(The story of my witch patient)

In a perfect world we would finish all of our root canals in one visit, prep the tooth, and cement the crown an hour later. It would be seamless and effortless and everything would succeed. Unfortunately, life is not ideal and endodontics is not perfect, patients can be a pain in the rear, and sometimes it takes two visits to finish root canal treatment.

So how do we manage patient expectations prior to the start of the root canal process? How do we communicate the reason why we are needing two visits to complete the endo? How do we make sure the patient comes back for completion and does not get lost in the sauce?

In the Army, I performed root canal treatment on a real live WITCH. She was a wife of an American soldier who happened to be a Wicca leader for the military in Germany. She came in one day on an emergency basis in a great deal of pain. I performed a pulpectomy (cleaned out the majority of the nerve to the apex at least up to a #25 hand file- ideal pulpectomy) and placed calcium hydroxide. I informed her that she needs to come back so we can complete the root canal treatment and restoration. I then promptly forgot about her except the witch part.

One year later she comes back to the clinic swollen and in pain. I look back in the records and see that she never came back for the completion of the root canal treatment or restoration and that we never called to re-appoint. Now I’m nervous because she’s a witch and what if she puts a spell on me (she told me she is a good witch and only practices white magic and doesn’t really place spells on people- Yes I asked her!)?

Again I perform a pulpectomy and place new calcium hydroxide and place her on antibiotics (I routinely give Amoxicillin 500mg, 1 g loading dose and then Tid for one week or for serious infections or an allergy to Penicillin, Clindamycin 300mg, 600mg loading dose, Tid for one week). This time she comes back in a week and I complete root canal treatment and the restoration and it was a success because I exited the Army 8 months later (geographic success!).

I have learned a lot since the early days and now I have communication procedures for everything I do in my practice. My goal is to manage patient expectations right out of the gate. Fist off, I tell my patients that, “This root canal will take an hour to an hour and a half and it may take 2 visits”. I have said this phrase ~8000 times and it works. If it takes two visits, I tell them, “We had to place an antibacterial medicine inside the tooth to help kill the infection.” If its vital (Irreversible pulpitis) then I say, “We had to place an antibacterial medicine inside the tooth to help kill the bacteria (because the tooth is not infected)”. I have said this ~3000 times and patients accept it for the most part because you are placing medicine to help kill the infection and in their mind prevent it from spreading.

The last step is to have good recall and re-appoint systems so that the patient does not get “lost in the sauce.” Make sure your front office appoints the patient for the completion appointment prior to them leaving and call and remind them of their next appointment.

I hope this helps. Please visit RootCanalAcademy.com for more patient one-liners.

Happy Endo My Friends,

Reid