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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

This #patient works in a hospital as a patient-car

This #patient works in a hospital as a patient-care provider & started experiencing severe pain on this past Sun
Overnight, they began to swell & Mon am they went to their #dentist who referred them to us at 4pm
This patient was SWOLLEN up to their infraorbital area but the swelling was diffiuse & non-fluctuant; there was nothing to drain.
I decided NOT to give any local anesthesia!
I HATE DOING THIS!
I NEVER DO THIS!
But, the patient was so swollen that I felt that the anesthesia would be very minimally effective & I didn't want to risk "tracking" the infection further to another facial space.
@her_holiness_the_pulp and I chatted that evening about the pros and cons of no anesthesia
We both agreed we hate to NOT give anesthesia
It was a great discussion however regarding my concerns & I'd love to hear your thoughts!
The RD had Rx'd Amox, which the pt started on Mon, but overnight they started to swell more & so they went to the ED (I always do warn patients that if they continue to swell, have difficulty breathing or swallowing to go #protip ) where the pt was comforted and VIP'd among their colleagues & got IV Abx, which is usually what is needed
I opened the #tooth & got a very tiny pit of #purulence drainage through the tooth; I left the tooth "open" with a cotton pellet - no temp
The pt was discharged early Tues and we continued to check in with them periodically
The plan all along was to perform an I&D once it localized, hopefully by Th/today
We exchanged more pics & chatted a bit more & we were tentative with today's appt - sometimes it's better to let the pt's swelling come down & come up for air, so to speak, and get comfortable with life again (chewing, sleeping, not taking Advil, etc)
This morning however the patient responded that they had immense pain overnight
I asked the pt to come in & they agreed
I removed the CP and immediately purulence gushed out
What I do for these cases is let it drain as much as possible first & I use a microtip down the canals until I see heme (what I call blood in the office) & then I irrigate with NaOCl and reinstrument a
a bit more
Today I debated whether or not to place #calciumhydroxide and ended up doing so..

🤔 Ever have those patients that you see as for

🤔
Ever have those patients that you see as for emergency treatment and then they disappear?
🤷‍♀️
Thankfully, it's rare, and our in-office systems prevent this as much as possible, so we continued to reach out to this #patient who had been feeling "much better" after their emergency appointment but consistently cancelled or rescheduled their completion #rootcanal appt
📞 ☎️
In January, pt reported their #tooth hurt to hot/cold and ached, and biting gave radiating pain over the weekend. Further, when they laid down, the pressure would wake them up (we hear this OFTEN - classic #endodontic symptom)
🤕😵
Thankfully, the pt finally responded and returned.
🙏
This was a pretty calcified tooth, and am pleased with the result.
🙌
When the pt was dismissed they were a bit incredulous as to how easy the 2nd visit was. They were ecstatic!!!
However, this is often how #endodontic treatment goes!!!!!
🤗
A "toothache" can act like a bruise, so when you touch an existing bruise, it hurts!!!! Same thing with #teeth
🦷
It truly is best to be proactive (rather than reactive) with toothaches and tooth discomfort.
📢
The longer one waits with discomfort, the harder it can be to 1) achieve profound anesthesia and 2) negotiate any complications that may arise and 3) when a tooth progresses to being necrotic, the prognosis of a #rootcanal slightly decreases!
🥼
So, don't wait, #rootcanaltreatment is SO MUCH EASIER and is most often #painfree
😷
Medicated and temporized in January and completed with BC liner and BC sealer and used @kavokerr #zenflex files
🥳
#weareendodontists
#saveteeth
#sytm2021
#i❤savingteeth
#healthyteethdonthurt
🐇🐰

It's Wednesday and I'm inspired by @endogenie s po

It's Wednesday and I'm inspired by @endogenie s post yesterday of #fingerfatigue as this case definitely tired out my 👋
But this post is also about cracks⚡
😬
A year later into this pandemic, everyone's stressed out!
🙋‍♀️🙋‍♂️
And teeth are suffering!!!!
🥴
😔
#patient referred by spouse [and RD too 😜] - that's love!
💕
HOT tooth and pt was in a lot of pain
🔥 🤕
But, quickly I could visualize a crack
😵
Transillumination confirmed the crack
😣
We discussed options and poor prognosis extensively but the pt 1) wanted pain relief and 2) wanted desperately to save the #tooth
🙏
#pulpvitalitytests results:
Dx: LR6 Ir/reversible pulpitis with symptomatic apical periodontitis; recurrent decay
Dx: LR7 Necrotic pulp with symptomatic apical periodontitis; recurrent decay/calcification HOT!!!!!!!!!!!! - most symptomatic over #30 (pt agreed)
😷
In these cases, I work on the most symptomatic one first as referred pain is likely and I always wish to rule that out
🤗
Found: 3 canals; D crack extended into D orifice - pt informed again
🙏
We still decided to proceed and hope for the best
🤞
Closed with @brasselerusa BC Blue liner and bioceramic putty in the D canal, CPs and @coltene_us #duotemp
💙
Prognosis: Poor d/t distal crack, preop symptoms, necrosis and lack of tooth structure remaining - informed pt may not last 5 years
Pt still wanted to continue and proceed and knows ext next if symptoms return
🙏🤞
#letthehealingbegin
#truelove #iykyk
#saveteeth
#endodontics
#endodontist
#rootcanaltreatment

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