eanews eanewsan extension of your practice ®

March 2020

Bloomfield Hills - Troy50 W. Big Beaver, Ste. 200Bloomfield Hills, MI 48304248 647-7930

Waterford - Pontiac2335 Pontiac Lake Rd., Ste. DWaterford, MI 48328248 683-2300

Clinton Twp. - Sterling Heights15870 19 Mile Rd., Ste. 110Clinton Twp., MI 48038586 286-3390

Rochester - Lake Orion1460 Walton Blvd., Ste. 208Rochester, MI 48309248 656-1626

Farmington Hills - W. Bloomfield31410 Northwestern Hwy., Ste. CFarmington Hills, MI 48334248 737-1360

Clarkston - North Oakland5825 S. Main St., Ste. 103Clarkston, MI 48346248 620-0002

Ann Arbor - Ypsilanti315 E. Eisenhower Pkwy., Ste. 220 Ann Arbor, MI 48108734 761-3166

Commerce Twp - White Lake2900 Union Lake Rd.Commerce Twp., MI 48382248 363-9345

Novi - Northville25500 Meadowbrook Rd. Ste.125Novi, MI 48375248 427-0488

Carl BotvinickMichael GlassRichard RubinsteinRichard GardnerGerald Dietz Jr.Alayne EvansStephen NavarreMark RobinsonTiffeny ChimelakCraig DuhaimeJames NowickiRoss RyanChad SpeirsNeema Mehrkhodavandi

Tony TranMark Shallal-AyzinJohn LindellCara McCaryAmruta Mahajan

Our Newsletters are Archived!

EmeritusGerald Dietz Sr.Melvyn EderJohn DylewskiEdward FitzpatrickMichael HoenRichard Somerlott Allan Jacobs

eanewseanews Go to Referring Drs tab on our website; rootcanalinfo.com or endodonticassoc.com

EA INTRODUCES NEW ASSOCIATE Dr. Amruta Mahajan Endodontic Associates is proud to announce the addition of a new associate, Dr. Amruta Mahajan. Dr. Mahajan will join Drs. Richard Rubinstein and Chad Speirs at the Farmington Hills office.

Dr. Amruta Mahajan received her Bachelor of Dental Surgery from VSPM’s Dental College and Research center, Nagpur, India. She was awarded the Best All-Around Student and Scholarship by the Indian Dental Association and graduated with honors.

After dental school, she pursued the Advanced International Education Program in Esthetics at New York University College of Dentistry followed by receiving an International Post-Graduate Training Certificate in Endodontics from UCLA School of Dentistry. She was also involved with teaching the second and fourth year dental students. Dr. Mahajan then worked as a research assistant in endodontics at the Forsyth Institute at Harvard School of Dental Medicine and then completed her residency in Endodontics from the University of Pennsylvania School of Dental Medicine.

Dr. Mahajan received the outstanding presenter award and teaching certificate for training general dentists and endodontists in micro-surgical techniques. She has lectured in Endodontics both locally and internationally with an interest in Micro-Surgery, vital pulp therapy and teaching.

Dr. Mahajan is a specialist member of the American Association of Endodontists, the American Dental Association, the Michigan Dental Association and is currently working toward Diplomate status with the American Board of Endodontists.

The Pulp May Not Be The Problem Educational Seminar held by EA Bloomfield and Rochester

Representing Endodontic Associates Bloomfield and Rochester offices, Drs. Michael Glass, Jerry Dietz Jr., James Nowicki and Ross Ryan hosted an educational seminar on Wednesday, January 29 at the Michigan State Management Education Center in Troy.

The event speaker was Dr. David Landwehr, D.D.S, M.S., a nationally renowned speaker, author, researcher, educator and clinician, who holds dual certification in endodontics and oral pathology. Dr. Landwehr is Chief of Endodontics for the Meriter Hospital general practice residency program in Madison, Wisconsin. His afternoon and evening sessions titled, “Advanced Endodontic Diagnosis: The Pulp May Not Be The Problem“ helped attendees differentiate between lesions of endodontic origin and those that aren’t from endodontic disease.

