Case No 12. RA can be ideal for short notice problems

Today we saw a patient who was so anxious that he had failed to attend two previous appointments. He had arrived at the front door and THEN TURNED AWAY thorough fear. Today he booked himself in under a pseudonym because he thought we would refuse to reserve an appointment for him a third time ( he may have been right !).

So what was his dental problem?

1) He is a commercial pilot

2) He was flying tomorrow and would be away for 3 weeks

3) He was worried about a LL7 which had had a composite placed elsewhere about a year ago and hadn't settled. Having had several root fillings before he assumed he would need the same again.

4) Recent treatment had been carried out under IV sedation.

Given that he was booked in as an "emergency" we were not in a position to offer IV sedation at short notice and with no escort. The tooth was vital but not especially hyperaemic, slightly TTP, no buccal tenderness and with a normal perio condition. The composite filling was reasonably satisfactory externally but was an occlusal with a long buccal extension. A P.A. radiograph revealed no pathology and the filling appeared relatively shallow. I provisionally diagnosed post-composite sensitivity , probably as a result of setting contraction. I advised this was unlikely to get worse in the short term but he was keen for me to "do something".

Using RA we needed to go to a 35% Nitous oxide/ 65% oxygen level to achieve sufficient sedation. I also used the "WAND" for an ID block with no reaction from him. Effective LA was swift and removal of the composite revealed a clean, well prepped ,shallow cavity. I placed a glass ionomer and he recovered uneventfully. I expect that this will have settled his problem . He booked a full New Patient consultation and paid for this in advance before he left today. Another happy patient & another source of referrals. I will ask him to write a testimonial at his next visit. We didn't have time to begin to discuss the reason for his dental anxiety, but RA was the right tool for the job for him today.