tips and tricks

I recently had a patient that required extraction of a heavily filled lower 6. The last xray we had was a PA 2-3 years old. I told him that I would like to take a new Xray to plan the extraction. HE kicked up a big fuss about the cost of the xray. I compromised and said I would take the tooth out with the old xray. Big mistake. The crown fractured and the roots kept fracturing with elevation. The extraction would have been just as difficult with the updated xray but medicolegally I don't think I would have a good defence if things went sour. I took a PA halfway through anyway to check the progress of the extraction. It scared me because at the angle I took it, the IAN overlaid the roots. Then I realised I should have taken the xray at the start. In the future if a patient kicks up a fuss about the cost of necessary diagnostic tests I would either straight up refuse to perform the treatment or give the xray for free. It's 30 seconds work to save a lot of headache down the track....

-Full smile For this shot, a point-and-shoot camera should be switched to macro mode; DSLR macro lenses should be used at approximately 1:2 magnification. Attempt to take the photo from directly in front of the patient, avoiding a downward or upward angle of view. The patient should exhibit a natural smile, with framing of the photo extending from the right to left corner of the mouth. Point of focus for this shot is on the central or lateral incisors. The horizontal midline should be the incisal plane; the vertical midline should be the anatomic midline.  -Anterior retracted Patient seated with dentist in front. Cheek retractors used with the cheeks pulled outwards away from the teeth. A common mistake is to pull the lips outwards and backwards which pulls the buccal area inwards. Use the largest retractor possible to avoid the centre of the upper and lower lip from appearing in the photo. Air dry the teeth. the teeth should be in MIP but they can be slightly apart to aid in...

Preliminary restoration for crown is the code 627. I believe that this code is too all encompassing. I restored a tooth with composite resin today, lower molar 5 surface. If my core buildup was only 3 or 4 surface the cost would be the same, I think that there should be an increase in cost for larger buildups which perhaps relates to the cost of the correstponding 5-- code. e.g Half the cost of the 5-- code. Such problems would be less obvious if we used a dual cure composite core buildup system which involves a single layer which would be a timesaver. If I have to buildup the whole tooth in CR with incremements then running costs increase significantly.

Today I placed a large 12MIDL composite resin without rubber dam. Not sure about my reasoning about the lack of rubber dam but it would have been difficult to place due to the subgingival nature of the prep. This is not an excuse however and the patient's inflamed gingiva kept bleeding onto the composite resin. Long term, this increases the risk of staining and secondary caries. I placed a retraction cord but didn't place it interproximally. Instead i placed it flowing onto the gingival margin of the adjacent teeth. I think that the lack of cord in the interproximal allowed bleeding onto the composite resin. If I could restore this tooth again, I would pack cord or teflon tape then rubber dam from premolar to premolar and use floss ties to invert the dam into the sulcus +/- an anterior cord. Also, the contralateral lateral incisor was missing which made it difficult to form anatomy till symmetry. Additionally the ipsilateral canine was buccally and labially positioned. A cont...

Extra root present on lower molars. Non concentric position and easily missed in RCT RE is present distolingually in lower molars but can be located as far messially as the central portion between the mesial and distal roots. RP is present mesiobuccally but can be found centrally between the mesial and distal roots RE Rare in Caucasian populations Max 3-4% RE Eurasian and Indian <5% RE Mongoloid population (Chinese, eskimo and american indians) 5% - >30% RE can be found on and lower molar but occurs most commonly on the 6 and least commonly on the 7. 50-67% bilateral Morphology can vary from a short conical extension to a mature root with normal length and root canal. In general, the RE is smaller than the DB and mesial roots and can be separate from or partially fused RP is very rare. 2% 3rd molar, 0.5% 2nd molar, 0% first molar but other studies have found RP in first molars.  An additional cusp (Tuberculum paramole) may be present on the buccal side in a tooth wi...

I've picked up some patient information sheets from work, just going to spend a few posts summarising the key points of these. -Usually occurs on a molar or premolar (in order of likelihood): 1. Upper premolar 2. Lower molar 3. Upper molar 4. Lower premolar Symptoms: -Sharp and erratic pain on chewing or after release of biting pressure. But not all cracks cause pain  -Pain or discomfort when exposed to cold or hot liquids or food -Sensitivity to sweet -Difficulty in pinpointing location of pain -If the crack extends blow the gum, a periodontal pocket may be present -Often a history of other cracked teeth Causes: -More likely in recent times as teeth are retained for longer with larger restorative cycles and teeth more prone to fracture -Stress leading to grinding of teeth especially at night -Time, wear and tear from chewing, grinding and clenching -Chewing on hard foods e.g ice, sweets or pencils -Trauma especially if upper and lower teeth have been rammed to...