tips and tricks

Stock impression trays are generally designed to fit all of the population however as for anything designed with the average in mind they tend to fit absolutely no one. A particular issue I find in choosing the right sized stock tray are the arch form and the space between the maxillary molars and the coronoid process. Patients with teeth crowded out of the arch or wider or narrower arch forms would benefit from a stock tray that is wider between the flanges, the peril of using this regularly however is it can encroach into the buccal and lingual soft tissue boundaries and make seating the impression more difficult. Individual modifications en be made to plastic stock trays by heating them in a flame till soft and bending the tray to suit the patient. This will then solidify when cool. A particular issue I had today was on two separate patients where the stock trays fit seemingly well on the maxillary arch however the flange area in the maxillary molar area was not caught in the im...

Often it is difficult to tell the difference between composite and GIC when charting as they are both adhesive, "tooth coloured" materials. It has implications for charting and treatment planning. To differentiate the two, there are multiple ways of testing the materials: -A GIC will generally have a poorer wear resistance and a higher susceptibility to acid dissolusion. A GIC restoration will be more likely to have loss of surface anatomy and a scooped out appearance like eroded dentine. -The location of composite resins are usually placed in higher stress areas such as the occlusal surface. GICs can be restricted to small class 1 cavities as well as class 5 restorations and may also be more prevalent out of the aesthetic zone. However this is not always the case as many dentists will use mainly composite resins for their restorative work and many will place GICs in larger cavities. -Air drying the restoration may provide more of a clue. Dry GIC will have a frosty and r...

Multiple visit endodontics requires a good seal between appointments to allow medicaments to remain in place and to avoid further bacterial ingress. Additionally, it is important to have good integry of your restoration during every visit. Complete removal of caries  will remove the bulk of coronal bacterial reservations and a non leaking restoration will avoid leakage of irrigants out of the tooth and oral fluids into the pulp chamber. Deep, subgingival restorations can be difficult to seal against a rubber dam as the gingiva often gets in the way of the dam septa. It is a good idea to restore these subgingival margins before commencing intracanal endodontics to have a better seal against the rubber dam. This is made even simpler if it is restore before the pulp chamber is accessed as there is less contamination from pulpal bleeding and less risk of extrusion of restorative material into the chamber. The best way that I have found is to access the caries and caries free the ma...

When a patient presents complaining of pain to temperature changes in all parts of the mouth, think dentine hypersensitivity. Differential diagnoses such as pain to caries, cracked teeth  or debonded restorations tend to have different symptoms. This is due to the latter symptoms being caused by a pulpitis. Pain from pulpitis generally waxes and wanes and rarely will affect all quadrants at once whereas pain from dentine hypersensitivity due to toothbrush abrasion, erosion or recession will typically occur in a less inflamed pulp and the causes for these generally affect all quadrants simultaneously. The easiest way to isolate dentine hypersensitity as the cause is to pre test with cold water swished around, Apply a varnish such as Duraphat or MI varnish to the exposed dentine surfaces only and then retest with the cold water. If there is a marked improvement then dentine hypersensitity is the likely culprit. Most commonly, undiagnosed reflux and a hard toothbrushing habit must...

One thing that I can say as a new graduate is that the moment you graduate, it is a big shock to your confidence. You leave the safe embrace of supervised treatments and enter something more of a solo practice. Even if you work in a multi chair practice or with a mentor, the same level of supervision isn't there and it can be very easy to start undervaluing your work. A big part of my practice in the first year out was discounting my treatments. Sometimes it was without even telling the patient I had done so. It was sometimes but not always because I thought my work wasn't worth full price but also because I thought that some of the costs were outrageous for what we had done or because I felt sorry for the patient. A few things yo umust keep in the back of your mind are: -You are not responsible for the patient's current condition, you are only there to return them to a state of health and stability and you have to charge accordingly. Feel free to feel sorry for them when...