His review, based on clinical cases, highlighted a variety of diagnostic roadblocks including the limitations of pulp testing and other potential sources for endodontic pain, including cracks and resorption.

Over 80 dentists attended the CE lecture and enjoyed the presentation, dinner and cocktails with their colleagues and friends.

The Endodontic Associates doctors hope everyone that attended gained some useful and practical information on patient care that they can take back to their practices.

2 eanewseanews

March 2020 www.endodonticassoc.com

Quote of the

Quarter

“You have a choice on where to spend your limited energy. Proving the people that don’t believe in you, wrong; or proving

the people that do believe in you, right.”

EA Dr. James Nowicki, Dr. David Lipton

Dr. Kathryn Sonpal, Dr. Christine Muzychka, EA Dr. Carl Botvinick, Dr. Charlotte Kroll, EA Dr. Michael Glass, Dr. Geri McLean, EA Assistant Nathalie Sardenberg-Rodigues

EA Dr. Ross Ryan, EA Dr. Jerry Dietz, Jr., Dr. Kerry Brown, Dr. Spencer Brown, Dr. Talia Shackelford

Dr. David Landwehr

EA Dr. Ross Ryan with Dr. David Landwehr

3eanewseanews

March 2020www.endodonticassoc.com

In order to properly treat or manage a patient’s problem, an accurate diagnosis must be made. This involves obtaining and interpreting all objective and subjective findings.

One clinical exam that is usually overlooked is tracing a sinus tract. A sinus tract, sometimes incorrectly referred to as a fistula, is a communication between the source of the pathology and the gingival or extraoral surface. It may provide relief through drainage and can be useful in determining the source of an infection.

The following case is an example in which tracing the sinus tract was significant in addressing the patient’s chief complaint:

An 89-year old patient was referred for root canal treatment on tooth #3. Her chief complaint was having a constant dull and burning pain in the posterior upper right quadrant that initiated three months ago. Her medical history was significant for type 2 diabetes, hypertension, hypercholesterolemia, and osteoporosis—all of which were controlled and managed with appropriate medications. She saw her dentist regularly and her most recent dental work was the extraction of tooth #2 five months prior.

Clinical exam revealed that tooth #3 had pulpal necrosis with asymptomatic apical periodontitis. The tooth had class II mobility with deep buccal, palatal, and distal probing depths. A distal-buccal sinus tract was present, and the tooth had no tenderness to percussion or palpation. The gingiva distal to tooth #3 was severely inflamed and tender to palpation.

The initial impression after reviewing the periapical radiograph (Figure 1) was that tooth #3 was the culprit, due to the presence of a periapical lesion on all roots. However, after tracing the sinus tract and exposing another radiograph (Figure 2), it was determined that the patient’s chief complaint was not from tooth #3, but rather the edentulous site where tooth #2 was extracted. The area appeared suspicious, with sparse bony trabeculation that was also visible on the bitewing radiograph (Figure 3).

After reviewing all findings, it was determined that the proper course of treatment was to refer the patient to an oral surgeon for possible medication-related osteonecrosis of the jaw (MRONJ). The biopsy from the oral surgeon confirmed the diagnosis of MRONJ, and she was treated with surgical curettage, systemic antibiotics, and an antimicrobial mouthwash. Tooth #3 had a questionable prognosis and the patient elected to have the tooth extracted.

Tracing the sinus tract assisted in diagnosing so that the most appropriate management of the patient’s chief complaint could be rendered. A complete collection of data and thorough assessment is highly valuable, and should be accomplished even if the problem appears obvious.

The Sinus Tract: A Pathway to the Problem Written by EA doctor Tony Tran, D.D.S.

Figure 1

Figure 2

Figure 3

Often, we are quick to formulate a diagnosis without gathering all essential data.

4

March 2020

Administrative Office - 50 West Big Beaver, Ste. 205, Bloomfield Hills, Michigan phone 248 647-7930For information or suggestions - contact Denise phone 248 647-7930 fax 248 647-6067 email djc2@endocentral.com

www.endodonticassoc.com

eanewseanews

EA Bloomfield EA Waterford

EA Clinton Township EA Rochester

EA Farmington EA Clarkston

EA Ann Arbor EA Commerce

EA Novi EA Central