An unfortunate example of how patient non-compliance can lead to poor outcomes

So often I find myself reminding patients to avoid confusing ‘no pain’ with ‘no problem.’ Many dental and non-dental infections progress in an insidious manner, and timely intervention is critical regardless of symptoms. This case highlights that, as well as another vital component of treating an asymptomatic infection: patient compliance. This patient first presented to our office 10 years ago for evaluation of an apparent periapical infection of tooth #18. An endodontic evaluation confirmed that the tooth was necrotic and in need of root canal treatment. Given the patient was not in pain, he said he would consider it and call back later, despite being informed of all risks.
Fast forward to 2020, when he returns for treatment of a different tooth. I happened to notice that tooth #18 was still present, so I asked him about it. He told me he’d been pain-free in that area for the entire 10 year period, so he sought no further treatment. The images below, from 2010 and 2020, show the magnitude of bone destruction that had occurred. We finally convinced this patient to see an oral surgeon, which ultimately led to the loss of multiple teeth and a much more invasive course of treatment than was necessary years ago.