All of us at some time or another have most likely dealt with a patient complaint of post-op sensitivity. You know, the one that often starts with, “Doc, my tooth didn’t hurt before you touched it.”
For us practitioners, this sequela can become a real annoyance and demand a nonproductive use of our time. But for our patients, who don’t understand it to the depth that we do, it can evoke extreme anxiety and even panic.
We all know that composite placement is very technique sensitive and even with best practices, post-op sensitivity can arise due to acid etch irritation, desiccation, inadequate sealing of dentinal tubules, occlusal interferences, voids under the restoration, and even a loss or fracture of the composite material after the patient leaves the office. Our patients, however, are usually thinking one thing: “Great, am I going to need a root canal?”
What can we as dental professionals put in place to best serve our patients while avoiding nonproductive use of chair time—particularly during this pandemic where capacity has been decreased and the risk of COVID-19 exposure continues?
Get ahead of the possibilities
For starters, I think it’s important to tell the patient at the end of the procedure that post-op sensitivity to hot, cold, and biting force is a possibility and can last for days and even weeks. Follow that up with the advice that unless they’re in constant pain, running to the medicine cabinet for pain medication, or being awakened at night, it’s nothing to be alarmed about. This alone can often eliminate anxiety or panic a patient may feel in the days following the procedure.
But what about those cases that eventually result in a phone call to the office with the complaint of either sensitivity to hot, cold or biting force? I imagine your front desk team has had to deal with these calls.
In these cases, we need to have our team educated to understand post-op sensitivity at a high level. Is it hot/cold sensitivity? Biting sensitivity? Occlusal interference? Are they in constant pain, running to the medicine cabinet for pain medication, or being awakened at night? Do they feel they’re hitting on something when they bite? Equipped with this knowledge and a good script, the team member can allay the patient’s fears and potentially avoid an office visit. The team member can then offer a week to 10-day follow-up phone call from a staff person, or, if the patient prefers, from the doctor. In all cases, the treating doctor should be informed of the phone conversation with the patient and make an entry in the chart.
Should you charge the ones who come back?
As much as we try to address the issue in a way that lessens the potential for nonproductive use of chair time and risk of COVID exposure, there are always those patients who will demand a return visit to the office to be seen for follow-up.
When I see these patients for follow-up, I am asking the same questions: Are they in constant pain, running to the medicine cabinet for pain medication, or being awakened at night? Do they feel that they are hitting on something when they bite? I check to make sure the filling is intact, and I check the bite. I take a radiograph to ensure there is no void in the restoration. I do an endo-ice pulp test and a percussion test.
If all of those check out normal, I can reassure the patient that the issue will most likely resolve over time. I educate the patient to a higher level of understanding and tell them to look for improvement week to week, not day to day. I inform them that replacing the filling at this time will most likely not resolve the sensitivity and may even make it worse. I ask them to call the office if things change for the worse, in which case, a root canal treatment may be indicated. This will usually motivate the patient to give things more time. A two- to three-week follow-up phone call from the doctor can elevate patient trust and often bring closure to the issue.
In these cases, should we be charging the patient? Certainly, that is up to the owner of the practice to determine. In my practices, we feel that in most cases, any charge related to follow up for a recently completed procedure is bad business. We post a D0171, RE-EVALUATION-POST-OPERATIVE OFFICE VISIT and any radiographs taken at our normal fee and adjust the balance as a patient courtesy. We make sure to communicate this courtesy adjustment to the patient.
Post-op sensitivity can be a real nuisance for any dental practice. Being sensitive (please excuse the pun) to our patients’ anxiety and even panic can go a long way toward maintaining trust and preserving good relationships with our patients. Doing so in ways that maximize efficiencies will have a measurable long-term positive impact on the success of the practice.