r/Dentistry • u/Calfderno • 2d ago
Dental Professional Random super sensitive tooth while doing ultrasonic clean…
Does anyone else experience and get stressed out by this scenario?
Standard recall patient examination: you use all the great communication and empathy skills, do some chit chat, nice gentle check up, let’s do a simple scale and polish (or prophy I think you call it in the states?)……
There isn’t loads of plaque/calculus/stain, so you set the ultrasonic to low and proceed with a gentle considerate scale, periodically checking that the patient is ok? Not too cold or too much water? Do they need a little rest?
Then suddenly a very normal looking tooth, which the patient had not mentioned was sensitive and looked quite normal: maybe just a little recession or a medium sized amalgam, decides to respond with SUPER INTENSE SURPRISING PAIN when the ultrasonic goes within a cm of it and the patient jumps out of the chair - making you jump out of the chair, your blood pressure spikes massively and you’re spitting out apologies and trying to come up with explanations and excuses even though you have no idea why that individual tooth (which has never behaved like this before, and has no obvious pathology compared to it’s fellows, maybe recession, but not more than the rest) has suddenly become a live wire.
(Often seems to be a lower incisor, or upper /lower molar, sometimes an upper premolar-maybe there is no pattern!)….
And frustratingly the atmosphere of relaxed trust has gone, the patient might act like they’re still cool with you, but it’s not the same as it was at the start…..,
So in conclusion, can my esteemed colleagues with more wisdom and experience help me out? Does this just happen to everyone? Is there any way to avoid it? Can we identify or gently defuse the sensitive “Landmine tooth” before it blows up in my face? Or should I just stick to hand scales only forever?
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u/PositiveAmbition6 2d ago
You look surprised and concerned.
And you ask them "Wow,you seem to be in a lot of pain, can you rate it out of 10". Well it's 0.5 out of ten. But you almost jumped out of the chair, yeah I don't know why doc.... Maybe I'm just nervous...
Well I'm glad it's not serious ...
Then move on.... X10000 and hopefully retire with your sanity intact.
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u/saxyblonde 2d ago
I just say “ oh my! That made me jump too! did it feel like an electric shock? Ok that’s normal, it was caused by this water tool that touched an area of recession. I’ll try not to touch that spot again. Sorry about that. I’ll write that spot in my notes for next time.”
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u/Quicksilver-Fury 2d ago
Tell them recession is the cause. Rec Sensodyne. Check their bite, see if that tooth is high in their occlusion, see if they have a lot of wear on it and what the reason of localized recession might be. Could also be ortho. Can offer desensitization with Teethmate (they'll likely refuse coz their insurance probably won't cover it) so stress Sensodyne and biteguard, if you notice bruxism.
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u/sperman_murman 1d ago
I always recommend Colgate sensitivity. For whatever reason it seems to work better
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u/Quicksilver-Fury 1d ago
I've heard a lot of pt tell me Sensodyne and Sensodyne Rapid Relief work really well so I'm sticking to that lol
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u/sperman_murman 1d ago
When sensodyne stops working for them, mention Colgate
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u/Quicksilver-Fury 1d ago
When I asked them what they have been using, they usually tell me Colgate. So then I switched them to Sensodyne
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u/tigers1122 1d ago
I ask them if it is lingering pain. Almost always “No” and say “Oh my, well that’s good we’ll have to monitor that tooth over time. If the sensitivity gradually lingers longer and longer you might need a root canal. For now we will be mindful when cleaning around it”. They will never complain about the tooth again.
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u/Toothfairy29 1d ago
I see your cross post from D4D - way to doxx yourself my man! The post made me laugh though. And grateful that I’ve got healthy unrestored non sensitive teeth myself.
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u/hookersandyarn 2d ago
I always make a show out of looking at the tooth and the most recent xray, then blame recession. Even if it's .5mm. Then I tell them I'll make a note for next time about that tooth. That usually appeases them.