tips and tricks

I had a good demonstration about how to manage a patient with painful teeth where pulp tests are ineffective. This generally means that the pulp is either too calcified to respond or the canal is necrotic or pulpless. In either of these situations, chances are there is some periapical involvement. A PA radiograph of TTP is a good sign of this. Also symptomatic questions are useful with a prolonged, intense dull pain which may wake the patient up at night. A way to approach this would be to get the patient to bite down on a cotton stick saying you're going to test the teeth and you want them to bite down with firm pressure on 3 teeth 1, 2 and 3 and to tell them afterwards which hurt the most 1, 2 or 3.

For the 3062 presentation we had an anaphylaxis case study and this is just a summary from memory of the clinical protocols: A patient's hypersensitivity reaction may occur as redness or urticaria (Rash), breathing problems from bronchospasm or odema, systemic odema. Oral manifestations include    Pruritus of lips, tongue and palate, edema of lips and tongue. If there is suspicion of an allergic reaction or an allergen has been administered e.g. LA, penicillin then administer 10mg chloramphenamine and 100mg hydrocortisone. Lie the patient down to counter hypotension unless there is airway involvement then keep the patient upright. Administer oxygen if symptoms appear and if there are serious symptoms or breathing problems then administer 1:1000 epinephrine  Intramuscularly via epipen in lateral of thigh or arm. You may need to readminister adrenaline every 5 minutes or so due to adrenaline's low half life until the chloramphenamine has taken effect. If serious symptom...

Today I perfomed a buccal infiltration of the 18 and the patient had a sharp reaction and after the LA complained of a tingling sensation below his right eye. I observed a blanching below his eye of irregular shape about 6-7cm in size. This was a phenomenon of the needle tip coming into contact with the sympathetic nerve plexus surrounding the maxillary artery causing a chain reaction spanning down the length of the artery causing vasoconstriction. This presents as blanching of the tissues suppled by the infraorbital artery of the ipsilateral side due to local vasoconstriction of the blood vessels. This will last as long as the LA is effective in the area. What to do? Assure the patient that it is normal and will wear off over time. You can show it to them in the mirror if they'd like. Say people wouldn't normally notice it but it will wear off as the LA wears off. Monitor their condition to see if there are any changes in vision or heart rate which would indicate injection ...

Had a go with Fuji II LC the other day on a 45DB. It's a pretty weird thing... RMGIC so it partially sets as a GIC and must be light cured as a resin. This 45 in particular had terrible access. the adjacent 46 was absent and the caries was on the distal surface meaning I had a choice of either performing a traditional box preparation or approaching from the distal surface in the gap between the 45 and 47. I chose the latter and visibility was terrible! after quite a bit of guesswork, I prepped the cavity which extended buccally under a class V composite. I removed this and cleaned the margins of deminned enamel. The demonstrated, a fill in Dr. L suggested I somehow incorporate the RMGIC in the restoration as it had potential to be aesthetic. She suggested RMGIC on the buccal aspect and FujiIX on the distal. She suggested the use of Hawekerr clear matricies? It had a clear triangular form with a handle to hold with tweezers. The idea was to fill the cavity from the buccal and when t...

Today I witnessed an educational demo of the fabrication of a michigan splint from start to finish. 1) take alginate impressions of upper and lower. Make sure there are no tears and distortions and that the alginate hasn't come away from the tray at all as that will distort the tooth shapes of the cast 2) Pour the cast up in dental stone and trim. Don't remove bubbles as removal can be unpredictable and excessive removal of stone will result in high spots on the acryllic which though small can cause rocking of the final appliance as it will not fit closely to the fitting surface. When it will interfere with occlusion, you can use a sharp scalpel to trim it slightly. 3) Take a wax bite of the pt at the desired bite opening. a good estimate is 3mm anteriorly and 2mm posteriorly to allow for bulk of acryllic. The idea of a splint is to disocclude the teeth to avoid locking movements during grinding. the wax bite should cover all the teeth and have sufficient bulk. take the wax ...

A set of tips from a pediatric dentist in gaining specialty. -Show you are interested in the specialty. Go for observations in the field and keep a log book of patients and things you've seen -Mphil helps.../Honours/or later study -Racds?

It should be beneficial to scan the gingival margin before commencing perio probing looking for classical signs of gingivitis: redness, loss of knife edge contour and height of gingiva. This may hone in on places of interest. Burnished calculus may not be immediately obvious to the tip of your probe so a more perpendicular position to the surface of the tooth may be needed. When scaling possibly the ultrasonic may be unnecessary and hinder progress in very light deposits of calculus and may aid in burnishing them.

