Apical Periodontitis in Root-Filled Teeth by Thomas Kvist

Author:Thomas Kvist
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

6.6.5.1 Monitors and Blunters

Kristina is a 62-year-old teacher, and I have just told her that the X-ray of her upper left first molar does exhibit a periapical radiolucency and an inadequate root filling. The root canal treatment was done 6 years ago. I tell her that this indicates a persisting root canal infection and that it might become symptomatic sooner or later. I suggest a CBCT examination for better imaging, verifying the diagnosis and support for decision making. I am telling her that a minor surgery might be needed to solve the problem. Then I tell her that I will contact her again when I have looked at the CBCT results and suggest a treatment plan. “Will it be painful to do a surgery?”, she asks slightly surprised. “No it is a standard procedure done with local anaesthesia at our clinic”, I answer. “Do you have any further questions”, I ask. “No, I trust you to tell me what I need to know”, she answers before rising from chair and leaving.

In the same week, I see John, a 50-year-old shop owner, for a check-up of a root canal treatment of a lower first molar I finished 1 year ago. The X-ray shows that the periapical radiolucency is unchanged in size. I am telling him that no signs of healing are yet visible but that is too early to diagnose it as a “failure”. I suggest further follow-up with a new X-ray for another year. Unlike Kristina, John has a lot of questions. “How come that healing has not occurred yet? Are there bacteria left in the tooth than? Isn’t dangerous? Perhaps you should have taken my tooth out already from the beginning? Will I have pain now? What will you suggest if you don’t see healing at next check-up either? Will I have to go through any further treatments?” he asks. “I have many friends who also had root canal treatments and they never said that it took so long to heal. I'll probably ask them. Then I will go on the Internet and search as many sites as I can about this. My feeling is that something is wrong and I need more information”.

It is striking how two patients facing similar situations took two very different approaches to gathering and processing information. Miller [53] has categorized these two approaches to information seeking under threat as “blunters” and “monitors”. The blunter—Kristina—wants just the basics, while the monitor—John—craves more information. High monitors and low blunters chose to seek out information about its nature and onset, whereas low monitors and high blunters chose to distract themselves. Each style has its strengths and weaknesses. But, under unfavourable conditions, both styles risk becoming more flawed and hamper a good patient-dentist relation.

My own clinical experience is that people react very differently to the information about signs of persistent apical periodontitis. Health information is not neutral, especially when you’re the one affected by a condition. If you, who are reading this, have your own experience of

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