tips and tricks

As dentists and health professionals our assets are our minds and body. If either one starts to decline then our work with suffer as a result. The foundations of health involve a good diet, ideal sleep, sufficient exercise and good stress management. If we take care of our bodies well then our minds will benefit as a result. Our eyes are probably our most important yet most fragile asset. Once we have a decline in eye performance our ability to perform fine motor tasks goes out the window. Here are some tips to take care of your eyes: -Have regular eye checks: Most people should have their eyes checked every 2 years so that degenerative conditions and decline in vision can be caught and addressed early. -Wearing the right prescription lenses: On the advice of your optometrist you should wear the correct prescription of lenses because although the change in vision may be imperceptible to you, over days of working your eyes will fatigue faster with the incorrect prescription and you w...

Parents can occasionally present with their children asking about gaps between their teeth. You must assure them that spaces between primary teeth are normal. These are a good sign and often indicate a favourable eruption of the permanent incisors with less chance of crowding as permanent teeth barring the premolars are wider mesiodistally than their corresponding primary teeth. There are two types of spaces: -Physiological spaces which appear between any of the primary teeth. These provide valuable space to fit the erupting permanent teeth -Primate spaces which appear mesial to the upper primary canines and distal to the lower primary canines. This space is important in developing a class 1 occlusion. When primate spaces are present the mandibular molars will drift mesially to close the lower primate space (early mesial shift). This will convert a flush terminal plane to a mesial step and allow the first permanent molars to erupt into a class 1 occlusion. When primate spaces are ab...

Clinical photographs provide a wealth of information about a patient's clinical situation. It is the only record that demonstrates accurate reproduction of tooth shape and colour and it is the record most easily interpreted by our patients. Despite the extra time and effort involved, there are many reasons to take clinical photographs in daily practice: Photographs are useful as clinical records. Full arch photos show a true to detail snapshot of the patient's condition on the day. From a set of full arch photographs you could almost perform a full examination in terms of charting restorations, caries and wear. Treatment planning: Complex treatment plans can rarely be constructed on the spot. A set of models and full clinical records can be a substitute to having the patient in the room and time can be taken to treatment plan off these records. Models alone don't consider the patient's tooth position in 3 dimensions relative to the face and smile line. Communicatio...

Premolar extractions can be tricky because on conventional radiography it can sometimes be hard to determine the proper root structure to plan your extraction. This is because there can be one, two or even three roots superimposed on one another and you can't gain detail about the convergence or divergence of these roots. One tip to determine the number of roots is to carefully examine the PA radiograph and carefully count the number of root borders. This number divided by two will give you the likely number of roots present. If there are multiple roots and they appear quite short of the Xray there are a few possibilities. Your Xray angulation may have forshortened the tooth, the tooth may actually be short or there is a large buccal-lingual divergence of the teeth which has resulted in their occluso-apical dimension appearing short. You can attempt to take a tube shift xray from a different misal-distal angulation. This may give more information of the number and angulation of the...

Local anaesthetic is in general a safe drug which is fortunate because as dentists we use this every day. More than any technique or surgical skill it is the single most effective tool to improve success rates in our procedures. Can you imagine how hard any simple restorative or surgical work would be without the assistance of local anaesthetic? As it is used locally as opposed to systemically, the body can tolerate a fair amount of solution before we are concerned about toxicity. For most dental procedures toxicity isn't a concern however for complex and lengthy procedures as well as in children and the elderly it must be a consideration. In procedures such as full clearances or lengthy procedures such as rehabilitations you must use a safe local anaesthetic and keep track of the amount used. Adrenaline containing local anaesthetics cause localised vasoconstriction which reduces the rate at which local anaesthetic solution is washed into the system. Therefore a lower concentra...

Today a difficult extraction went very well. I thought I would have difficulties but the procedure went a lot smoother than I was expecting. Always prepare for things to go wrong. That way you will never be caught surprised. Of course this type of planning only comes with a bit of experience. Always assume the roots will break or the tooth won't budge and be mentally prepared to go to the next level to get the job done. Be sure to try and focus on the positives. It is very tempting to focus on the negatives of our day to day practice. For example if my next extraction goes horribly wrong I will find the process more scarring and off putting than I found this experience positive. However you have to remember we are in this for the long game. Some things will go wrong but most things will go right (assuming you are competent). So for your own sake take a moment every now and then to pat yourself on the back when you get something right.

