Jennifer presented as an emergency patient having just arrived on a flight from England. She was experiencing radiating pain from this lower left second molar. Clinical and radiographic exam showed a deteriorated amalgam restoration with a hairline distal fracture.

Though this tooth was the most obvious etiology, it is important to not disregard other possible etiologies. The adjacent first molar had a crown restoration and had been treated endodontically. The radiographs showed no obvious pathology. Percussion of both teeth indicated slightly more sensitivity on the second molar.

Following administration of local anesthesia (topical plus carbocaine 3% via a mandibular block) the amalgam was removed and the frature was observed extending midway through the tooth. Neither the bucal nor the lingual structure appeared mobile. At this point, based on the clinical findings, it was necessary to initiate endodontic therapy (based on the most likely diagnosis of irreversible pulpitis).

Initiation of Endodontics

The pulp chamber was open, canals located, initial debridement and irrigation with antiseptic solution was performed. The tooth was taken out of occlusion and a medicated cotton pledget was placed along with cavit temporary material. Definitive therapy should include completion of the endodontics and the placement of a core and final restoration.

The Rest of the Story

Jennifer continued on her vacation. I received a call about a week later from Dr. Renee Peet, a dentist in Nassau, Bahamas (familydental@coralwave.com). Dr. Peet indicated that Jennifer was at her office and again experiencing pain from this lower left second molar. Following discussion of the case, Dr. Peet eventually replaced the temporary materials with an antibacterial medicament and placed Jennifer on Augmentin antibiotic (amoxicillin and clavulanic acid) 1000 mg for a week. Jennifer was also given percocet narcotic analgesics. A week later Jennifer had returned home and was feeling much better. She would be returning to her dentist for final therapy.