Failing to make the correct diagnosis inevitably means the treatment will fail too. As this case illustrates, seeing the bigger picture should always be the aim...
A dentist saw a patient over a six-year period. The patient then presented with pain and swelling on the right side of her face. A lower right molar had been previously root-filled and the dentist diagnosed an abscess on that tooth, providing antibiotics for treatment.
The patient subsequently saw another practitioner who advised her that she needed extensive dental treatment, some of her previous treatment had been inappropriate and there was disease present in her mouth.
The patient had a continually high caries rate and poor plaque control, but no routine bitewing radiographs had been taken over the six years that the initial dentist had been treating the patient. Such bitewings may have aided the diagnosis of early interstitial decay and bone loss due to periodontal disease.
The bigger picture
Bitewing radiographs taken by the second dentist after six years showed generalised horizontal bone loss with some deep vertical pocketing and extensive carious cavities in a number of molar teeth. The first practitioner had failed to diagnose both periodontal disease and caries over an extended period of time.
In addition, at the conclusion of the relationship the first dentist had failed to diagnose a deep carious cavity in the lower right last standing molar tooth and in the upper right first molar tooth. This dentist had also failed to be aware of an apical area over the upper right lateral incisor.
Any of these teeth could have been the cause of the patient’s pain but the first dentist chose to only treat the lower right first standing molar tooth that she had previously had some difficulties root-filling.
If the diagnosis is inappropriate, it follows that the treatment provided will be similarly inappropriate.