Does a J-Shaped Lesion Always Mean Extraction?July 2, 2023
Top Endo Tips and Tricks: Best Quick HacksJuly 3, 2023
Last year, I had a conversation with Dentistry Today’s team about having me write a Dentistry Today magazine feature article in 2023. I didn’t imagine I’d actually end up on the cover of the April 2023 edition! I am honored that I was asked to write this article because it has allowed me to talk about the most important part of endodontics: believing in its power to save teeth.
Here’s the idea behind the article: You can have access to all the fancy endodontic technology in the world, but if you don’t believe that most teeth can be saved, then those teeth will get extracted.
You can read the whole article by clicking the image here:
At the end of the day, it’s about your headspace as a healer and provider. If you don’t believe you can save a tooth, then you might not even give it a shot.
I’ve written this article to inspire you to rise above that assumption and doubt.
Ralph Waldo Emerson wrote, “We acquire the strength we have overcome,” and this is SO TRUE in my experience. When you are able to overcome a challenge, the power, fear, and uncertainty it had over you is defeated.
When you save an “unsaveable” tooth, it changes who you are as a dentist. Suddenly you believe in the impossible. And I want us all to believe.
The Process of Writing My Dentistry Today Magazine Feature
When it came to writing the article, I had so many ideas. It was hard to narrow them down into the topics I wanted to focus on.
But then it came to me… mythbusting! There are a lot of beliefs that are handed to us in dental school that we either don’t have the time to explore with more nuance, or where the science has actually changed. Endodontics continues to become more sophisticated, and that requires more time than most dental school curriculums can give the subject. So, that leads to a number of outdated beliefs or myths that are very common among dentists. I wanted to provide alternatives to those beliefs.
So, feeling inspired, I began writing the article. I had fun picking out tooth stories to go with each commonly held belief, and I got fired up! And then, I took a step back and thought about the tone I wanted the article to have.
I’ve gone through a huge personal shift in the last year when it comes to thinking about the energy I put out in the world. Each of us is capable of both masculine and feminine energy. As I’ve written before, this has nothing to do with whether you’re a man or a woman. It’s all about the type of energy you bring to a situation. Both of us help us succeed in different ways. Masculine energy is all about pushing forward, whereas feminine energy is about being in flow to go forward. Masculine energy is more forceful, where feminine energy is more gentle.
I had to resist the urge to tell everyone in my Dentistry Today magazine feature what they “should” do as providers. Invoking shame or blame, or barking orders doesn’t actually make anyone want to listen.
So I did a few editing passes on the article to make sure that I used inclusive “we” language as much as possible, and that I made suggestions rather than orders. After all, everyone reading the article is just as much a dental professional as me, and I wanted to talk to all of the readers as the smart equals that they are.
The Main Takeaways of the Article
There are four commonly-held beliefs that I tackle in the article. By using tooth stories as evidence, I suggest that we can rewrite these beliefs.
The first commonly held belief that I address is the idea that big lesions just don’t heal. So often, when there’s a big lesion, many dentists want to extract the tooth. However, we can often perform a root canal instead.
For example, here’s a patient who had a significant amount of circumferential bone loss around tooth #31, where her dentist found a periapical radiolucency. I diagnosed the tooth as Necrotic Pulp and Chronic Apical Abscess #31.
Here’s the preoperative radiograph…
And the two-year follow-up…
The only treatment she received was a root canal. Endodontics truly is incredible. If you want the full story about how this impressive recovery happened, you’ll have to read the whole article.
I invite you to rewrite your beliefs. Let’s turn “Big lesions don’t heal,” into “Lesion size is not a determinant of healing ability.”
Here are all the commonly held beliefs that I encourage you to rewrite through my Dentistry Today magazine feature:
|Big lesions don’t heal.
|Lesion size is not a determinant of healing ability.
|The J-shaped radiolucency means the tooth is fractured and needs to be extracted.
|The J-shaped radiolucency is NOT synonymous with a root fracture.
|A probing equates to a root fracture–and therefore a non-restorable tooth.
|A probing can simply mean that the body has found the pathway of least resistance, and that tooth can be saved.
|Bone doesn’t grow back.
|Bone can regrow, but it is slow, so have patience.
|When a canal can’t be seen on a CBCT, it’s not there.
|Look at your cone beam scan in all of its planes, and assume that the MB2 is almost always there.
|When a tooth is still symptomatic after root canal therapy, it must be cracked.
|When a tooth is still symptomatic after root canal therapy, some of the infection may have been missed, and a retreatment will lead to a good outcome.
What Can You Do to Reexamine Your Beliefs?
Over the years, I’ve learned and relearned a lot about dentistry and endodontics. It’s one thing to be taught something during class, but it’s another to live it with patients.
In my 15 years as an endodontist, I’ve pretty much seen it all. After all, it’s the tricky cases that end up in my office! I’ve successfully treated, saved, and healed countless teeth that other dentists would condemn to extraction.
I know you don’t have the luxury of doing root canals all day every day to see their efficacy over the long-term. That’s why I’ve created E-School, an endodontic CE course, to teach you all the tips and tricks I’ve learned over the years to make your root canals more successful.
What if you don’t do endo in your practice? E-School is still for you! If you are diagnosing your patient’s pain, you’re doing endodontics. E-School starts with basics like diagnosis, so that you can better manage your patients’ pain, make diagnoses you’re confident in, and send your patients to the right referrals.