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Showing posts from March, 2014

An aid to explaining dentinal hypersensitivity

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.

Communication

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

Composite restorations

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...

Root Fractures

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...

alginate impressions

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 ...

011 SOFT TISSUE EXAM

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...