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January 2006 – MS Paint – A Useful Tool for Case Presentation

Helping patients understand treatment options is an important part of successful Dentist patient communication.  The old adage” a picture is worth 1000 words” applies here. The intricacies and small sizes involved in endodontic treatment make actual visualization of treatment very difficult. It is often more helpful to illustrate the problem with a diagram.  January’s case of the month is a good example of how illustrations can explain problems to patients in a way that they can understand.

A 54 year old woman presented in my office with a history of endodontic treatment perfumed in another office several years ago.  The tooth had been restored with a crown.  Her current complaint was a dull ache in the area and the inability to chew hard on the tooth.

The film furnished to me by the referral seemed unremarkable. Nevertheless, all patients who come for an examination receive a digital image, regardless of how recently the referral film was taken.   My image clearly showed furca radiolucency.  Further probing with a curved furca probe clearly showed at least a buccal Cl II furcation involvement.  The differential diagnosis at this point was possible root fracture, furca perforation or leakage from a furca accessory canal. In any case, the prognosis for this tooth was not good, considering that the rest of the patient’s mouth showed other areas of localized periodontal breakdown.

Such subtleties are often difficult to explain to patient simply by explaining them in words.  Instead, I prefer to use a simple MS Paint program with my light pen.  The tooth is drawn out on the CRT screen right in front of the patient.  Not only does this allow them to see better, it gives patients the feeling that they are receiving a “customized” illustration of their problem, and not some canned or generic presentation.  In many cases patients ask for me to print up the illustration so they can tell their spouse, dentist or insurer.

In this case, I explained that it was impossible to tell from visual inspection as to whether the root was cracked, as I had suspected. I explained that the crown would have to removed, the core disassembled and the root inspected for signs of fracture, perforation or missed canal system anatomy.

After explaining the steps involved in disassembly, the chances for retreatment success and the overall prognosis, the patient elected for extraction and prosthetic replacement.

Use of customized illustrations in combination with photographic images and scope video allows patients to better appreciate the complexities involved,  to be better informed about treatment options, and allows them to be in a better position to go back the to the referring dentist to discuss possibilities for treatment or prosthetic replacement.