Endodontic Misadventures: Diagnostic Challenges and the Element of Bias – Ep. 69
In this episode of Endo Voices, Dr. Marcus Johnson engages in a thought-provoking conversation with Dr. David Landwer, fellow of the American Academy of Oral and Maxillofacial pathology and endodontist, exploring the intricacies of diagnostic challenges within endodontics, with a particular emphasis on the pivotal role of Cone Beam Computed Tomography (CBCT) in differentiating between various lesion types. Dr. Landwehr underscores the necessity for a sophisticated and methodical approach to diagnosis, advocating for the refinement of clinical discernment to distinguish endodontic pathologies from non-endodontic conditions. He recounts a case involving a patient with osteomyelitis, illustrating how rapidly evolving clinical symptoms can lead to diagnostic ambiguity. Dr. Landwehr further stresses the importance of meticulous documentation of all findings, including incidental observations, not only to meet legal obligations but also to elevate the standard of patient care. Additionally, he emphasizes the critical role of transparent communication with both patients and referring clinicians.
Episodes of Endo Voices may include opinion, speculation and other statements not verifiable in the scientific method and do not necessarily reflect the views of AAE or the sponsor(s). Listeners should use their best judgment in evaluating the merits of any content.
Episode Resources
- Neville BW, Damm DD, Allen CM et al: Oral and maxillofacial pathology. 4th ed. Elsevier, St Louis, 2016.
- Bhaskar SN: Oral surgery-oral pathology conference No. 17, Walter Reed Army Medical Center. Periapical lesions–types, incidence, and clinical features. Oral Surg Oral Med Oral Pathol 21:657, 1966.
- Becconsall-Ryan K, Tong D, Love RM: Radiolucent inflammatory jaw lesions: a twenty- year analysis. Int Endod J 43:859, 2010.
- Kontogiannis TG, Tosios KI, Kerezoudis NP et al: Periapical lesions are not always a sequelae of pulpal necrosis: a retrospective study of 1521 biopsies. Int Endod J 48:68, 2015.
- Kuc I, Peters E, Pan J: Comparison of clinical and histologic diagnoses in periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:333, 2000.
- Sirotheau Corrêa Pontes F, Paiva Fonseca F, Souza de Jesus A et al: Nonendodontic lesions misdiagnosed as apical periodontitis lesions: series of case reports and review of literature. J Endod 40:16, 2014.