The hard outer enamel layer of your tooth has worn away a bit and/or your gums have receeded exposing the root and the root doesn't have the hard enamel layer. And the root surface is covered in these fluid filled tubes which run all the way into the centre of the tooth where all the nerve endings are. So when you have a sip of coffee or have something sweet or cold the fluid in these tubes gets moved and pushes around the nerve endings which you feel as sensitivity. You can fix these by plugging the tubes with the ingredients in a sensitive toothpaste and we might consider switching you to a softer toothbrush to stop the damage to your teeth and gums. credits to dr vivz.

Lectures on communication are just words on a screen with little to no actual real life value, but human interaction is the best kind of teacher when it comes to communication with complete strangers. Here are some tips about communication with patients i have picked up or noticed. I will add to them later: - when you greet them, call them by their full name. If they're old then ask subtly what they'd like to be called (may i call you margaret or is it mrs jones?) or screw it if they're young and call them by their first name. - shake their hand with a firm grip (don't wanna seem weak and put off a bad first impression) - Be smiley and enthusiastic but not to the point of crazy - Don't waste time... take them to the chair and sit them down. offer to put their bag in a safe place where they can see it at all times (obviously not when lying down but you know what i mean) - When you're first talking to the pt sit down on your chair at eye level to them

Just a few tips and tricks for completing posterior composite restorations... 1. You can apply some flowable composite in a thin layer after you've etched, primed and bonded to allow the restoration to fill the space adjacent to the matrix band in proximal boxes. only a thin layer though as any thicker will compromise the strength of the restoration (i.e. bad resistance form) 2. Use a half hollenback carver to slice a chunk of composite (from composite syringes assuming you don't use the disposable tips) and place it into the cavity by any means possible. a chunk of about 0.3-0.5 is a good compromise of time management and increment size. Increment is important yet again as it decreases the overall polymerisation shrinkage stress of the increment when you apply composite in smaller layers. Use a ball burnisher in a wiping motion towards the proximal outwards and coronally to "squeeze" the composite into the macrovoids. 3. You can apply a thin layer of bond to instr...

Hi, just a tip on detecting root fractures which i learnt from an endodontist today. 1. Look at the aetiology: Roots don't fracture just because. There needs to be something weakening the tooth structure to predispose to the fracture. even heavy occlusal loading on a sound tooth is (i believe) more likely to fracture the crown than it is the root. Look for big things such as root canal treatment, large posts etc which would lead to a root fracture 2. radiographs: a pt of mine had a suspicious looking line on her PA radiograph which i then showed to an endodontist. He said that it may or may bot be a fracture since the pt only had a crown and no root treatment prior. If it wasn't causing her undue problem then it was best to let sleeping dogs lie. 3. pocket depths: when you are doing routine PSR or even when you suspect a root fracture the probing depths around the fracture will be exceptionally large when compared to the surrounding areas due to the attachment loss around t...

Ttoday we did alginate impressions on pts. some were edentulous, some were dentate. Note that there are two different trays for these but dentate trays can be used in edentulous patients with large ridges. Lower impressions: May ideally be taken first as it is easier for the pt to tolerate i.e. doesn't tend to go down their throat and so it can give them a chance to feel the impression and expect what happens next and puts a bit of trust in you (provided you don't screw up). Things you'd like to capture for F/F dentures are: - The retromolar pad (whole length) - Ridges to their entirety - depth of the sulci: Labial and lingual - Frenal areas (Buccal, lingal and labial) - External oblique ridge Have the pt seated with their mouth just higher than relaxed elbow level so you don't have to stretch down as their jaw will open and depress further Upper impressions: More difficult to tolerate for the pt but it is important to keep them calm and tell them to breathe ...

As any good relationship starts with a pt we have the oral exam. an intentional "non invasive" exam to screen for disease in the pt and build some rapport. What we've been assigned to do in our 011 is basically: - Intro and greeting - History taking - Soft tissue exam - Plaque Free - Hard tissue exam - Radiographs and diagnosis/ Tx planning SOFT TISSUE EXAM extra oral "Before i look inside your mouth i'm going to look and feel outside your mouth just as a routine screening to make sure everything is healthy" soft tissue exam consists of bimanual palpation (for the most part) of the pts extraoral features. TMJ, Muscles of mastication, Lymph nodes (before ear? retroauricular, cervical, sub mental and sub md. I found this videa useful: http://www.youtube.com/watch?v=yY9-7pOTROM . Target all the nodes and feel for gross swellings. I've never found any myself so i honestly have no idea what i'm looking for but oh wells. I find it good po...

Hi, just a random inspiration again so probs won't last long.... About 4 weeks into clinics so I thought it would be a good idea to try and write down the tips that i've picked up so far before i forget them. as a friend told me not too long ago "i tried to make a blog about my clinical experiences and it failed." As is my tradition i guess i've started this blog with a bit of pessimism so now that that obligation is out of the way let's get to it...