tips and tricks

Patients may have unrealistic expectations given to them by the media, friends, family or preconceived notions. However, the notion that dental work lasts forever is a difficult one to build. It may be a hope that they hold that the hard earned money they pay will result in teeth that will last them the rest of their days but whatever built up that notion in their head needs to be torn down before any treatment is commenced. An individual who has survived to 60 years old is highly likely to live till 80 or even 90 so the days where the "elderly" were promised lifetime lasting work is long gone. We must plan for restoration replacements late into life. Often times it is the dentist themselves that builds up these expectations in patient's heads that the work will last forever and part of this stems from our overconfidence in our work and insecurities about failure. We often are tempted to provide guarantees about our work to convince patients of certain treatment plans b...

When explaining the patient's condition to them you must remember that they have very low capacity to visualise what you are talking about. When discussing the prognosis of teeth you must communicate: -Tooth location -Tooth surface -Tooth condition -Prognosis of treatment Patients can sometimes visualise the location of the tooth and surface if there is obvious markers such as cavitated caries or a missing tooth as a reference point however they do not have the dental anatomy knowledge or experience that you do. Patient's can't understand how a small cavity can open up into a much larger one or how far under the gum the decay has progressed. Their ability to see into their own mouths is limited to one very narrow angle and insufficient lighting with no magnification. You must be able to use alternative methods to communicate with them. -Put a mirror in their hand and shine a light in their eyes. You can point out the location and surface of the tooth in question wit...

Core buildups before crowns is a step that is important for the retention of a crown. It removes undesirable undercuts in the tooth, provides a material to shape the tooth to an ideal resistance form and in aesthetic cases can change the stump shade of the tooth for aesthetic effect. In full mouth cases core buildups are much more efficient than those in single crown cases because you don't have to worry about things like damage or bonding to the adjacent tooth. Rubber dam is desirable for gingival retraction and moisture control but this is not always possible. You will find it much easier to perform an occlusal reduction from the desired vertical dimension before your core buildup. A shrink wrap mock up transfer can be done and burs of ideal depth used to prep the occlusal surface of multiple teeth at an angle following the contour of the cusps. Old restorations can then be removed much easier due to improved visibility. Remove all stains especially at the DEJ till you are on...

Education in dentistry has a strong focus on what  the procedure is and less on how  we perform it. Long appointments and indeed long days are tiresome and by the end of the day you can feel as though your attitude to your work has declined and the quality of even simple procedures is poor. One thing that you need to learn not only in rehabilitation procedures but in general day to day practice is resilience in your work. Strategies to overcome fatigue include: -Take breaks: Break up your day with a cup of tea or some fresh air. Long appointments can be split up with a break for yourself and the patient. If you take 5 minutes for a bathroom break and a glass of water you will make up that time afterwards by being refreshed and being ready to jump back into the procedure. It may give you the clarity to solve some issues that you have been struggling with that appointment. Seeing the case with fresher eyes is always helpful. Even the 20 seconds while your dental assistant is l...

Today I had an interesting occurrence whereby there was a sinus infection associated with a dental infection. While I was going through routine consent, he responded to the risk of OAC by saying he has had recurrent sinus infections in the past. he has apparently seen his GP who found nasal polyps and has recurrent sinus infections that he is prescribed antibiotics for. On a side note it is important not to take everything the patient reports as a fact. One would hope that the GP offered more investigation i.e referral to an ENT rather than symptomatic relief from antibiotics. Who knows, maybe the patient was offered this but declined or maybe he sees a different GP every time. Additionally, on the PA it did seem as though the palatal root was close to the maxillary sinus with a periapical radiolucency involved. These should be warning signs to get prooper consent form the patient and inform them of the possible adverse outcomes of treatment and the possible follow up strategies includ...

