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Hopkinton Endodontics - Judy McIntyre, DMD, MS

Endodontics Hopkinton MA

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Hopkinton Endodontics

Judy McIntyre, DMD, MS
225 Wood Street #1
Hopkinton, MA 01748
508-686-7668

Hours

M: 8am — 4pm
Tu: 8am — 5pm
W: by appointment
Th: 8am — 5pm
F: 8am — 3pm
Sat: by appointment
Sun: closed

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drjudyendo

About 20 yrs ago, the medical & dental communitie

About 20 yrs ago, the medical & dental communities began realizing that bisphosphonate usage had significant oral effects, particularly on the mandible, and thus, we embraced a new term: osteonecrosis... that specifically bisphosphonates had a direct correlation to ON.

Earlier, the medical community had known about osteoradionecrosis related to radiation treatment of head/neck cancer patients, which is - if I recall and understand correctly - how the community caught onto ON related to bisphosphonates so quickly.

Hence, the dental community was introduced to the terms osteoradionecrosis and osteonecrosis, both related to the radiation and/or medication treatment of cancer and osteoporosis patients.

We learned to inquire better about medications/history and health history, with these focused questions in particular.

This #patient had a history of throat cancer and a history of radiation treatment to their neck/head.
Some of these patients are specifically informed ***against extractions*** and that they MUST always have #endodontics to save their teeth - extractions are contraindicated, for the most part [this is what I am informed often by these patients].
This pt nevertheless also wanted to save their #tooth . The tooth's history included a D crack along the pulpal roof, then a beautiful crown, then pulpal necrosis with a chronic apical abscess and a draining Facial sinus tract.

#endodontics was completed uneventfully after medicament placement, and sinus tract healing was noted... As mentioned in my previous post

The pt called several wks ago in pain and when they came in reported decreased discomfort.

Clinical exam, PA and scan confirmed cracked tooth😢
But, what to do?
This is my first case where there was nothing more I could offer: extraction finally became inevitable - this tooth is cracked into nearly 2 separate pieces as evident from the #cbct and clinically. But, what about their history???

And, so began this exercise...

#protips 1) ask for the contact information for their oncologist, 2) they should hopefully know the amount (#greys) of radiation received [in this case is was 7K greys to the head/neck], when and the.....

Happy Thanksgiving! 🦃 EXCESSIVE decay - save or

Happy Thanksgiving!
🦃
EXCESSIVE decay - save or not?
🤔
This is probably the extent of what I wish to save... the other end of the spectrum.
I planned on the decay going subgingivally, and likely even below the bone, or very darn close...
😵
This #patient was thankfully well-informed already by the RD😍, who had already discussed the need for CL on this case.
👍
The pt had a consultation first where we discussed that I wished to also do the core, and that there was a pretty guarded long term prognosis, even still with CL. The pt still wanted to save their 🦷 #tooth
🤗
We proceeded and did everything - soup to nuts - in 1 visit. The MB2 was surprisingly tight (can barely see on scan axially) and took longer than expected - 2 POEs also!
🙄
However, what was fascinating to me - and I hear this from a lot of my RDs as well - was the diagnosis. This tooth was 🌋 ENTIRELY VITAL🌋 in each and every canal!
🧐Note the PARL around the palatal canal on the #cbct view?
🤷‍♀️
!!Vital in each and every canal!! but with a periapical lucency.
🤯
We've been taught that PARLs are a reflection of necrosis but this is a clear example of that's not ALWAYS the case. It's the human body and it's remarkable and surprising.
🙇‍♀️
Conversely, a reminder (since I fielded this question just a few weeks ago from another RD) that even with PARLs, a tooth can test vital - and this is a great example of why! [esp on multirooted teeth]
🤩
Enjoy the friends and family time!
🧡

Another wonderful day #alwayslearning #endodontics

Another wonderful day #alwayslearning #endodontics
🙌
Although I may not look thrilled here, I was truly delighted to share the @savingyourteeth AAE/AAOMR joint recommendations re #3dimaging for #teeth with my @kavoimaging#cbct cases
🦷
Going into this well-deserved weekend, I thought a contest would be fun....
🥳
Caption this picture please!!!
Go.....
😆
#saveteeth everyday!
🙌
📸 by @ryanz3d imaging specialist
.
"You can't treat what you can't see" @conebeamguy
.
#dentists #dentalce #bostondentist

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