Dental Tribune U.S. Edition

Dental Tribune U.S. Edition | Month 2012XX Dental Tribune U.S. Edition | January 2012A6 cliNical Internal root resorption rules out restoration to avoid — at great harm to the practice. Consider this all too familiar scenario. The new employee, “Rita,” comes on board. She is bright and enthusiastic. Her responsibilities increase over the years. She has her way of doing things, which is fine with the dentist because he doesn’t have to worry about things getting done. Before you know it, she’s been with the office 15 years and knows the practice better than the dentist does. The problem: That once bright, young, enthusias- tic employee has become stubborn and controlling. She challenges the dentist and staff regularly. She’s negative, difficult, and regularly re- fuses to comply with routine re- quests. She has be- come the proverbi- al “employee from Hell.” The dentist has finally had enough. He spent the better part of the last two years — yes, two years — making ex- cuses for her to the remaining staff who actually didn’t quit in disgust. “She’s go- ing through a difficult time.” “She really is a good employee; you just have to look past her shortcomings.” “You have to ad- mit, she’s very good with the schedule.” As McKenzie Management HR Solu- tions division has found, this situation is a common scenario in dental practices. The dentist hands over so much re- sponsibility to a key employee that the individual becomes central to the con- tinued operation of the practice. This person changes over the course of weeks, months or years and issues surface. In the case above, the dentist wanted to dismiss the employee. Somehow Rita learned of the dentist’s desire to termi- nate her and threatened to sue him for 15 years of back pay and overtime. The dentist was terrified. Sadly, he spent months paralyzed from fear and trying to convince himself he could just live with her disruptive behavior. He couldn’t. This one employee was running his practice into the ground. Eventually, he sought legal counsel and learned that he lived in a state where an individual had only one year to sue for back wages. But even at that, it was still far more than the dentist wanted to pay. Moreover, the entire ugly situation could have been avoided if the dentist had es- tablished office policies and procedures in place. He didn’t think he needed them until he needed them. When faced with situations in which an employee must be terminated, first and foremost, practices must have estab- lished policies and procedures. Second is to seriously consider offering severance agreements. Severance agreements in which employees give up all rights to sue are valid in every state. Offer a severance agreement with a modest amount of money to put the issue to bed and send the employee on his/her way. The amount of severance awarded will vary based on the employee’s position in the practice and how long he/she has been there. It could be three-five months salary, but when you’ve been dealing with a seriously poisonous staff member, most dentists will do just about anything to be rid of this person. And most agree that a few months’ salary is well worth it. Rita was eventually sent on her way with six months’ pay. Additionally, the agreement should as- sure that the employee will not disclose confidential practice information or trade secrets. This can be taken care of up front when the employee is hired. There should be a confidentiality pro- vision in the handbook and the employ- ee must be required to sign off that he/ she is aware of it and agrees to follow it. The key is preparation. Waiting until employee behaviors are so problem- atic that they are damaging the practice make the dentist and practice highly vul- nerable to litigation. “ Page A4 DOv M. alMOg, DMD, is chief of the Dental Service, at the Veterans Affairs New Jersey Health Care System (VANJHCS). ODalyS HECtOR, DMD, is a general dentist in the Dental Services at VANJHCS. For inquiries about this article, please contact: Dov M. Almog, DMD, VA New Jersey Health Care System 385 Tremont Avenue East Orange, N.J. 07018 (973)-676-1000, # 1234 dov.almog@va.gov Permanent maxillary central incisor replaced with removable partial denture By Dov M. almog, DMD, and Odalys Hector, DMD F or decades, case reports and sci- entific studies have described the condition of internal root resorp- tion. A recent web search related to internal root resorption revealed 247 results in PubMed and more than 1 mil- lion results in Google. According to many of the studies, internal root resorption is infrequently detected in clinical or radio- graphic examinations of teeth, but is a fre- quent finding in teeth with pulp inflam- mation or necrosis. Case report Many of the published works on internal root resorption condition are in the form of case reports similar to this one. Some, though, are scientific studies that exam- ine the histological and biological aspects of the condition.1 A recent scientific study revealed that teeth with healthy pulps did not exhibit the condition of internal root resorption. By comparison, half of the teeth with pul- pitis, and the majority of the teeth with necrotic pulps, had internal resorption.2 Inflammation was shown to be an impor- tant etiologic factor of internal resorption. In our case, a 42-year-old African Ameri- can male, a U.S. armed services veteran, presented for the first time to the Veter- ans Affairs New Jersey Health Care System Dental Service at East Orange, N.J., seeking dental care. The patient’s primary reason for coming to the Dental Service was for a complete dental exam. This case report describes the condition of a permanent maxillary central incisor affected by internal root resorption. While the etiology of this pathology is unknown, most commonly it is associated with trauma or seen postoperatively following a large resin restoration. According to the literature, this type of progressive internal root resorption can be stimulated by on- going inflammation from infection.3 A comprehensive oral and maxillofacial examination included an intraoral and extraoral exam with cancer screening, full-mouth X-rays and a panoramic radio- graph. Among other things, the examination revealed extensive internal root resorp- tion condition in tooth #8, coupled with a buccal fistula draining purulent discharge (Fig. 1). After careful assessment of all the avail- able diagnostic information, and upon further exploration of the feasibility of different treatment options to restore the patient’s tooth, the case was discussed and explained to the patient. While root canal treatment has been the treatment of choice for this pathologic condition to date,1 after reassessing the ex- tentoftheinternalresorptionanddescrib- ing the condition to the patient, including the potential associated postoperative ramifications, it was collectively decided to extract the tooth followed by socket preservation. At the same visit, an immediate acrylic removable partial denture (RPD) was de- livered. Consequently, all restorative, periodon- tal and prosthetic needs were addressed, including a cast RPD replacing tooth #8 and other already missing bilateral teeth. Conclusion As described in this case report, for de- cades it has been determined that inter- nal resorption is seen frequently in teeth associated with pulp inflammation or necrosis. Following suggested course of action in the literature, when internal root resorption condition has progressed to involve an external communication with the periodontal ligament space, this con- dition should not be restored and main- tained.4 ˙ References 1 Patel S, Ricucci D, Durak C, Tay F. Internal root resorption: a review. J Endod. 2010 Jul;36(7):1107–1121. 2 Gabor C, Tam E, Shen Y, Haapasalo M. Prev- alence of internal inflammatory root re- sorption. J Endod. 2012 Jan;38(1):24–27. 3 Wedenberg C, Lindskog S. Experimental internal resorption in monkey teeth. En- dod Dent Traumatol. 1985 Dec;1(6):221–227. 4 Heithersay GS. Clinical endodontic and surgical management of tooth and associ- ated bone resorption. Int Endod J. 1985 Apr;18(2):72–92. Fig 1 Based on clinical and radiographic diagnosis with conventional two- dimensional periapical radiographs, tooth #8 appears to have a large internal radiolucency in the middle of the pulp canal defined as an internal root resorption. Photo by Dr. Dov Almog Photo/Shae Cardenas, www.dreamstime.com