By Grant Stucki DDS, MS
Recently, I came across a patient case that I think is worth recounting—not just because of how it ended, but because of all the lessons hiding in the chaos. Here’s the run-down:
A 76-year-old man developed pericoronitis on a partially impacted wisdom tooth (#32). He saw an oral surgeon, who extracted the tooth. Four days later, he had a root canal on the neighboring molar (#31) due to pulpitis, and a few days after that, he got a shiny new crown. Pretty routine stuff—until it wasn’t.
After the root canal, he started experiencing persistent pain in his lower right jaw. One week later, he returned to the endodontist, who confidently declared that #31 wasn’t the culprit—it was the wisdom tooth site (#32) causing the problem. So off the patient went to follow up with the surgeon.
The surgeon, after examining him, disagreed. “The wisdom tooth site is healing beautifully,” he said. “It must be the root canaled tooth.” Back to the endodontist he went, and thus began a game of dental ping-pong.
Days later, the patien
t developed swelling in his right jaw—worsening by the hour. He returned to the endodontist 2.5 weeks after the root canal (and 3.5 weeks post-extraction). The endodontist remained unmoved: “Definitely not from my tooth,” he insisted. “Go back to the surgeon.”
The next day, the swelling doubled. The patient called the surgeon’s office only to be told—surprise!—the surgeon was out of state for two weeks, as he did every month. Now, with growing swelling, worsening pain, and no one taking ownership, the patient was understandably panicked.
That Friday, he could barely swallow and could hardly open his mouth. He and his wife, at a loss, called their general dentist out of desperation. The dentist saw him, wasn’t sure how to manage the infection, and called my office.
The call came in at 4 PM on a Friday. We were done for the day and physically and mentally heading out the door to enjoy the weekend. My office manager stopped me as I was walking out and said, “A referring dentist says he has a patient who is really swollen and in a lot of pain. Is there any way you’d consider seeing him now?”
I rubbed my eyes, and let out a tired “Hmm…” Every fiber of my being wanted to say no. But something—a small, persistent whisper in the back of my mind—told me to stay. I knew my assistants would be irritated. I had every reason to say no. But I didn’t.
About 20 minutes later, the patient arrived.
From the moment he walked in, I could tell: this was bad. His jaw was visibly swollen, and the abscess was tracking under the mandible, pressing on his airway. We needed to act quickly.
The tricky part? Figuring out where the infection was coming from. The extraction site looked reasonably well healed. The swelling, however, seemed to center around tooth #31—the root canaled molar. I explained this to the patient, gently letting him know that I believed the infection was coming from that tooth. I also told him that even though he’d just paid for a root canal and crown, the best course of action was to extract it and clean the area thoroughly.
He didn’t hesitate. “Take it out,” he said. “I just want my life back.”
I’ll admit—I hesitated to tell him at first. The endodontist had written a confident note just days earlier claiming the tooth was fine. But the location of the swelling, the urgency of the situation—it was clear what needed to be done.
I told him this was serious. He needed to go to the hospital. IV antibiotics, immediate admission, and surgical drainage through the neck. His eyes went wide, but he nodded.
That night, I admitted him and drained the abscess. He stayed for a few days, recovered well, and returned to my office a week later—grinning from ear to ear. “I’m so glad I found you that Friday night,” he said. “If I hadn’t… I think I would’ve died.” His wife nodded solemnly as he said that.
I gently brushed off the comment and redirected the conversation away from death. But inside, I knew he was right.
That Friday evening, we didn’t just drain an abscess. We quite literally saved a life. And in doing so, I was reminded of how important it is to stay curious, flexible, and humble as a clinician.
Lessons from the Ping-Pong Match
What complicated this case so much?
Two separate procedures. Two different teeth. Two different providers. All within days of each other.
And then… two sets of blinders.
Each provider looked only at their own piece of the puzzle. Their “7mm of turf.” Once they confirmed their work looked good, they wiped their hands of the problem and sent the patient back into the void.
Neither clinician was unskilled or uncaring. But both were operating in silos. And when you’re in a silo, it’s really hard to see the whole barn.
From reading their notes, I could feel the pride each clinician had in their work. “The root canal is pristine!” “The extraction site is healing perfectly!” And sure—maybe both were technically right. But their combined lack of big-picture thinking allowed an infection to fester and nearly kill the patient.
If just one of them had called the other, talked through the findings, shared suspicions, or made a joint plan, the patient would have suffered far less. But instead—ping—he was volleyed back and forth until things got critical.
So… What About Us?
Ever found yourself in a situation like this?
Ever been so focused on your corner of the map that you missed the entire terrain?
Ever thrown out the baby with the bathwater because you didn’t want to deal with the mess?
Action items:
- Think of a challenging situation you’re facing (or have faced).
- Step back. Zoom out.
- Are you missing something because you’re too zoomed in on one part?
- Is there a way to take action—even if it’s technically “not your job”?
Sometimes, doing the right thing means breaking out of your box. And sometimes, that choice—though small and inconvenient in the moment—might end up saving someone’s life.