From Therapeutic guidelines Oral and Dental 2012 Anaesthesia: A state of controlled, temporary loss of sensation. It may involve analgesia, paralysis and amnesia or unconsciousness. Analgesia: Inability to feel pain Local anaesthetics in dentistry are used locally or regionally to produce loss of sensation essentially blocking somatic and noniceptive stimulation as well as motor nerve conduction. Their action is mainly blocking of sodium channels along neurons that essentially block the formation of action potentials. The progression of nerve function blockage relates to nerve diameter, myelination and conduction velocity. First, autonomic activity is blocked then nociception, other sensory functions then motor activity. In dental applications, Soft tissue innervation tends to be located on the outside of the nerve trunk and pulpal innervation towards the centre. Therefore soft tissue anaesthesia will precede pulpal anaesthesia and pulpal anaesthesia will wear off before soft tiss...

The "classical" technique of performing an IAN block involves inserting the needle just anterior to the pterygomandibular raphe at a level in the middle of the occlusal plane at the height of the deepest concavity of the anterior border of the ramus from an angle aiming from the contralateral premolar region. Multiple factors can hinder ideal placement of the needle including trismus, lack of hard and soft tissue landmarks, patient anxiety and a large tongue. A large tongue tends to spread out over the occlusal surfaces of the lower teeth and move laterally and may actually block the site of injection in severe cases.it may also rise upwards especially if the patient is anticipating pain and hinder the correct angulation of the barrel of the syringe lying across the arch. Rather than instruct the patient to move their tongue to the side which almost always causes them to spasm their tongue in random directions, attempt to have the patient's head in different positio...

Back at the end of last year I subscribed to the RACDS college. I made a post discussing my thoughts about taking the primary exams. http://dental-tidbits.blogspot.com/2018/12/thoughts-of-racds-primary-exam.html I've now paid for the orientation course over 2 weeks in July. I am seeing this as another hurdle for me to pass. I've had a look at the past papers for this exam and they look pretty full on. I will see how I go at the orientation course. If the motivation is there to study for these exams then I am likely to do it this year. I have been saying to people if I don't do it this year then I might consider taking the exams next year however deep down I know this probably won't happen. Will keep you updated on how the orientation course goes. I am likely to have many posts after July on medical subjects covered in the primary exams if I intend on continuing with the exams. Wish me luck!

Some points on final impressions from Lincoln Harris' course: Every step of the appointment is important in the lead up to the impression; Local anaesthesia,  final preparations, tissue and moisture control and the impression itself. The issue is that we complete the most important step at the end when we are the most tired. If any of these steps are lacking then the final impression will be affected. -Final preparations should be as smooth as possible as it allows wettability of the impression material and final cement. There is an argument as to smooth preps vs rough preps and wettability vs retention for cement but if there is a rubbish final impression you won't have a well fitting crown to cement in the end. If the gum is inflamed the cord won't stay in. The gum needs tightness and elasticity to hold the cord in place or the cord will fall out. This is why in the initial appointment it is important to produce well fitting temporary crowns that will allow good tiss...

Fear is something we are faced with every day. In fact I would wager that the majority of patient harbour some fear of the dentist. In some cases this fear is overcome by logic and reason and these patients present with the desire to avoid future problems. However in the sadder cases fear leads to avoidance of treatment and dental neglect and they often present for emergency treatments only. Obviously when they are in pain the appointment becomes a lot more difficult and this perpetuates the idea that all dental visits are painful and reinforces avoidance behaviour. Far down the line, after much pain and suffering, the patient is rendered edentulous with reduced function, self esteem and capacity for healthy lifestyle. Much of this reaction lies in the patient's childhood experiences which also determines their personality and how they cope with adversity. When attempting to manage these patients we must take special care. In clinical practice, depending on how we react to the chal...

If doing a rehab case of uppers and lowers together, aim to finish the form of the lower arch first. This is because the lower arch is the arch where the aesthetic and occlusal surfaces are the same. Any adjustment of the lower occlusion will result in the change of the aesthetics of the case. However, if you finish the lower arch first, any issues with occlusion can be compensated for in the palatal surface of the upper teeth. Conversely, if you finish the upper arch first and don't get the palatal surface of the upper teeth correct it will affect the position of the lower incisal edge affecting aesthetics.

A few tips when checking the occlusion after a restoration. -Use articulating paper to check the contacts between the upper and lower teeth. Check open and close into MIP first. and after adjusting this to your satisfaction then check excursive contacts. Ask them to move their jaw all the way out to the side past cusp to cusp contact as you aren't sure how far along they may be parafunctioning. Often the bite is fine in normal function but a wide parafunctioner will crack a cusp at night. -If the tooth or restoration is fragile ensure that you tell them to bite gently first. Say "gently bite" not "bite gently" because by the time you say bite, some people will already be cracking down on your new filling. -After biting on the articulating paper, get them to bite and stay closed without it in. Check the contralateral tooth and the contact between the anterior teeth before adjusting the bite. This will give you an estimate on how much vertical you need to redu...