RE: Lower Carnassial Lesion Advice please

Sarah Bolt — Tue, 07 Feb 2023 10:32:26 GMT

Evelyn, Thank you very much for your incredibly helpful reply, and big apologies for taking so long to reply to you, it's been a bit of a crazy couple of weeks and I'm not keeping up with things very well at the minute!

I didn't mean to send the maxillary x-ray, sorry, the names of the files were similar and I must have clicked the wrong one when I was selecting them.

I think that the owner is not keen for referral and endodontic treatment is something I have no experience with, but perhaps an analgesia trial might give us a bit more of an idea of whether there is a degree of pain in the meantime.

Thank you again for the help and advice, I really appreciate it :-)

Sarah

RE: Lower Carnassial Lesion Advice please

Evelyn Barbour-Hill — Sun, 29 Jan 2023 18:33:57 GMT

Sarah, the photographs are a little small but what you seem to have there is attrition, or more probably a combination of small fractures and attrition.

First – and I imagine you've done this – explore the affected surfaces very carefully with a sharp dental explorer. If there's any suspicion that a crack or opening goes deeper than the very surface then almost certainly some treatment will be necessary.

Having said that, it was shown in one study recently that with fractures of this tooth, even with no evidence at all of pulp exposure, pulpitis and pulp necrosis often occurs – as evidenced by periapical pathology on radiography, which you case does not have.

You sent one radiograph of a mandibular tooth, and one of a maxillary – is that what you meant to do? You say 309 and 409 are both affected. On the mandibular Xray you sent the pulp chamber does appear very abnormal – unless this appearance is actually because there are big chunks of tooth substance missing from these cusps, which I presume is not the case. This would appear to mean considerable internal resorption, which would be due to chronic pulpitis, which we have to assume would be painful in a lowgrade grumbling sort of way. In my opinion this tooth should receive endodontic treatment (but I would say that, wouldn't I !)

There's also mild periodontal disease, with loss of bone height distally and mesially.

If there are absolutely no symptoms at all (and are you and the owner absolutely sure about that?), and the owner is reluctant, don't do anything but monitor the tooth at every opportunity.

There's no reason to go for extraction at this point. In fact, I would advise against extraction except as a very last resort. It will be very hard work for the surgeon, traumatic to the patient and expensive.

Incidentally, there are interesting abnormalities of the mesial root of the neighbouring 08.