This patient hadn’t had a good night’s sleep the night before presenting.
The pt came at the EOD and seemed very calm and pleasant, not the typical HOT tooth presentation.
Pt reported pain to HOT and COLD but more so COLD.
Testing on LR6 was definitely an outlier but the pt still remained calm.
I was NOT impressed…..
**Of note, for me to recommend/initiate RCT, I must be impressed!**
Upon clinical examination, I noted their molar surfaces were all very worn down and exposed down to the dentin – see clinical pics attached.
I reviewed meds, med hx and diet.
**Meds were notable for an SSRI.**
I asked about clenching and grinding as all other avenues seemed insignificant.
The pt shared that they’ve noticed extreme clenching coincident with the start of their SSRI.
If you read the small print on pharmaceutical sheets, you will see that bruxism is a side effect.
Protip – become friendly with your pharmacist. They are a wealth of information and I often have great, informative conversations when I have to call in an Rx for a patient and have some questions about interactions and/or which Rx might be better than another in a given instance, etc.
It’s thought that SSRIs can cause bruxism by indirectly lowering dopamine levels. Dopamine inhibits certain movements including jaw clenching.
Bruxism associated with antidepressant use is an underrecognized phenomenon, particularly among neurologists. → Antidepressant-associated bruxism/jaw pain most commonly begins within 3–4 weeks of medication initiation or dose titration, and can resolve within 3–4 weeks of drug discontinuation.
To summarize, as you can see in the sagittal @dexisimaging #cbct screenshot here, the enamel is completely worn through on LR6 (more so clinically, and the dentin was exposed.
(It is on their other molars as well)
Please remember, when dentistry, attrition/abrasion/abfraction/trauma or caries gets within 2mms of closeness to the pulp inside the tooth, pulpal changes occur. In this case, although it’s a virgin tooth, it was HOT because there was so much destruction occlusally.
I thought this was a great case to share for:
1) SSRI reminder about side effects
2) reminder to *listen* to our patients
3) reminder that virgin teeth can need endo too!!!!!
And, yes, there is a D angular defect on the UR7!
#protip – be sure to always look at horizontal bone levels on PAs and BWs and notice any discrepancies.
