tips and tricks

Fremitus as it relates to teeth is the movement observed on closure into the bite. Generally fremitus is observed in upper anterior teeth in traumatic occlusion due to their labial inclination. Lower incisors and posterior teeth tend to have a more vertical force from the opposing tooth whereas upper anteriors will be forced labially due to their contact on the palatal surface. Overerupted lower teeth, anterior RCP-MIP slide and bulky upper restorations can cause traumatic occlusion that can be exaggerated in chronic periodontitis. This force and muscular forces out of the neutral zone can cause anterior teeth to tip and diastemas to open. In case where the teeth are drifting forwards or are mobile, check for fremitus by placing your finger on the labial surface of the upper teeth and have the patient tap together into MIP then grind into excursive movements. Movement of your finger in MIP is a sure sign that there is a traumatic occlusion and this can be adjusted easily with a bur...

When we are assessing a case, based on your experience there will be any number of thoughts swirling around your head about how to tackle the task ahead. You know you have the experience and know how about how to manage the case but the patient doesn't. When accepting treatment plans they will judge you very early on in the appointment if they trust you or not. Things like geographical location and cost are important to the convenience of the patient but just because you are the cheapest and closest dentist doesn't mean that you will win them over as a loyal customer. The appearance of your staff, yourself and your clinic are important to make a good first impression. Finally how you deliver your treatment plans is key to patient acceptance. There is no shame in saying to them "your case is a complex one and I need the right records and enough time to plan it our properly to ensure that we do not miss out on anything." The alternative is presenting to them a haphazard...

The old adage "treat people the way you would like to be treated" doesn't generally hold up in the practice of dentistry. When extending the saying beyond courtesy and professionalism, treatment plans shouldn't be influenced by how you would treat the problem if it was in your mouth. Complex dentistry to rescue a failing dentition is fine in a dentist's mouth but the majority of people do not have the time, finds or motivation to turn around a severely broken down dentition. Instead, we should be focussing on taking a very realistic outlook on the patient's biological, psychological and social condition before presenting a set of treatment plans. Sure, it is prudent to discuss simple and cheap to very expensive and complicated treatments but we do have to be grounded on what patient's can achieve in partnership with yourself and not be too upset if they reply with "sorry doc, that's out of my price range". Ask the patient what their goals a...

Radiographic planning is best done with a CBCT with the lips retracted and tongue off the palate. This will allow a view on a lateral view that will define the gingival soft tissue and the thickness of the palate if a connective tissue graft is needed. It will show on a lateral view the location of the CEJ and how much enamel is hiding under the gingiva. The amount of crown lengthening that can be done is limited by the aesthetics i.e the length- width ratios (usually around 80%) and the biology of the patient. Depending on tooth positions, you may not only be discussing crown lengthening. If the amount of gingiva to be reduced exposes the crown only with good symmetry between the inclination of teeth then the treatment plan may be crown lengthening only. However if there is significant asymmetry, orthodontics can be considered. If the crown lengthening exposure the root of the tooth you may also be considering crowns or veneers. Pre surgical planning is essential. Bony exostoses...

A while back, I explored a technique idea for getting stronger contacts with GICs: http://dental-tidbits.blogspot.com/2018/08/getting-good-contact-with-large-gics.html Thinking back on this technique, I don't think it's a good idea because the premise involves compacting the GIC after the gel stage i.e when there is some solidity to the material and it has lost it's sheen. Prof. Ian Meyers maintains that the best bond to tooth structure will be if the GIC is placed against the tooth while it is still flowy and shiny however this method involves manipulation of the material after this stage. Unfortunately, even light compaction of the GIC is likely to cause movement of the material away from the tooth that will lower or even completely remove its bond strength. This is likely why there was a restoration fracture soon after placement. Alternative techniques would be to place a wooden wedge with or without a V ring to get a very tight contact initially with the GIC. If t...

Building confidence in your work is a tricky topic. As new graduates from university we are thrust into the world of clinical dentistry fresh from the warm embrace of clinical supervisors. The harsh reality of increased legal responsibility and autonomy can be jarring for some. Personally, I feel like we were prepared sufficiently for this eventuality, perhaps a bit too much so causing me to err on the side of under treatment and over-referral. Like many things in life this is a see-saw and we move from one end of the spectrum to another. I think for now I've reached a happy medium where I can plan and tackle cases I am comfortable with and will attempt those that look only just a touch out of my comfort zone. In countless lectures, the speaker will bring up a diagram explaining the four stages of competence (unconscious incompetence-conscious incompetence-conscious competence- unconscious competence). This recurring theme does highlight that very experienced operators have gone ...

As dentists we are trained to look for the signs of gastric reflux as they are reflected in the oral cavity but our knowledge of their causes and management is lacking. Our medical colleagues are well versed in the diagnosis, causes and management but their knowledge and screening of dental effects is lacking. This represents one of many areas where the bridge between the two professions can be improved immensely. -Acid erosion is reflected in the mouth as progressive loss of mineralised tooth structure. Loss of surface texture (perikymata) and smooth, shiny enamel is a good sign that there has been acid erosion in the past -Thinning of enamel allows dentine lobes to show through more obviously. If you can see the shadowy texture of dentine through the enamel there has already been irreversible tooth loss. -Scratches into enamel in various patterns either horizontally or randomly are a sign that the patient has a habit of brushing their teeth after an acid attack -Erosion from gas...

Although it can seem to the contrary in our busy routines, there is more to life than dentistry. Having people in your life that you can turn to when times are hard is important. Even the most stoic of individuals have hard days and if you feel like there is no one around you that you can turn to then you must consider seeking professional help. Even a casual chat about your day to a psychologically trained stranger may be therapeutic and they have the knowledge and perspective to sort through your problems.

This post covers the physical and visual dental examination that can be done to screen for evidence of obstructive sleep apnoea. A thorough medical, dental and sleep history is necessary for a clear diagnostic direction. However, the clinical examination is invaluable to strengthen your diagnosis and to educate the behaviour on their risk factors and consequences of their diagnosis. The history and questionnaires will be covered in a separate post. Extraoral examination Blood Pressure measurement: High blood pressure is a common comorbidity in obstructive sleep apnoea. Screening patients for blood pressure is a good way to start the conversation leading to their diagnosis. Pulse oximeter reading: This measures the percentage of oxygenated hemoglobin in blood. This can indicate poor perfusion in an awake patient at rest. Ideal readings are above 95%. You would expect a person with poor perfusion to have comorbidities such as COPD, emphysema or a poor breathing pattern and ...

Sleep is an important part of life; we spend around 1/3 of our lives sleeping. It is important for daily functioning, health and cognitive performance. Manifestations of poor sleep indicate the need for further investigation. Patients may not even be aware of their own problem as manifestations may initially seem to be unrelated to sleep. Clinicians must be vigilant in screening for the signs and questioning patients on the symptoms of sleep disorders to organise the appropriate investigations or referrals. Fundemental symptoms that prompt the need for further investigation include excessive daytime sleepiness, insomnia and unusual events at night. These From Sleep medicine 6th edition Insomnia Difficulty initiating or maintaining sleep combined with daytime sequelae. These may include excessive fatigue, impaired performance or emotional change. Insomnia has to be differentiated from normal variation in the need for sleep (5-9 hours) or the occasional difficult night which may be ...