At Escondido Endodontics our goal is to partner with the general dentist in delivering optimal dental patient care. We understand and respect the role that you have in being the treatment manager regarding your patient’s dental care. At Escondido Endodontics we strive to be an extension of your practice and your practice philosophy.
1) Consultations: Keep in mind that all patients are evaluated on a case by case basis but these are some general guidelines. Frequently if the diagnosis and treatment is relatively straightforward, then the patient can be evaluated and treated in a single visit. Some examples of cases in which a consultation appointment is appropriate are: a) Children under the age of 18. b) Patients with complex medical problems or histories that may require alteration of normal treatment protocols. c) Complex diagnostic cases in which the temporal nature of endodontic disease may require more time to manifest as a definitive diagnosis d) Patients requiring or requesting sedation either oral, IV sedation, or general anesthesia. e) Patients with prior endodontic treatment that are being referred for non-surgical retreatment or apical surgery.
When in doubt, always schedule the patient for a consultation rather than assuming that treatment is required. We make special efforts to evaluate and treat at the same appointment for patient convenience if treatment is definitely indicated. The more information your office can provide regarding the patient the easier the referral process becomes. Many patients need SBE prophylaxis prior to dental care while others have significant medical issues and we will have to consult their physicians before proceeding with treatment. Anxious patients that have histories of difficulty with dental treatment such as problems reclining, claustrophobia, or difficulties with the rubber dam, should have an evaluation for possible oral sedation before appointing for same day completed treatment.
The restorability or “salvageability” of a tooth should be determined by you, the restoring dentist. If the tooth can be isolated, root canal treatment can be done but that does not mean that the tooth can be subsequently restored. Issues such as the need for crown lengthening should be planned and discussed with the patient prior to referral. Crowns with evidence of gross subcoronal or submarginal caries should be removed with all caries excavated prior to referral for endodontic treatment.
Although we accept referrals for the endodontic treatment of permanent teeth in children, it is on a case management basis. We do not offer nitrous oxide or oral sedation for children. We suggest that before referring children, you have had an opportunity to establish a behavioral history for the child that includes more than examination and cleanings. Becoming familiar with anxious patients during an evaluation appointment is beneficial for both the patient and our staff and allows us to establish rapport to provide the highest quality of professional care in a less stressful environment at the subsequent treatment visit.
2) Emergency Treatment: We will do everything in our power to accommodate patients that are true emergencies. We understand that there are cases that are “emergent’ not because of pain or swelling but because of other patient issues such as, scheduling, employment management, and patient convenience. We will do our best to accommodate those as well. We frequently work through lunch and stay late in the day when necessary. If your patient truly needs to be seen, direct doctor to doctor communication is best to facilitate the process.
3) Single vs. Multiple Treatment Appointments: Virtually all vital cases can be completed in a single visit, time permitting. Common examples of cases that may require multiple appointments include 1) Teeth that have undergone significant calcific metamorphosis where not all canal spaces can be located in a single visit. 2) Non-surgical retreatment cases particularly when restorative disassembly is required. 3) Patients who present with significant swelling where trismus may be an issue. 4) Necrotic cases with purulent drainage from the canals. 5) Necrotic cases with apical radiolucent lesions of significant size.
4) Use of the Microscope: Use of the surgical operating microscope has evolved from state-of-the-art to the standard of care in providing endodontic treatment. From start to completion, virtually all endodontic treatment procedures are performed in our office using a surgical microscope. The microscope puts you inside the tooth. The microscope can no longer be considered just a high tech piece of equipment to have in the office. The microscope has been used routinely in endodontics for the past twenty years. One of the major benefits of the surgical operating microscope is that in creating smaller access preparations,it conserves precious tooth structure. The combination of magnification with powerful illumination allows us to look deep within the tooth and locate canal spaces with as minimal removal of tooth structure .
The surgical microscope has assimilated into the realm of standard of care and should be held in that high regard. In addition to assisting in actual endodontic procedural accomplishment, the microscope is also an important device for the assessment of diagnostic and prognosis factors. Fiberoptic transillumination with the aid of microscopy helps determine if the tooth may later have problems with vertical crown-root fractures.
5) Post-treatment Restoration: Endodontic treatment is not complete until the tooth is permanently restored. The major cause of post-endodontic failure is coronal microleakage. The timeliness and quality of the restoration has much to do with the long term success of the tooth. Numerous studies have shown that the best time to restore a tooth that has had endodontic treatment is immediately following the completion of that treatment. The patient is anesthetized, an aseptic rubber dam is in place, and the tooth has been exposed to sodium hypochlorite for a significant period of time. There is no benefit in placing a temporary restoration (that leaks) in the tooth and referring the patient back to your office to have the tooth restored several weeks later. With that said, we are mindful of the fact that many general dentists feel that the restoration of the tooth is their responsibility and we are respectful of that. Our preference is that we restore the tooth when practical and reasonable, particularly when it involves an uncomplicated access closure through an existing crown. At a minimum, we will place a glass ionomer base over the filled canal orifice’s as a barrier to coronal microleakage. Again, we feel that your communication with us regarding restoration of the tooth is paramount in providing the best possible care for your patients.
6) Comprehensive Treatment Planning: Please feel free to contact us for our opinions regarding the endodontic aspects of your treatment plan. We would be more than happy to sit down with you (after hours or at lunch if necessary) and review radiographs, study models, treatment plan, etc.
7) Internet Communications: We love communicating with our referring doctors via e-mail and the web. We are happy to offer you the opportunity to access your patients’ records on our web site in real-time. This means that our reports will be available to you via our secure, HIPAA compliant, virtual private network, the same day they are completed. It’s easy to use and highly intuitive. Please contact our office and one of our staff will assign you a password and help guide you through the simple process. It helps us immensely when we can review radiographs and other pertinent information prior to the patient’s appointment. If you have questions regarding endodontic cases or treatment planning, feel free to forward us radiographs and we would (enjoy the opportunity) to discuss them with you.
We also ask you to encourage your patients to use our website www.escoendo.com The Patient Information section has valuable information regarding our treatment philosophy, some of our office policies, and what a patient should expect at their first visit in our office. There is a direct correlation with a patient's overall satisfaction of the endodontic experience and their preparation prior to their first appointment.