Q: I have had a toothache for months now and my doctor cannot find anything wrong with it on the X-ray our upon his examination. I have seen the root canal specialist twice who says I don’t need a root canal. The tooth has no fillings or dental work on it. What should I do?
A: I will respond with an actual patient’s case: For those that know who Howard Stern is, you will understand why I chose the name above to disguise the name of my patient in the title above : Ronnie the Limo Driver.
“Ronnie” has had the same complaint as you for almost a year now on a virgin tooth. (A tooth with no dental work; not a tooth that has not slept with another tooth.) In cases like this, we tell the patient that unfortunately we need to allow the tooth to manifest more symptoms and signs that allow us to say: “Stop the clock! It’s tooth #12!” Eventually, Ronnie’s tooth finally showed a small dark shadow that would indicate decay IF it had a filling, but on a virgin tooth this shadow implied that Ronnie had a hairline crack that finally opened up. A live intra oral fiber optic camera image confirmed this. (The “colonoscopy for the mouth”, as I say at my seminars.)
Many times in healthcare, too many complicated tests are performed along with too many referrals to specialists. A great book I just finished during the Thanks Giving holiday called Mindware: Tools for Smart Thinking by R. Nisbett spoke of the philosophical concept called Occam’s Razor: Entertain the most plausible hypothesis first; if you hear an animal running toward you that sounds like its’ galloping and warring horse shoes, then think “horses, not zebras.”
I extracted Ronnie’s tooth, placed a bone graft and set him up for an implant and crown in four months.