04/18/2020
COVID-19 dental emergency Friday night, 8pm. This patient and his brother drove from Long Beach to my office in downtown LA due to pain that lasted for couple of years. Tonight the pain was so intense, they traveled to see me. The story: this patient went to Mexico for this broken tooth #4 a couple of years ago. He wanted the tooth out but his dentist in Mexico convinced him to do a root canal instead. Fast forward 2 years, the tooth was never crowned, had significant recurrent caries and PA infection + a surprise I later found...
The treatment: I offered extraction but recommended saving the tooth. I explained it would require the help and skills of an Endodontist. I offered to stabilize the tooth and medicate and refer. They both agreed and off I went with my recommended treatment. I removed the old amalgam, removed the caries and found the L canal untreated. I instrumented the canal, drained the infection, irrigated with chlorohexidine, and built the tooth up (temp) while keeping the L canal accessible. My technique was to keep a bur in the canal while I placed the temp fill. Once the tooth is built up, I applied cotton and cavit over the L canal for easy access (Endodontist) and lowered the bite. For easy cleaning, the distal aspect was kept open intentionally.
The patient left with an Endodontist referral and a Rx. Since my referral can take the patient on Monday, I didn’t place CaOH. I’ve done many of these and patients have done well when the canal is fully cleaned out well and disinfected.
Anyway I thought this is an interesting emergency case to share with you all. I did (and still doing to a lesser extent) emergency 24 hour dental care in LA for over 15 years. I’m getting more calls than normal because so many dentists are not seeing patients. I wish our governor will open our state of CA for business because our state is fortunately not affected by COVID-19 a whole lot. I know there are two sides of this argument but I personally believe that this quarantine of healthy people is an overkill. We all want to be healthy. But we have to weigh the risks and the benefits. There are a lot of patients who are not getting the dental care they need until they suffer intense pain