodontic Evaluations

1. Confirming the Diagnosis

Our evaluation is really focused on confirming your diagnosis and making sure that we are treating the right tooth.  It is always better to have 2 sets of diagnoses that say the same thing, rather than one.  Experience has taught me to never trust a referral slip and to never trust what the patient is telling me.  I always need to do my own testing and go from there.  (If I didn’t do that, I would have started the wrong tooth more often than I would have liked!) 

 Referred pain is sneaky, and I always have to be prepared for it to show up in any case. There is nothing worse than doing treatment and the patient has the same pain after you treated them. Additionally, some pain is non-endodontic and can mimic a toothache.  I always want to make sure that my treatment is warranted and that a root canal is going to solve their problem. 

 2. Understanding Patient’s Medical History

 Since we are meeting the patient for the first time, we need to understand their medical history.  For example, you wouldn’t believe how many people I meet that have a blood pressure that is too high.  If I treated them in that moment, I could induce a medical emergency, and that is not what anyone wants. 

 “I prefer to understand the whole patient before I jump into any treatment.” 

 I prefer to understand the whole patient before I jump into any treatment. I always need to be certain of my diagnosis. This sets the stage for my treatment and how I handle the patient. Think about it: A dermatologist will always want to evaluate a patient before they remove anything.  An eye doctor will have to evaluate your eyes before they give a prescription for your glasses.  Everything in medicine deserves an evaluation to get the right diagnosis and treatment plan.    

 It’s kind of like how when a patient calls your office and says that they need a crown, you don’t just take their word for it — you evaluate before you treat. You want to do a quality job, and it takes time, period. That said, throwing an extra root canal in our schedule is like throwing an extra crown in your schedule! 

(But if a patient is in pain, then I do everything I can to treat them and relieve the pain right away. I’m sure you would, too!)

 3. Evaluation of Patient’s Anxiety Level

Not all patients are created equal.  They come in all different varieties… and anxiety levels.  Some of my patients are just so nervous, and I want to meet them to see if some sort of sedative would help make their root canal experience a positive one.  Many of my patients need some valium, which is something I want to know ahead of time and not after I already started treatment.  And sometimes, they need a deeper sedation that I can provide, which means they’d be better off being seen by another provider.  

4. Educating the Patient

Your patients have questions, and this is our opportunity to educate them so they can really understand their treatment.  I don’t like to call this appointment a consultation or even an additional endodontic evaluation… I prefer to call it an orientation appointment. Why? Because I want them to understand everything they can about the root canal procedure.  

I’ve found that this extra time helps alleviate a lot of the anxiety that they have about the procedure and it helps me develop my trust with the patient.  This is also where I manage my patient’s expectations so that they know exactly what to expect.  I want them to know if I think it will take 1 or 2 visits, if I have to take a post out, if they may need a new crown for some reason, if I am concerned about calcification, perhaps they need a surgery in conjunction with their root canal, etc. The list could go on and on!

 5. Is it Really Necessary?

So many people I meet actually don’t need endo.  Having an additional endodontic evaluation first creates an environment in which I don’t have to feel pressured to do the root canal just to keep my schedule full.  When things don’t add up at the evaluation, I don’t do the endo.  

 Sometimes, I like to give the patient some time to see if their problem will resolve on its own. And you know what? Oftentimes, one out of three patients don’t end up needing endo.  Case in point: When patients get sensitive after a crown and they have some symptoms, many times, even those elevated symptoms don’t need endo but rather just need time to calm down.  Or sometimes, I can tell the tooth is cracked or just better off being replaced with an implant.  If the tooth is coming out, they don’t need the endo, and my evaluation just saved them from unnecessary treatment.  

 6. Getting a CBCT

Most of the time, I need a CBCT, and this needs to be read carefully so that I can interpret the data properly.  I may also need to share my information with other specialists before I can initiate treatment.  There is a lot that can go into someone’s treatment plan, so doing that additional endodontic evaluation is really important!

7. Is the Patient a Good Fit

 This is the time my patient gets to interview me and make sure I am a good fit to be their provider. It also allows me to get to know my patient and make sure they are a good fit for me.  Even though most people do well with me, some people are not a good fit for our practice.  Doing an additional endodontic evaluation allows us to make sure we are aligned with our patients. 

Managing Expectations

 Even though an evaluation takes extra time, I am not saying that I don’t meet and treat patients on the same day.  I most definitely do, but I let their level of pain dictate if I need to open up that tooth right away.  Most people can wait for an appointment and don’t need to be squeezed into a schedule.  (Trust me, the less we do that, the better the quality of care that we can deliver.)

I believe that when you as the referring dentist understand why we do our own evaluation, you can help manage the expectation of the patient so they know what their appointment will be like at the specialist’s office.  With this understanding, your patient can really have a smooth transition from your practice to ours. 

-Sonia

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