Cotton-Cavit-Fuji IX Cotton-Cavit-Fuji IX Cotton-Cavit-Fuji IX These steps were drilled into me in dental school when sealing up endodontic accesses for multi visit treatment however there are several flaws with the method. The rationale behind this method is as follows: -The cotton pellet acts as a spacer to stop hard setting materials from entering the root canals. It also allows easy removal of the temporary restoration as you do not have to be instrumenting right down o the pulp floor every time you reaccess -Cavit has been shown to produce a reliable seal when used in increments of 2mm. This is because it is a gypsum material and will expand slightly on setting in contact with moisture. -GIC: GIC is relatively inexpensive and can be used over Cavit in cases where the restoration must stay in place more than a few days. This is because the hardness of Cavit is relatively low and it will easily be abraded away in day to day function. The Cavit-GIC combination is useful in p...

Recently I attended the part 2 course of Lincoln Harris' Full mouth rehabilitation live patient course. At the course, the dentists performed final tooth preparation and tooth impressions and retemporised. I took notes this time so there is plenty of information to share. I will split it into multiple posts about separate aspects of the patient treatment observed. These will occur over the next few weeks when I get time.

Often i'll find that the flat plastic I use to pack cord or teflon will have blood on it after I set it down. Also, the instruments to place materials e.g a base applicator or plastic instruments will often have GIC and composite resin caked onto them after use. Ideally your dental assistant will be trained to immediately wipe these clean to avoid them setting or drying onto the instruments. These are the things they can be doing to keep themselves occupied while you are working on the patient. When they aren't suctioning, curing, or mixing materials they should be constantly reorganising your instrument tray and cleaning the instruments off. However, in a busy situation or when the staff are not well trained, dried blood or GIC can be detrimental to the procedures. blood can be transferred onto the surface of your composite and stain/contaminate your restoration. GIC will obviously roughen the surface of the instrument and will cause composite to stick to it. Worse yet it ca...

Without exception, there will always be down time in the workplace. Patients cancelling late, patients running late and unexpected situations like weather anomalies and equipment breakdown. It is very easy when you are running a business to see this as money out the door however it does give you a rare opportunity to fill your day with other activities. There is always something to do around the workplace and it is important for the dentists and the staff to have a list of things they can do to fill the empty time in the day. -Have a break: You need time in the day when you can relax and unwind. Even planning to stopping midway through a long and complex procedure can allow you to catch your breath, recuperate and continue refreshed. Your dental assistant will be grateful, your patient will understand as we are only human and it will give them a chance to relax their jaw muscles and have a toilet break. Be sure to pick a time that is ideal e.g after corebuildups or during hemostasis ...

As opposed to bubble which are air inclusions, rag marks will appear as smooth, thin vertical lines in an impressions. Contrary to what I believed before, drag marks are unlikely due early removal of the impression material but more likely due to wet oral surfaces. the excess moisture is put under pressure from the seating impression and the path is is displaced through to escape the impression shows up as a drag mark. This is especially noticeable in hydrophobic impression materials such as PVS. Setting times for intraoral impression materials are minimum suggested times for the warm oral environment. Add at least a minute on top of the setting time when using intraoral impression materials for your putty keys for temporary mockups and crowns.

When using the ultrasonic scaler on fairly heavy calculus I find it useful to clear the interproximal calculus first. In cases where there is a heavy bridge of calculus joining the lower incisors, it is often beneficial to break large chunks of calculus off in one go. This saves the effort of running the scaler over every square mm of the root surface that can be very sensitive. Removing the interproximal calculus first starting at the contact point and working towards the gingiva removes the areas of calculus that are locked in between the teeth and makes the bulk of it less retentive. Always be sure to prewarn the patient that after cleaning the teeth may be more mobile. This is because the extra support from the bridge of calculus has been removed and the actual mobility of the teeth is revealed. In cases of moderate to severe mobility where function is uncomfortable you can prewarn the patient that you may wish to splint the teeth with resin post debridement. Consider taking intr...