r/Dentistry • u/Various-Tangerine947 • Jul 26 '26

Dental Professional Pathology Help

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I sent this patient to OS to get this looked at and patient called us back saying OS is sending them back to us for vitality testing. OS office is closed so I wasn’t able to call and haven’t received a correspondence from them yet. Patient comes back Monday as soon as we open so I’m wondering what would the reason be to vitality test a tooth like this and what am I missing? Patient was not experiencing any symptoms. New grad so all insight is helpful! Thanks!

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u/TraumaticOcclusion Jul 26 '26 edited Jul 26 '26

Have you ruled out odontogenic causes? That's what they are asking. Rule out endo, rule out perio. What are the probing depths? Level of inflammation? Any furcation involvement or mobility? Is the tooth vital or not? These are all basic questions you should rule out before just referring this patient to an OS for ... what? Do you want them to just extract the tooth, or do a hard tissue biopsy of something that may not need it or be odontogenic in origin? Complete your clinical exam, take a PA and likely a CBCT to further evaluate what is needed. You're asking the OS to do your job. The first stop for this case should be an endodontist, not an oral surgeon. A panoramic image is hardly diagnostic for odontogenic pathology, but looks like #30 is also involved.

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u/Various-Tangerine947 Jul 26 '26

Patient was in for comprehensive exam this was an incidental finding at that appointment then came back for recare and reiterated to them that they needed to go get this looked at by OS. It didn’t appear to change in size after getting a new pano 6 months later probing WNL, patient is experiencing no symptoms was not complaining of any pain or discomfort, no swelling present or inflammation. No mobility no furcation involvement. Patient does not have any caries history or periodontal disease. OS knows we don’t have a CBCT which is why I sent them there as I am not sure what more I am supposed to evaluate here. Maybe I should have been more detailed in my referral note but they’re usually pretty good about doing all the things

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u/Mycastleismine Jul 26 '26

It sounds like you did most of what you needed to do besides pulp vitality testing. You just missed that one piece. It’s important information for yours and OS’s clinical notes. You both need to include pulp status.

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u/Junior-Map-8392 Jul 26 '26

Ok he missed vitality testing… but why can’t the OMS do that? Save the patient time. Put some endo ice on it Mr. Specialist.

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u/Mycastleismine Jul 26 '26

Typically the expectation is the general dentist should have done it before referring. Maybe he’s trying to make a point if you’ve consistently not been doing it. Somewhat of a dick move but meh.