Maria Lessani – “Challenges and dilemmas in endodontic diagnosis and treatment planning”
Featured Products Promotional FeaturesPosted by: Dental Design 7th January 2022
Maria Lessani is President of the British Endodontic Society, and also a teacher and practitioner of endodontics. She joined us at this year’s Dentistry Show London presenting a session, “Challenges and dilemmas in endodontic diagnosis and treatment planning”. She shared her experience of Dentistry Show London and presenting her lecture at this event:
“I was very impressed because we had so many people in attendance for my early morning lecture on the challenges of diagnosis and treatment planning in relation to endodontics.
“I think it’s important to talk about managing pain for our patients, especially after the last few years. In my session I highlighted the key aspects of patient assessment and the latest terminology we use for diagnosis in relation to the guidelines. I hope my session will help delegates improve diagnosis and treatment methods. For example, it’s important to know in which cases to give antibiotics and use CT imaging. More importantly, I hope delegates have understood the importance of getting the diagnosis right and treatment planning accordingly.”
During her session, Dr Lessani discussed the value of taking time during the patient assessment to determine the source of their pain, and establish a cause before going forward to endodontic treatment. She recommends giving patients time during these assessments to describe their pain, and understand what hurts and why. Ask patients where their pain radiates to, and whether their pain worsens on bite or release – with pain on release being a classic sign of a cracked tooth. Dr Lessani also suggests establishing whether repeated irritation may be causing tooth pain, making an interesting comparison to tapping fingernails causing irritation and pain, in which case cessation could be a solution.
Dr Lessani then went on to suggest some practical tests you could carry out to establish the source of pain. Firstly, use lighting to your advantage, as this may help you to see any fractures. To test for sensitivity, conduct a thermal test by heating up gutta percha sticks and see if your patient can feel any pain – if they can this is a sign of pulpitis. You may also consider conducting an electric pulp test (EPT) to assess for sensitivity. It may be necessary to test neighbouring teeth to narrow down and isolate the source of the pain. Dr Lessani also described a case in which a patient with a highly restored tooth was experiencing pain and, after CBCT images were taken, it was found that they had an extra root canal which wasn’t initially treated as part of previous endodontic treatment, so she was able to re-treat this tooth and solve their pain.
For endodontic diagnosis, Dr Lessani recommended using a tooth sleuth, CBCT and radiograph together where possible, and following the British Endodontic Society’s guidelines for diagnosis. Treatment may include vital pulp therapy to preserve the remaining healthy pulp, or root canal treatment if necessary. She said:
“There is a lot more information out there now about challenging cases, and in practice we see more oral-facial pain cases. These are cases where pain is not caused by dental problems and might include TMD, and cases where patients have problems with their sinuses, not their teeth. So, it’s important to understand this and appreciate that it may not always be a dental problem. It may be useful to liaise with ENT professionals in some situations.”
Dr Lessani discussed the “red flags” which may be problematic for dentists when diagnosing pain. She recommended looking for the classic symptoms of pulpitis before assuming endodontic treatment is the right choice, and where possible take a CBCT and consult a radiologist and ENT. It’s always beneficial to check prior to treatment for an accurate diagnosis.
Delegate, Dr Julie Mahmoud of Perfect Smile Chiswick, commented:
“Dr Lessani was a very good speaker. The session covered everything, which was extremely helpful – I haven’t done endodontics since lockdown so it provided a good recap. This show offers a great opportunity to keep learning and we always encourage our whole team to attend.”
Reflecting on the show as a whole Dr Lessani added:
“I think it’s wonderful to have face-to face meetings back again, it think many dentists have really missed that. Although webinars are good and have really opened the door for another way of education, Dentistry Show London provides us with CPD opportunities alongside the ability to stay up to date with the latest technology. Trade, associations, and educators all have stands now – so, you come to the show to experience both the trade and educational elements hand-in-hand. Technology is moving so fast, so it’s a great opportunity to see these developments as well as attend educational seminars.”
Dentistry Show London 2023 will be held on Friday 6th and Saturday 7th October. Visit london.dentistryshow.co.uk for the latest details
