Tips from 3rd may 2016
Started with Dr Kelsey today and have had a good experience so far. Here's what I picked up:
-To test if a restoration is high, you can apply a localised bite force with a thick bit of cotton pellet and place it on the resto surface with some tweezers. On adjacent MO and Do restorations, you can place it on the interproximal area and then narrow it down by placing it on individual restorations
- To find a cracked cusp, you can give the patient a frac finder and tell them to chew around with it till they find the sore cusp. then leave it there for you to take a look.
-Pain on release with a cracked cusp occurs as biting causes separation allowing fluid to enter the cracked space. Release of pressure will cause rebound of the tooth and will force fluid down the dentine tubules which are quite raw as they are normally unexposed.
- An explanation--> "There is enamel covering the tooth which is non sensitive with no nerve endings and underneath is the dentine which is sensitive. Enamel is thick up the biting surfae of the tooth but thins down until it reaches the gumline where there is no enamel.
- On the most mesial tooth of the rubber dam there is little to hold the rubber dam down other than the contact point. If you need more retraction of the rubber dam, you can place a clamp on a tooth over the rubber dam to allow the wings to hold down the rubber dam.
-Especially when there is a matrix band, bonding agent will flow onto the tooth surface leaving microscopic roughness. and although you can't see it, the patient will report roughness after the LA wears off. Running a sickle probe with some pressure along the tooth adjacent to the restorative margin will shred the bond layer and alert you to the need for polishing
-Look for internal cracks as they may signify cuspal undermining. PICK UP A TRANSILLUMINATOR. They are very helpful and you can see cracks you wouldn't otherwise notice without illumination. Removal of existing restorations and placing an amalgam condenser in the cavity can allow you to place force on cusps just by leaning it outwards. Then, cusps that fracture off can be tested.
-To test if a restoration is high, you can apply a localised bite force with a thick bit of cotton pellet and place it on the resto surface with some tweezers. On adjacent MO and Do restorations, you can place it on the interproximal area and then narrow it down by placing it on individual restorations
- To find a cracked cusp, you can give the patient a frac finder and tell them to chew around with it till they find the sore cusp. then leave it there for you to take a look.
-Pain on release with a cracked cusp occurs as biting causes separation allowing fluid to enter the cracked space. Release of pressure will cause rebound of the tooth and will force fluid down the dentine tubules which are quite raw as they are normally unexposed.
- An explanation--> "There is enamel covering the tooth which is non sensitive with no nerve endings and underneath is the dentine which is sensitive. Enamel is thick up the biting surfae of the tooth but thins down until it reaches the gumline where there is no enamel.
- On the most mesial tooth of the rubber dam there is little to hold the rubber dam down other than the contact point. If you need more retraction of the rubber dam, you can place a clamp on a tooth over the rubber dam to allow the wings to hold down the rubber dam.
-Especially when there is a matrix band, bonding agent will flow onto the tooth surface leaving microscopic roughness. and although you can't see it, the patient will report roughness after the LA wears off. Running a sickle probe with some pressure along the tooth adjacent to the restorative margin will shred the bond layer and alert you to the need for polishing
-Look for internal cracks as they may signify cuspal undermining. PICK UP A TRANSILLUMINATOR. They are very helpful and you can see cracks you wouldn't otherwise notice without illumination. Removal of existing restorations and placing an amalgam condenser in the cavity can allow you to place force on cusps just by leaning it outwards. Then, cusps that fracture off can be tested.
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